02090007 •"rr.'� & a ro d Y$ 4
CITY OF CUPERTINO
BUILDING DIVISION PERMITURACTU^-
BUILDING ADDRESS: STEVE NAN CONSTRUCTION PERMIT"°02090007
ER'S NAME: PERMIT LS
10599 N STEELING RD �S°i�.9/2003
NOD BANSAL
"E' (408) 203-3933 SANITARY NO. CONTROL NO.
ARCHTIEC7ENGINEER: BUILDING PERMIT INFO -
RUDOELECT PLUMB MECH
>✓op LICENSED CONTRACTOR'S DECLARATION O O O
1 hereby affirm that I am Ilcamsed Ardor previsions M Chapter 9(commencing Job Description
with Section 70U0).f Dlvrion 3 of the Basin.and Normal.Coda.end my license is
j� In fall Ceande em.s LSFDWL-3562 SQ FT LIVING SPA
g2 LhUUMLkcnwCluk.a *11 IALE0
- Dam Colnclor 585 SQ FT GARAGE
Y
ARCHITECTS DECLARATION
Y I understand my plans atoll M used as public records
s &�'� 2004
5 8� Licensed Professional JAN 1 V
OWNER-BUILDER DECLARATION
50 f 1 mosso affirm on 11. exempt from the Conlns Co License taw for the
501 following moss.Permit
t ]1131.5,construct.aitea[and ve,de oli Codc:Any city lir county BUILDING
°�$ which myulrta a posit re theaper,Improve,demolish, r c a sig ed stmdum
that hprior e
its lasusnce,also dpursuantto to theapplicantContratoch r'tUmam,signedstatement
FF< t nomealicanmdpuection7M)nfDivionsn of theBuiress Lccmclaw(sCode)9 Sq.Ft.Floor Area Valuation
d$ that he
exempt tSemfrom and of hums n3Mtheege Ascription.Any
si Code)or
�+ Nal he V exempt therefrom and tim basis fm the alleged exemption.Any violNun of $470000
Section 7831.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy e
not mom than five hundred dollen($504 P Y TYP
❑I,asowneroftWpmparty,mmyemployceawlthvnguu NairwleenmMnutlon, 35702040 . 00
will do the work end themectme is notintended or uttered forsale(Sec.7094,Business RR
end Profession.Code:The Oonbacuras Lim..law data not apply to an owner of 101 . - FOL7NDATegDOi�X Inspections
property whobuilds or haprofl
ves m on,end who doessuch work himselfor Throughhis 1
own employ=,provided thatsuch improvements art not intended confirmed(anile.if. 102 — PIERS
however,the building or Improvement is sold within one year of completion,she owner.
Wilder will have the burden of proving that he did not Wild or Improve for purposcof 103 — UFER
"le')' 104 - REBAR
s 1,as owner of the property,am exclusively contracting with licensed esuacton to
strum the project(See.7094.Business and Professions Code:)The Connector's U. 105 — ANCHOR BOLTS
ce.law does not apply to An owner of property who Wilds or improws thereon.and, 106 — SEWER & WATER
who contract far such projects with a comm�or(O llcemed puuvent to the Csnnetor's
Etre"Lew. 202 - UNDERFLOOR PLUMBING
El ren exempt on r Sec. BA P C lm this mason
er Dale ° 5 03 203 - UNDERFLOOR MECHANICAL
/ WORKER'S COMPENSATION RATION 204 - UNDERFLOOR FRAME
7 hereby Alline under penalty of perjury one ofthe following dulantions 205 - UNDERFLOOR INSULATION
plhswand will mslru..CenlBeuoC...antrul6rsummrworker'e Comper- 301 — ROUGH PLUMBING
se0en,as provided fm by Section 37M of the Labor Code,for the performance of the 3 02 - TUB & OR SHOWER
work for which this permit is issued. N
❑1 have and will maintain Worker's Compensation Insurance,An required by Section 303 - ROUGH MECHANICAL
37M of the Laborcodc,for the performance ofthe work for which this permit is issued. 304 — ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Policy number am: 305 — FRAME
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
nm (This Auction wed not W completed if the Permit is for one hundred dollars I$10() 308 - SHEETROCK
I uniftyy that In 1W performance of the work for which this permit is issued,.I shall not 309 - EXTERIOR LATH
Laws o(cefl�iburocSnann manneraoRs cplgp tpbjecGomeworked Compensation 310 — INTERIOR LATH
Applin t lRe.pal `7 (J—t 311 - SCRATCH COAT
'WL
TO APPI-`7 .1, fter making this Cemim a of Exemption,you shsld 313 - ROOF NAIL
bac subject to the Workers Compensation previsions of the Iahm Code,you must
.J'z forthwith comply with such provisions or this permit shall bcmounted mvoked. 501 — FINAL ELECTRICAL ENERGY
zO
CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
F them Is a 503 - FINAL MECHANICAL ENERGY
the workforwhich this permit is meed(sae.3097,Civ.CJ 504 - FINAL BUILDING ENERGY
W Q Lendcr'e Name
z Lcnder'aAddress 505 - FINAL ELECTRICAL
U O 1 certify that 1 have read this application anti slaw that the about information is 506 — GAS TEST
0Fcorrect.I agree to comply with all city and county ordinances and state laws relating to
O buildingconswcion,andherebyouthouerepresentativesofthiscityinenterupondu FIN PLUM$I G
W alm.-manicotti property for impaction purposes.
(We)agree in save,Indemnify and keep harmless the City of Cupertino against 0 8 F I L
V) liabilities,judgments,sem and saxpenes which Maybe&nywayaccrue agalnsluid City 5
V 7 in come nonce of the granting of this permit.
Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOURCE RE ULATIONS. 09171%3
IQU3
Re-roofs
jnatum ofArpicanV ntracror Dam 6 2 — OOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE TypeofRW63 - ROOF BATTENS
Will the applicant or future building occupant store or handle hszardeus mated&]
As defined by doe Cupertino Municipal Code,Chapter 9.13.and the Health and Safety 604 - ROOF IN-PROGRESS
Saction 25533(.)? () All roofs shall be inspected prior to any roofing material being installed.
❑Yee 9"D°
a,, °
Will the applicant or future building occupant esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmll hazardous air conuminarys u d.0ned by Bu Bay Amu Air Quality Management all new materials for inspection.
District? tl�Tq\r,/�
❑Yea
1 hewmad Nee U.sm.uri&hmquimmenuunder Chepurd.95ofthe Gelding
datanalthgrSafety Cede,SONem355115s Myrsnd35534.1 undersande ocup Wiring
docs no cuncmly how a mnent,than h h my rospomlMllty b nntil'y the occupant of time
mqb cnuwhb muslW Ipdormissuanceofe Cctorms of to, an Signature of Applicant Date
I/AV
Owner or A.9mr0cd a gar Dare All roof coverings to be Class"B"or better
J