00040057 CPC,OF CUPERTINO
BUILDING DIVISION . RMIT CONTRACTOR INFORMATION:
SINGHANIA 00040057
BU ILII ING UDRESS: PERMIT NO.
OW'NER'S MPOHANIA - APPLIGT N S
PHONE. SANITARY NO, CONI ROL NO.
M-ZARCHITECTIENGINITER: , - BUILDING PERMIT INFO
E °0 L) IILDG IiLEC'r PLUMB MECH
v<�
'SH= nerenYafrml"mi DC°NIRa uR'SmEocn"ter9fcnmmenans ADDITION/AL
°�IZL;;duwith Scmian700)orDnkinn 3ofdieBueincss,md Is Id,slnn.Gnm,uwmrrem»c - ,• .
m y'rj infull Pone and effect,
fin{
z°M v License Claes [.i,.#K Date Contractor
ARCHITECTDECLARATION
g wmler,mma tin g1an,,Ind1 be
use used a,public neon,
Licensed Po fw,innnl �`"-l/
OWNERBUILDERDECLARATION
hereby,ILII o n70 am exempt form the Cessions r•s License Law fur.tdietary e
a oi
wh oh re Nass(Section Tconsumer,alnnsmpr improve.
demolish,
e professions Cadet Any city stcounty O
ce O whichrequitesne,also muires1ealter,i Ino,te ,crumsh,orrepairunyswnunt J
ii3� arien)itpissuonee,ulsn rcyuires the upplicnal[nr-mc:h permitwGlensigncA.autemem
thatheiaucensevpnan.mSq. FL Floor Area I
fmminencins,'ith Section 700(l)onlmision 3 of the Business and Prafeasioms Code) .
or thin he is<cempt therefrom and the basis for the alleged exemption.Any violsoun
of Scmion 7WI.5 by any applicant fora permit subjects the applicant toss civil wnalty
ofaot mare roan Bae bamdred dmdm.050d1, A' Occupancy Type
❑1,us owner of the progeny,nr my employees wish wages as their sole (Sec.
7 inn,
will ne the work,and me ode:T e is not intended a offered Law for snot(Sec. to an —
Business and erty recessions Cale:The Co s there's License it d ares not tally to if I OSpeCl10I5
rughhisow emnuBasorividedtmenaceandwhotamnworkhdedor 102 — PIERS � '
or through his own employees. eiloid that such improvementstissolam not intended or
comredmf,tae.ILhOwuilderathhvete impmof ervissolawdhinoneyearer 103 — UFER
acompletion,rat owner-nwmtr win nava rat Horden of pmemg that nt dm not beim Wilder
nion//,trnrwp tnrxale.). 104 — REBAR
IN..1"Itim of the pmpeny,man exclusively contracting with licensed comranonto 105 — ANCHOR BOLTS
Lons ode,tilesec.project sec.7044,Business and Professions C(ile:) I'he Contractor's -
iieemeLow does net apply maaawaerofprassay who Wild,orimprn.esthereon, 106 — SEWER & WATER
and who contracts far such projects with a connote, (0 lievowd pursuer,u,the
Coal rmair,LfamscLaw. 202 — UNDERFLOOR PLUMBING
Oland exemp der Sce. .B&PCfort n 203 — UNDERFLOOR MECHANICAL
wn`r , ft
w eR'scoMPEN`snrroNDECLARnnON 204 — UNDERFLOOR FRAME
Ihereby tuirenorder penahynrprjn nbeonhefollowing dechemEons: 205 — UNDERFLOOR INSULATION
❑ I have.1 will maintain a Cent of Crowd, to wif-imsnre for worker's 301 — ROUGH PLUMBING
Compensation. as Provided lir by Section 3700 of the Lahnr Code, for the
perfommdw of the work for,Inch this pemtit is issued.
❑1 have and will mai main Worker's Compensation Insurance.as required by Section
37M of the Lahr Code.for the performance of the work for which this permit is
.sued.My Worker's Conmensadon Insurance carrier Intl Pal icy in lie,arc:
Camepoliicyst 302 — TUB B• OR SHOWER
CERTIPICAfION OFEXEMFr1ON FROM WORKERS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE
(This section need Nat be completed if the permit is for one Lundie)dollen 304 — ROUGH ELECTRICAL
al Wl nners') 305 — FRAME
I terory that in he performance Of,hc work for wiicn this permit is issued,I 306 — HOLDOWNS
shall not employ any poison in any interior so as to become subject m the Workers'
Civa'arminm".ofcrfnmia.Date 307 — INSULATION
A,dec. UPICEt
NOr1CtiTO APPLICANT:It,oftor making this Cene idcmof Exemption,you 308 — SHEETROCK should `a
Q QM1ecome subject to the Workerst s Compensation provisions of the labor Cale,you mu
fomnwith comply whh such pn)v isians or this permit sball be deemed revoked. 309 — EXTERIOR LATH
Lam" 4 CONSTRUCTION LENDING AGENCY 310 — INTERIOR LATH
4' ' I hereby affirm that there is a construction lending agency for the performance
ifthe workfor,vhichthis Nriaitisissued(See,AN7,Cie C.) 31. 1 —
SCRATCH COAT
dersAddreLe ' ss 313 — ROOF NAIL
U O 1derifymatIhave mail application aadsmtcthanheabrute infonnminnis 501.' — FINAL ELECTRICAL ENERGY
Qe F. c,rrem,I agree to comply with an city and count,ordmidee,,and,toe laws nwting 502 — FINAL PLUMBING ENERGY
U u,building construction.and hereby authorize wpresemuthde of this city to anter upon
w me ab (We)agree ,,cnadd npnymrm,andke,mmaa 503 — FINAL MECHANICAL ENERGY '
Ps
(We)agree m scostov.and expenses
end which
mmaa,,in the way a dist against
so ii,maid m liabilities,judge me roses and upenxs which may in any way aecme uguima said 504 — FINAL BUILDING ENER
U City in rnNTONcc ofthugranting of this permit.
GV
APP CANTON ERSTANDS NDcstWILLCOMPLYWITHACLNO POI f
RCF.REGI' . ON s � J'rj�� Issued by: 505 _ FINAL ELECTRICAL Dat �—
Signature A ¢an Lontmem, Old Ke-roofs -
uAznRDOUSMATERIALSDISCLOSURE 507 — FINAL PLUMBING
Will Ne applicant m haurc(wilding ax'uam rePsonr handle humorous material Type of Root
as defined by the Cowards,Municipal Code.Coiner 9.12,and the Health and Sanc,, 508 — FINAL MECHANICAL
Corle,Section 23532(a)4
°Y`s ON. - All roofs sha5619inspefffllWbr tElt799&fing material being installed.
Will the applicant or future Wilding decupam use equipment or devices which If a roof is ingdMil willi"o WRla oMgti(I@WUMpection, I agree to remove
emit h:n.nrdons air cunwminnnts as del fined h4,the Bay Arta Air Quality Ahmugen cat
District? oma all new mael�,lf,4oc-inypq*fgL IPBn(WORI<4 and will comply with
all non-point source regulations.
have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 bud 2.5534.1 undermund that
if the building does not currently have a tenant.that it is my responsibility to notify the .
rceupant of themcmdemems which most be met prior m ismance LA o Ce forme of
kt � 6
Signature of Applicant Date
o, th e agent J Date All roof coverings to be Class "B"or better
OFFICE