02110030 CITY OF CUPEWHN0 �. -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BDll"(1, a@r1 E ESTATES DR PERMIT N02110030
/ t7 / 28
IUNSA TNA VENKATESH APPLICATl?1`Y V5T82002
PHONE: SANITARY NO./ / CONTROL NO.
ARCHI]LCAENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MEGA
�00 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions ofChapter 9(commencing ADD 270 S . FT ,Job Description with Section 7000)of Division 3olmeBusiness and WolesaioosCude,and mylicense in Q APR 2 4 2003
in full force and ilfeed.
H�K License Class Lie R
F=Fn Dam ConVaanr
As shall
ARCHITECTS DECLARATION BUILDING
sx a C< 1 understand my plans mall M used as public records
K0y
w Licensed Professional
,f_' OWNER-BUILDER DECLARATION
oi
ex
a7 1 hereby affront that 1 am exempt from Inc Convector's License Law for the
d�00 following motion.(Section]031.5.Business and Professions Code:Any city of county $30000
x m Y. which requires a permit to caribous.alter.improve,demolish.or repair any slrucwm
_zy ph.,felt,issuance,also requires the applicam for such Temtit to file asigned sentiment /
8i ao that he is licensed Pursuant the previsions of the Contractor's License Law(Chapter 9 3W B-Morf A@a Valuation
aF-$ (commencing with Section 7004)of Division J of the BusineR and Professions Gwc)or
y;— Nat he is exempt therefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by thry applicant for a permit subjects the applicant to a civil pcfalty of
nor more than five hundred domrs($500). 102P NPIERS Occupancy Type\`
01,as owner of the property or my employees with wages u their sole compensation, I --
will do the work,and the structure is not intended or offered for sale(Sec.]OCC.Business ,
and Professions owe:The contactors License Law does not apply to an owner of 104 - REBAR Required Inspections
property who builds or improves theram,and who dwisuch work himself or through his
own employees,provided that such improvements are not intended or offered missile.if, 105 — ANCHOR BOLTS
however,the building or improvement s sold within one year of completion,the owner-
buBGer will nave the burden of proving that he did not Wild or improve for purpose of 10 6 - SEWER & WATER
al`) 202 - UNDERFLOOR PLUMBING
rorthe
t,(See 704ol.Bsinssany<omamns CWc:) heeCoonacttrs le 203 - UNDERFLOOR MECHANICAL
onswct thas e pmjca ISec.]I1gC.Business and Professions Cowe:)'ITc Convenor's Li.
cense Law Nes not apply to an owner of property who builds or improves theme,and 204 - UNDERFLOOR FRAME
Licettmvafor such projectswhhantmannr(s)lmenseapnrsoannu the Comaaor's 205 — UNDERFLOOR INSULATION
License Law.w.
❑lam eau 11 ander Scc. ,B&PC re thisreaao" 301 - ROUGH PLUMBING
{�Rq Karhg A&-m4�s1o2 302 - TUB & OR SHOWER
n —) WORKER'S COM ENSAT� IONDECLAR,\rrION 303 - ROUGH MECHANICAL
I hereby affirm under penalty of perjury one of the following dalarmions:
❑l have and will maintain acerificam ofconsem to elf-insure for Worker's Compere 304 — ROUGH ELECTRICAL
saloon.u provided for by Section 3700 of the labor Care,for the performance of the 3 05 - FRAME
work for which this permit is issued. 306 - HOEDOWNS
0 1 have and will maintain Workera
Worker's Compensation Insunce.as required by Section 3 07 - INSULATION
3700,of hN
f the Lar Code.for e performanm of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art: 308 — SHEETROCK
Carrier: PoliceO
CERTIFICATE309 - EXTERIOR LATH
IINSURAN WORKERS' 310 - INTERIOR LATH
(This.aceinn need not be enmplemd if the permit is form,hundred dollars Sloth 311 - SCRATCH COAT
orles') 313 - ROOF NAIL
employ Ill.,,.the pendpp of work for which this me it is reurd, allum 501 - FINAL ELECTRICAL ENERGY
employ any ry:cum iay�Jna I suhjcnmlac Wnrkers'Cnmpcnsatien
Laws of Cottle 'a Dec�` pctY ,"gym` 502 - FINAL PLUMBING ENERGY
Applicant
O \PPLICAN'C IrQmaking ls�Clcv fttmptinn.you should 503 - FINAL MECHANICAL ENERGY
bee bjea to the Worker's Compensation prev sions of the 1vMa Crate,you must
cl z RmhwithComply With such provisions orthis permitshall Is,deemed mvokcd. 504 - FINAL BUILDING ENERGY
Z O CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
F work
whianion Oat
ermitiisaed(seconstruction lending,C.) cyfor Ncperfurmanccof 506 - GAS TEST
a > Neworkforwhicn'his p mil isissucd(Sc.109],CaC.)
Lenders Name 507 - FINAL PLUMBING
W
� Z
Lender's Address 508 - FINAL MECHANICAL
U O 1 certify that 1 have read Oilapplication
and county ordinances
send that and above information is 509 - FINAL GRADE
W f comm.1 agree to amply with all city and county drdiaentta and sac laws relating to U—
U building construction,and hereby authorize reirmsenativcsofpas city menter upon the 5 - FINAL PLANNING
W
above-mentioned propenyfor Inspection purposes. *— F P BLIC O KS
(we)agree tosim,indemnify and keep harmless the City of Cupertino againstIiabili ties.judgments,costs and expenses which may in any way same against said CityU z inconsequence of the NDERSTA of Nis permitAPPLICA UNDENSTAND$AND WILL COMPLY WITH L NONPOINT Issued byDate
SOURCE �GULA'TIONS.
t/ �'� Re-roofs
u d ank'Crmhmh r Date
IIAGARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of hourc building occupant sere or handle hazardous material
s defined by the Cupertino Municipal Code.Chapter 9.12,and the Ilcalth and Safety
de,Section 25532o)1
0 yes KNo All roofs shall be inspected prior to any roofing material being installed.
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
coil hazardous air contaminants as defined by the Bay Area Air Quality Management
DiffricR all new materials for inspection.
0 Ycs KNo
I have mad the henNous materials requirements under Chap er6.95 of Ne Califon
ria HcaIN&Swcly Cows,Smtiom 25N1S.255JJ am1255JC.1 understand Nal iftM building
Jces nm currently hate a tenant Nal it is my respowM1ility m notify rcoupant of the
require .wmchmpsll,r pnoftoiaapaneeoraceNfica nrau cr Sign ofAppplicant Date
ec ft,<a aaehl Date All roof coverings to be Class "B" or better