01030019OFFICE
CITY OF CUPERTINO
1i
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
13UILDING ADDRESS:
PERMIT NO,
19040 LDREE AVE.
0103001.9
OWNER'S NAME.
APPLICATION SUIT DATE
GURJOF SINGH
03/06/2001,
PHONE:
SANITARY NO. CONTROL NO.
.oZ6 [� y
ARCHII'PCI IENGINHER:
HIRLIANG PERbfl'I' INFO
CC
HI.HG ECI' 111011 MECH
ay
N
LICENSED DECLARATION
COM'RACnder
Job DtsCI'Ip11OO
p
that 1 am licensed under provisions of Chapter 9lcommnming
I hereby I a
G tJa
(flint
with Section 9l"ad of Uivi.ion3of the Onsincss and Padusaions Code. and myliceme
,
a<
in tall Inn, -seal dlnn.
Date wecww, fe,.11
ADDITION.
Date SDCLA'
FINALED
u.
ARCIII'I'IiC?'S DECLARATION
S1
undeoend my planuhmll M used as public records
a`s
JUL 2 7 2001
Lire-sedProleuiona
OWNER -BUILDER DECLARATION
I botchy lotion rout I an, exempt Loon the Convnetor'e License Law fait the
E 6
following rea.om. Nrofion 7031.5, 13nuYn and Profcs ,.a Code: Any eiyor,00 ty
❑
which «maims u line o.mrncl, uh.c Improve. Janmklo or repine any xfrtuetn
Run n
hr
3�
PH in its i.nuance, also re4uires the applicant for such permit to life a signed.maenamf
Sq. Ft. Floor Area
Va ualion
than he isbceredpursuant nthe prossIon.ofthe CommenesLivenaLaw (Chapter 9
(commencing with Section )1g)(1) of Division 3 of the Rusineas and Professions Code)
or that he is ucnpr therefrom and the basis for the alleged exenprion. Any violation
of Soodon 7031.5 by any applicant for a pernat subjean the applicant to a civil penalty
of not more than five hundred douse. With.
APN Number
Occupancy Type
cr of the mopena or lny.,with wa,v, aw their sole rtllnnenmm�on.
5
Required Inspections
-
711 do thewock. and the sw.num in mol intended nr od—d for sale (Sm. 91Hq,
Eaanes.. and ponewwions Code: me Conmoors ldcrmse law does nm apply a, an
wor, of pmpeny Who builds or imp v, n wro load who docs such wad himself
or through his own employees. pmvidcd that such improvarlcnts are not amended or
101 — FOUNDATION
offered for sale If, howeverthe building or improvement is wld within one year of
ompletion.the ownervhui lifer w ill have the humom of proving that he did not build or
1.02 — PIERS
mpmve Tor pig ..c is ,ale.).
-
103 — UFER
otthepmpeny.0 nchrciv,ly. uara,,mg wi tb licensed e,mmenr.,,
,naamciwhe pfoj,c, see. y(we;z nu. ,lona Pont; .., ,a co I.) fine canto,...'..
of
104 — REBA R
License law diw. con apply m an owner pmpeny wh�Ibu loly or improves fiction,
and who contract, for such project, with a conlmctohe licensed pursuant n the
105 — ANCHOR BOLTS
--
unse
Commove, .rLaw.
° l an corner makhjo . It R I' C for this reason
106 — SEWER & WATER
-
�Sce. �t
owmerdl"^ D.,re��w/'�
202 — UNDERFLOOR PLUMBING
wTatll arS cO10I'1HSAr[ON 1).cLARAI'ION
203 — UNDERFLOOR MECHANICAL
Ihereby arnnaunder Penalty ofperjury one of the ollowingdeclarations:
204 — UNDERFLOOR FRAME
0 1 have and will maintain a Certificate of Consent n sell-in.are for Workers
20S — UNDERFLOOR INSULATION
Compensation. os provided for by Section 3700 of he lalur Code, for the
Krionnance of the wo,k for which this perat is i91Yed,
301 — ROUGH PLUMBING
° l have and will maintain Warkcrs entneeo.ation Insurance. as requbed by Srenil'n
302 — TUB & OR SHOWER
3700 of the Lnhar Code, for the perfurn—ue of the wore Ifor which this permit is
N,ned,MyWork.r.Cmmpen.a.n,homoaeecarrierandPoh,ymm,berare:
fi
303 — ROUGH MECHANICAL
came= PolicyN,a:
304 — ROUGH ELECTRICAL
CIiRI'IFICATION OP ILYEMPI [ON FROM WORKERS'
COMI'CNSATION INSURANCE
305 — FRAME
nit lent is tot one hundred dollars
Anis...a.edmolbe,omplewil iraten
306 — HOLDOWNS
1SIUW ar 1es..)•or
307 — INSULATION
1 ccmty prat in the wrom,ance of the work for which this prrinit is issued. 1
n in any manner no a. to Mcome sustor , Ile rkers
shall not employ any Persian e
308 — SHEET ROCK
Compenwmion Law, of Calimmia. Dale
Applicant
309 — EXTERIOR LATH
NOTICE TO APPLICANT: If. after making this Certhi a of Euemption, you should
cmesobject r,, me Worker's Co apeahon p ... iytmi, of the Labor Cade, you men
I,cam
310 — INTERIOR LATH
O
forthwith cnitply with Inch pr ... ..inn. or this boom, shall be deemed revoked. .
—
311 SCRATCH COAT
AGENCY
CONSe. is a ON LENDING leading
Imrhy this lendingagcnry lin the perfnrmuntt
6
313 — ROOF NAIL
Q
nkfar,nitich Permitsueand seen
[,Me,,NamewhichrhizpermitisissuedlScc.1119].Civ.C.1
501 — FINAL ELECTRICAL ENERGY
j Z
Leader, Address
502 — FINAL PLUMBING ENERGY
F0.1.
.
I certify bad I has, read his n,,li,mimn and date ilia, the above antorrealoo is
,ouref. l ui to comply wilt all cif ..bol ,ottnry ad nate, :cod state laws reluling
hi.caytocnterllpol,
503 — FINAL MECHANkCENERGY
v
tobedding,m"...I n,. andhuehyaud,ori,emprCwatLfi.c—I
for in.peninlI
504— FIhIRL PIJII_ ERGY
. W
. a
the above -mens fed property taposo.
(Wo agree it, save.imlennilyundkeep harmles.the City ofCupeni to,mmf
_
505— FINAL ELEC
h
liabilities. judgmens• ends and r,scowwboth may in any nay .,me against sail
APTR
UND Rthe graving Debs Permit. y
in APPLICANT UNDERSTANDS ANU WILt�CgMPI WITH ALLNON.POINT
Issued b t Date
SOURCE RHOULERSTANUg
SOURCE RIiGl1LAT1O .t/l. y.,se_y4r's/� �g '
_ �'' _
Re -roofs 506 — FINAL MECHANICAL
S'Ignalnra of Appll<:e11C'nnl1r1to —S�— —q-�D'
fsree
IIA''/.AltOO ' 1A1HKIAL5 )ISCLOSUIIE
Will the:p,ho,art tommbuilding ,cmean,>fineo,handle baamoaanafrnal
Type of Roof 509 — FINAL GRADE
on defined by rhe Cupertino Municipal Coyle. Chapter 9.12. ad the Health and Salery
Code. Section 25531ta1^
OYe.
— r
S10 FINAL FLRpI�
All roofs shall be jjs�ected aniyrpR(II py'{J ng Ins e .
Will lheapplicann or future huimingts,apam taw c,pdenwm or devices which
•}qr�J.(�
If a roof is installeLU without IttI shR 6lihailLL i7 iii$Ij rcc t est
it b,laalouw mr,onwtninars sew dem¢d by the Eay Are, Air Qmdity Management
ndtdre ��
Ely"'1
all new materials for inspection. Applicant un ands and will comp- h
all non -point source regulations. MAR .S — 2001
1 have read the ha ouw materials mquirvocn¢ under Chapter 6.95 of the
Ci lifamia Health &Safety Cbdc. tieeions 25505.'-5533 and 25539. 1 understand than
if rhe building does not currently have m tenant. that it is my responsibility n, noesis rhe
occupant of the requiremenc which n list be me, prior to issuance of Cenifieme set
�j lo,ll
SiSignaulrcofApplic
All roof coverings to be Class "B" or better
wact a,man ... , agcaf Date
OFFICE