03010199 Permit CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION-
BUILDINGADDRESS: ROCK SOLID CONSTRUCTION PERMITNO.
11522 COUNTRY SPRING CT
JOER'S NAME: 3372 CREIGHTON PL' APPLICATION SUB DATE _
NISHTALA SATYANARAYANA AND S E 01/30/2003
PIIONE: 408 249-7625 SANITARY NO. CONTROL NO,
ARCHITF.CTRINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
Op LICENSED CONTRACTOR'S DECLARATION
rc 1 herehy affirm that I am licensed und"novisions of Chapter Y(c mencing O DCSCrIpIOn
with Scaum]f 1 IDivisionJnf NC Busi dPrefcssinm Cndc, dm licenm is \
inmlu Gfe,,,et. /��Il�� 6 3B REMOD L POWER RM (12 BA
Z Lwenx�Cas Lie
i OIC rV•.e / I I-
?ZF�
-�-'-- ARCIIITECTS D LARA ION
I undersand my plans shall M used as pslhlic recnNs
LL ELM
o�CC� Licensed Pmfcssional
Mu� OWNER-BUILDER DECLARATION J
x I hereby affirm that 1 am exempt from the Contractor's License Law for the
apo following reason.(Section 7031.5.Business and Professions Cale:Any city or county
a.
K$�i which requires a permit In construct,alter,improve,demolish,or repair any structure
w—r^ prior to its issuance.also requires the applicant l or such permit to file a signed statement
that he is licensed pursuant o the previsions of the Contractor's License Law(Chapter 9 Sq. Fl. Floor Area $3`B'"tion
y+Fm (commencing with Section 700))of Division 3 of the Business and Professions Code)a,
$ Nat be,u exempt therefrom and she basis for the alleged exemption.Any vmladan of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of .3 UAffiTgaTejn Occupancy Type
not more than i.<hundred donaa($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for We(Sec.]MG,Business —
and Profceaiore Code:The Canwctofs License Law does not apply to an owner of 102 — PIERS equlred Inspections
Property who builds or improves thereon,and who does such work himself or through his
own empluycm.provided that such improvement are not intended or offered for rale.If, 103 — UFER
however,fie building or improvement is sold within one year of completion,the owner.
builder will have Ne burden of pmving that he did not build or improve for purpose of 104 — REBAR
a.m.). 105 — ANCHOR BOLTS
❑1,as owner of the property,am exclusively contracting with licensed comments to 106 - SEWER & WATER
construct the Project(Sec.]OCG,Business and Professions Code:)The Contractors Li.
cense law does not apply to an owner of property who builds or improves thereon,and 202 - UNDERFLOOR PLUMBING
who contracts for sub projects with a cuntracmtls)licensed pursuant to the Contractors
License Law. ' 203 - UNDERFLOOR MECHANICAL
❑I am exempt under Sec. ,B&P C for this reason 204 - UNDERFLOOR FRAME
Or Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
1 hereby alarm under penalty of perjury one of the following declarations:
❑I have and will maintain aCeriGcate ofComu
eno sel6imure for Workers Compare 3O2 — TUB & OR SHOWER
ration,as provided for by Section 37M of the Labor Code.for the Performance of the 303 - ROUGH MECHANICAL
work for which this permit is Issued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
37BO of are labor Code,for the Performance of Ne work for which this permit is issued.
M7t cerAPetnia¢rnn1l1�'wi4tumrcewmrk ierPaend Pmiey:Dromtaar arez: Z 306 — HOLDOWNS
C.;wkr307 - INSULATI
ON
COMPENSATION INSURANCE
308 — SHEETROCK
(Thfusecdonmeed nmbeeomNeted B theremitisformnc hundred dollara($Nh 309 - EXTERIOR LATH
tr1es ) 310 - INTERIOR LATH
L certify Nal in the Performance of the work for which Nis Permit is issued,1 shall not 311 - SCRATCH COAT
employ any person in any manner so m subject to become subjeco the Workers'Compensation
Laws of California.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT If.after making Nis Cc niticatc of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Wodefs Cmmpertation provisions of the Lahr Code,you must 5 02 - FINAL PLUMBING ENERGY
OZ forthwith comply with such provisions or this permit shall be deemed revoked.
0 503 - FINAL MECHANICAL ENERGY
4 CONSen is ac ONLENDINGng agent
[.+ kforwhichhithat semitissaamsSuetTonlendingogcncylorthclwrformanccuf 504 - FINAL BUILDING ENERGY
a� the LendersNameichNisp mit isimoeJ(Sa.3d].Civ.C.) 505 - FINAL ELECTRICAL
firs- Q
Lenders Name
aZ L<ndersAaarem 506 - GAS TEST
U 0 1 wary that I have read this application end auto that the above information is 507 - FINAL PLUMBING
f, correct.I agree to comply with all city and county ordinances and sum laws relating to
0 U building construction,and hereby authorixreprcsenadwsofthis city to enter upon the S09
FINAL MECHANICAL
W eb.--mendnnedproperty for inspectionpurpesk FIN(We)agree to save,indemnify and keep hamllcss the City of Cupertino against
V) Iiabilitirs,judgmemarcuser and expenses which may in any way accrue against said City I Gs
in
the granting
U APPLICANTeUfDEE%gDfAts�WI OMP 1 I ALL NON-POINT Issued by 51 WORKS Date
so cF.
Re-roofs
-�1 Signamrc of APPli HData
AZARDOUS MATERIALS DISCLOSURE REQ`
RType of Roof
Will the applicant or future building occupant store or handle Wooden,material
as derined by the Cartoon Municipal Code,Chapter 9.12,and the Health and Safety
S.imn.15532(a)? All roofs shall be inspected prior to an roofing material beim installed.
❑Yes N., P P Y S g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hamrdous air conuminante 9.I defined by NC Bay Area Air Quality Management all new materials for inspection.
District] tel/
❑Yes Nn
1 have read the hovardims matorias requirements under Chapter 6.95 of the Califor.
ou HceW&safety Coca. .tie v15,2. 3. d255W.1 andersundthmt if the holding
it'..nal certainly hose a unam a it is y sqt ilily t nodly tM oxnupant of Nc
require. vwILor toia cc0a anifm ertkcuuPaneyy. Signature of Applicant Date
nCr Or fialM1011]CJ Y6CN Date All roof coverings to be Class "B"or better