03020010 JCITY OF CUPERTINO alks �^
BUILDING DIVISION PERMIT �CONTRALTO_R3INFORMATION
HUI LDING ADDRESS: ABHIJIT PANDIT PERMIT NO.
10420 LANSDALE AV 01020010
Flits NAME: APPLICATION SUB DATE.
ABHIJIT PANDIT 02/05/2003
ONE: SANITARY NO. CON'1'ROLNO.
AHCI IITEC'UENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 (�
w00 LICENSED CONTRACTOR'S DECLARATION
exu r 1 hereby air.that I am licensed under p nsigiona of Chapter 9(commencing Job Description
�<i with section 7050)of Division 3 of the Business and Professions Code.and my license is in fall
���n�A rC®Come awerra'' ADD 140 SQ. FT. nv t5ate
4 License Class Lic.g
_ F,0 Date Commetor
ARCHITECTS DECLARATION �n
200
Yiy z< I understand my plans shall W used es public records 17:r4Y 0 6
X0aDt�
NI.Iccnsod Poomesional
a1 OWNER-BUILDER DECLARATION BUILDING
f I hereby Milan that I of exempt from the Contractor's License Law for the
S C 0 following mutton.(Section 9031.5,Business and Promo.ions Code:Any city or county
x 2 l! which requires a permit to cnnnruct,alter,improve,demolish,or repair any structure
to—o^ prior to its issuance,also requires the applicant lot such Permit o file a signed sutemem
that he is licensed pursuant to the provisions of the Contractor's License law(ChapmrY Sq. Ft. Floor Area $40)Qlp�tion
be (commencing with Section 1")of Division 3 of the B usiness and Professions Code)or
y —
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not marc than five hundred dollars($500). B Occupancy Type
❑ I,as owner of the preperty,u my employees with wages ss their sole compensation,
will do Ne work,and the swctura is not intended a,Offered for sale(Sm.7044.Business —
and Professions Code:The Contractors License Law does nm apply to an owner or 102 - PIER S equired Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements are not intended or offered for sale.If. 103 — UFER
however,the building or improvement is odd within one year of completion,the owner-
builder will have the burden of proving that he did not addld or improve for purpose or 104 - REBAR
sale.)' 105 - ANCHOR BOLTS
1,as owner of the property,am exclusively contracting with licensed contractors to 106 — SEWER & WATER
construct the prosti(See.704A,Business and Profession Code:)The Contractors Li
cense Law does not apply to ea ower of property who builds or improves thereon.and 202 - UNDERFLOOR PLUMBING
who contracts for wm
ars projects with licensed ensee pnrsnatotha Conuacmn
I
new 2O3 — UNDERFLOOR MECHANICAL
tem cxc der See .B&PCfnr this nano 204 UNDERFLOOR FRAME
m Date 205 - UNDERFLOOR INSULATION
,W ER'SCOMPENSATIONDECLA 301 - ROUGH PLUMBING
I mby of rd under penalty of perjury one of the lellowing declaration: 3O2 — TUB & OR SHOWER
1� �j lhuve anJ will maimaine Cenifcem of Canunt to xclGinsure for Worker's Cumpem
soden,as provided for by Section 371()of the lather Code,for the performance of the 303 - ROUGH MECHANICAL
work for which this parentis isaued. 304 - ROUGH ELECTRICAL
❑ I have and will maintain Worker's Compensation Insurance,az required by Section 3 0 5 - FRAME
3101 of the Labor Code,for the performance of the work fur which this Permit is issued.
My Workers Compensation lnsumbee carrier and Policy number am: 306 — HOLDOWNS
Cartier: Policypla: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(Thissenionmed nothecompletcd ifthe fermitisforonchundmd dollam($I00) 309 - EXTERIOR LATH
Or legal 310 - INTERIOR LATH
I cendy that in the performance of the work for which this permit is imand.I shall not 311 - SCRATCH COAT
employ any person in any manner so a m become u
subjecn the Workers'Compensation
Laws ofcarfmniaDate 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oz forthwith comply with web provisions orfog Permit shall Wdeemed tevoked. 502 — FINAL PLUMBING ENERGY
'Z O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Iherebyaffrenthatthereisaconswctionlendingagencyfortheperformanceof 504 - FINAL BUILDING ENERGY
a >
the wok for NamehichHis p mitisissucd(Scc.311.Civ.C.)
Lender's Name 505 - FINAL ELECTRICAL
W Q
az I ndcr'sAddrcss 506 - GAS TEST
U O 1 certify that 1 have read Ibis application and some that the above hibernation is 507 - FINAL PLUMBING
W (~ comet.I agree to comply with all city and county ordinances and state laws relating uo
L] U building construction,and hereby authorim representatives of Nis city to enter upon the FINAL MECHAN CAL
W ahnvc (We)agree
property for inspection an keep cg. 0 9 FIN x
(We)agree ro save,indemnify and keep hartnlcu the City of Cupertino against {\J
Tap liabilities judgments,costs and expenses which may in any way merge against aid City 55 1`A G
of the granning of
his permit,
U Z APiiwinu?
enceUNDERS ANDStAND WILL COMPLY WITH ALL NON POINT Issued by:5 ( WORKS Date
: LATIO .
`1j 15 D3 Re-roofs
plic ontranor D c
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Aloe applicant or future building occupant store or handle ha�duur material
the Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
s 3s53z(ar! All roofs shall be inspected prior to any roofing material being installed.
s }qNn
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
oile s air contaminants as defined by the[lay Arca Air Quality Management all new materials for inspection.
Dyes i�No
I have mad the haymdousidwrials requirements under Chapa:r6.95 of the Califon
ma Health&Safety Coble.Sectitns25N15,25533 and 355M.1 understand that iftM Wilding
Joos not cu ly M1a�c a a t,doer itis my resptsnihility m nndf the arupanr of the
reel more hick must n t poor m issuance ora Certificate of ctrpaney. Signature of Applicant Date
mm nnHu nt S D All roof coverings to be Class "B" or better