02060070 v CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: `
BUILDING ADDRESS: - - PERMIT NO.
•• 1188 CRESTLINE.,DR 02060070
OWNER'S NAME:. - APPLICATION SUB DATE
UDEY MANDLELCAR 06/12/2002
PHONE: SANITARY NO. CONTROL NO.
u O ARCHITECf/F.NGINEER: .BUILDING PERMIT INFO
z or— - BLDG ELECT PLUMB MECH
z LICENSED CONTRACTORS DECLARATION ]Ob Description
rZ : lh 13 (�i�nd ,Imo Fc cdud p fChaPt rY lcomme ming P
f-u,
POOL DEMO
s�SS, I is in full YdreG add n
W'a ljcen<c Clank ) )# 7� kgl L{
r 3 H Data 4�n"a....
a t r b _O� ..., . t.• -
ARCHECT 5 DECLARATION
g 1 understand my plans shall be used as public records
s p z Licensed Professional
OWNER BUILDER DECLARATION
1a. 1 hereby am[h
ffirat 1 am exempt from me Cov
nsedn's License Law!o the
z<, following rcaann.(section 7031.5.Bteloness and Professions Code:Any city or county $8000
C wh dt q permit t t t Iter.improve.demolish.or repair any strucstructuretmc
a 3 oO. Pno us Its isducancia.also callifirel the pplicent far such pcmdt to Fileavgaed netemetn ------
,hake IcensW Sectors
pro rion3ot tamesandpr professions
Cer9 r pr Y_ 4 Valuation
from g aln at lin an �he Iasi 3 the Business and Professions cone) t�.i,..1-3'�C y'.�j-g-.'(C1.V e�.'f.t'i�.i;•
of Net he is exempt the f m and the basis roe the alleged exempnt t Any violation
of Section]031.5 by any applicant fee a permit subjects Ne applicant m a civil penalty
or but more tmn five hundred dollars($50B. - NO'�MisiftffD INSPECTIONS:: Occupancy Type
01.as owner of the property,or my employees with wages as their sole compensation.
.will do the work,and the suucture is net intended br offered for sale(Sec:"7044, -
Business and Proressions Code:The Contactor's License Law does not apply to an Required Inspections '
owner of property Who builds or improves thereon,and who does such work himself
or through h'. a PI e p 'd d th t h improvements tintended o .. ...._.. . . .. _.. __.. . __ _
oroofferedion sale:If.however.thebuilding Improvement IJ 'Ili y' f .._.-.
ofer t o theowner-builderII h 0 burden f proving hath did t build r 6/
pr er pm . of sale.).
conr tie property, 1 ' a t [ 'th 1 Jcontractors t
construct the project(S 7044 Business d Profession,cud :)The Contractor's
License 1 does oat apply t wrier th Property ho build pro s that - �-
.and:, ho c m ens.for such protects.with a.contcutor(s)li d pursuant.m the _. _ _ _. ..._.... .. ......._...___. -_ __ ._--______-,____._._.._._
__ Co1 am axe License Sec
' � ❑lameaempt under sec. •' •'' ;B&PCfor Nis reason F•`-. '. s.�
t.L W,ti' _... .. .... 'n
Ownoyir:. 'x n^i,e.•:ic^_a Daze'.:.._._' «-..�.� "j ...`a,. . - .-
` COMPENSATION S, DECLARATION r
p I h Foy m(firunder penalty of pep iy re of the following declarations: -
O 1`1 blic and will ma chis n a Cte-ifid-he of Consent to self for Worker's
Compensation. to Section 37W
perfornmenrc ofthe work for hicb,rovided for hi, permit is iviumatf the Lab Cod for the
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Timor Code,for the Nificatnance of the work,for which this permit is
Ismail,My W k Co p r lower and Policy ru be arc q
Ca
tito
Policy
,CERrIFICATIONOFF PT
%EMIONFROMWORKERS ..• nIt. .. _, at„y, I i„'7j, ' 1,
so, COMPENSATION INSURANCE'•-'•" " '
' (Th' 'section need not 4rnmpined it the permit is for one hundred dollars v'4',
(E100)or less)
`•.: ^I canify that n the performance,- of N<-ink
'fo A h th pe t issued.
'shall not employ any pew y e as io become b)et to[he Woders
Cmpensat on Laws rare! form.
Date rte
'Applicant ]
NOTICE TO A'PLICANT:IL a fee,cor thrs Cenifcarc or Enemp,ion.you shouldba OTT
sobjcmo the Workers Compensation prone,,ons of the Labor Code,you most
fdno ith comply wi,h ouch provisions or this permit shall be decmcd no, Id.
z -.. -.._. . . ..._ . _. . . _ -
.- _._...__ - .. ..... . ..... .. .__.....
_ CONSTRUCTION LENDING AGENCY
' -1 hemby alfirro that Nem is a construction lending agency for me performance ..
r
.1 be ok! hichth.pe it isiasurd see 3097 Civ.'C)
A. a -Lend Name
_
�.� h,lherc dN ppr oto dtt th he abase information is -
[� COne, to comply,with all city and county ordinances and state law x oclating
O tJ t Mile g t 't n dh by to p 'tt of this city to enterupon 1
�y W tab ab t d p pe ty f n c( p rp. C
[.a �0. (Wg t s e a e ry d k p barml theC'ty of c p ri against
cojoining
liabilities,judgment,cot d expenses sen h y in any way against said
V. City- y Ice of[h (this
APPLICANT UNDERSTANDS AND WILL COMPLYWITH ALLNDN-POINT` �s
SOURCE R,CP s Issued by: Date
dominate 01 ApoicanUCo[nractor. ^" •- Dae'
HAZARDOUS MATERIALS DISCLOSURE
Re-roofs
'. :: -'wubyflorl Thod Capetian ruturtWilding«t,;pant:torcurnaameha„rmu:mataim ..Type of Roof aow s defined by N Cupen M Ypal Code,Chapter 9 13 and the Health and Safety
Coda."Section
❑Ys 25532(^ ❑No. .[ <�rs• t• , .t� s
_All roofs
Will the -shall be inspected prior to any roofing.matenal being installed.
,applicant future bu laiog pat :< q p m u d area which a roof Is it lled without first obtaining an inspection;I agree[o remove
mdh dons S connotation, defined by me'B y A Air Quality Management g p
°i'- all new materials for inspection. Applicant understands and will cont 1 with
r oY ❑N all no source regala[ions; p`y'
sr 1 have read the h zallous natctials qu emor under Chapter 695 of the
if is . a Health&'Safety Club Scans 25505;25533 and 25534.1 understand that
ifthe buildin6 doo notcumntlymo,a¢,ant.that it is my responaibilityto notify the
rrcup,an
t f the q ' ta t hrch'must be i p m issua f C ni5cete o!
Occupancy, - _
'° L�Siignature of A licant/ - PP _.. Date
OwneroroulhanzeJugcni . ., Data All roof coverings to be Class "B” or better
.;
7
-OFFICE .- . .. .. . . _..
v CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: `
BUILDING ADDRESS: - - PERMIT NO.
•• 1188 CRESTLINE.,DR 02060070
OWNER'S NAME:. - APPLICATION SUB DATE
UDEY MANDLELCAR 06/12/2002
PHONE: SANITARY NO. CONTROL NO.
u O ARCHITECf/F.NGINEER: .BUILDING PERMIT INFO
z or— - BLDG ELECT PLUMB MECH
z LICENSED CONTRACTORS DECLARATION ]Ob Description
rZ : lh 13 (�i�nd ,Imo Fc cdud p fChaPt rY lcomme ming P
f-u,
POOL DEMO
s�SS, I is in full YdreG add n
W'a ljcen<c Clank ) )# 7� kgl L{
r 3 H Data 4�n"a....
a t r b _O� ..., . t.• -
ARCHECT 5 DECLARATION
g 1 understand my plans shall be used as public records
s p z Licensed Professional
OWNER BUILDER DECLARATION
1a. 1 hereby am[h
ffirat 1 am exempt from me Cov
nsedn's License Law!o the
z<, following rcaann.(section 7031.5.Bteloness and Professions Code:Any city or county $8000
C wh dt q permit t t t Iter.improve.demolish.or repair any strucstructuretmc
a 3 oO. Pno us Its isducancia.also callifirel the pplicent far such pcmdt to Fileavgaed netemetn ------
,hake IcensW Sectors
pro rion3ot tamesandpr professions
Cer9 r pr Y_ 4 Valuation
from g aln at lin an �he Iasi 3 the Business and Professions cone) t�.i,..1-3'�C y'.�j-g-.'(C1.V e�.'f.t'i�.i;•
of Net he is exempt the f m and the basis roe the alleged exempnt t Any violation
of Section]031.5 by any applicant fee a permit subjects Ne applicant m a civil penalty
or but more tmn five hundred dollars($50B. - NO'�MisiftffD INSPECTIONS:: Occupancy Type
01.as owner of the property,or my employees with wages as their sole compensation.
.will do the work,and the suucture is net intended br offered for sale(Sec:"7044, -
Business and Proressions Code:The Contactor's License Law does not apply to an Required Inspections '
owner of property Who builds or improves thereon,and who does such work himself
or through h'. a PI e p 'd d th t h improvements tintended o .. ...._.. . . .. _.. __.. . __ _
oroofferedion sale:If.however.thebuilding Improvement IJ 'Ili y' f .._.-.
ofer t o theowner-builderII h 0 burden f proving hath did t build r 6/
pr er pm . of sale.).
conr tie property, 1 ' a t [ 'th 1 Jcontractors t
construct the project(S 7044 Business d Profession,cud :)The Contractor's
License 1 does oat apply t wrier th Property ho build pro s that - �-
.and:, ho c m ens.for such protects.with a.contcutor(s)li d pursuant.m the _. _ _ _. ..._.... .. ......._...___. -_ __ ._--______-,____._._.._._
__ Co1 am axe License Sec
' � ❑lameaempt under sec. •' •'' ;B&PCfor Nis reason F•`-. '. s.�
t.L W,ti' _... .. .... 'n
Ownoyir:. 'x n^i,e.•:ic^_a Daze'.:.._._' «-..�.� "j ...`a,. . - .-
` COMPENSATION S, DECLARATION r
p I h Foy m(firunder penalty of pep iy re of the following declarations: -
O 1`1 blic and will ma chis n a Cte-ifid-he of Consent to self for Worker's
Compensation. to Section 37W
perfornmenrc ofthe work for hicb,rovided for hi, permit is iviumatf the Lab Cod for the
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Timor Code,for the Nificatnance of the work,for which this permit is
Ismail,My W k Co p r lower and Policy ru be arc q
Ca
tito
Policy
,CERrIFICATIONOFF PT
%EMIONFROMWORKERS ..• nIt. .. _, at„y, I i„'7j, ' 1,
so, COMPENSATION INSURANCE'•-'•" " '
' (Th' 'section need not 4rnmpined it the permit is for one hundred dollars v'4',
(E100)or less)
`•.: ^I canify that n the performance,- of N<-ink
'fo A h th pe t issued.
'shall not employ any pew y e as io become b)et to[he Woders
Cmpensat on Laws rare! form.
Date rte
'Applicant ]
NOTICE TO A'PLICANT:IL a fee,cor thrs Cenifcarc or Enemp,ion.you shouldba OTT
sobjcmo the Workers Compensation prone,,ons of the Labor Code,you most
fdno ith comply wi,h ouch provisions or this permit shall be decmcd no, Id.
z -.. -.._. . . ..._ . _. . . _ -
.- _._...__ - .. ..... . ..... .. .__.....
_ CONSTRUCTION LENDING AGENCY
' -1 hemby alfirro that Nem is a construction lending agency for me performance ..
r
.1 be ok! hichth.pe it isiasurd see 3097 Civ.'C)
A. a -Lend Name
_
�.� h,lherc dN ppr oto dtt th he abase information is -
[� COne, to comply,with all city and county ordinances and state law x oclating
O tJ t Mile g t 't n dh by to p 'tt of this city to enterupon 1
�y W tab ab t d p pe ty f n c( p rp. C
[.a �0. (Wg t s e a e ry d k p barml theC'ty of c p ri against
cojoining
liabilities,judgment,cot d expenses sen h y in any way against said
V. City- y Ice of[h (this
APPLICANT UNDERSTANDS AND WILL COMPLYWITH ALLNDN-POINT` �s
SOURCE R,CP s Issued by: Date
dominate 01 ApoicanUCo[nractor. ^" •- Dae'
HAZARDOUS MATERIALS DISCLOSURE
Re-roofs
'. :: -'wubyflorl Thod Capetian ruturtWilding«t,;pant:torcurnaameha„rmu:mataim ..Type of Roof aow s defined by N Cupen M Ypal Code,Chapter 9 13 and the Health and Safety
Coda."Section
❑Ys 25532(^ ❑No. .[ <�rs• t• , .t� s
_All roofs
Will the -shall be inspected prior to any roofing.matenal being installed.
,applicant future bu laiog pat :< q p m u d area which a roof Is it lled without first obtaining an inspection;I agree[o remove
mdh dons S connotation, defined by me'B y A Air Quality Management g p
°i'- all new materials for inspection. Applicant understands and will cont 1 with
r oY ❑N all no source regala[ions; p`y'
sr 1 have read the h zallous natctials qu emor under Chapter 695 of the
if is . a Health&'Safety Club Scans 25505;25533 and 25534.1 understand that
ifthe buildin6 doo notcumntlymo,a¢,ant.that it is my responaibilityto notify the
rrcup,an
t f the q ' ta t hrch'must be i p m issua f C ni5cete o!
Occupancy, - _
'° L�Siignature of A licant/ - PP _.. Date
OwneroroulhanzeJugcni . ., Data All roof coverings to be Class "B” or better
.;
7
-OFFICE .- . .. .. . . _..