02100110 (2) CITY OF CUPERTINO ^^ •• -
BUILDING DIVISION PERMIT CONTRACTORR INFORMATIONi°'
null. DRNORMANDY WY TROJAN REMODELING & DESIG PEMT02100110
S P R KHUNDHAR 681 ELDEN DR APPLICATTIOsYBID5Y2002
PINE: (408) 371-9179 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Mae, LICENSED CONTRACTOR'S DECLARATION
I berchy affirm that 1 am licensed under provision of Chapter 9(commencing
with Seaion]I)MI tfDivisianJofNeBusineasa PnsfessinnsCwe.enJmylicenvls REPLACE SUB FLJOb/� FIC� BIRCK SEAT
mfou force an ce. //[[ ' 1 AT FIRE PALCE
44 License Its
. rrV1.Ic.M
TECPS DE ION
s C� 1 undemand my Plaistow]W used as public records
pyU
LLO LiccnscJ PrnitssienalJ'
as fl OWNER-BUILDER DECLARATION
s 00 I masa .(Sero on 11. uempt from IW Contractor's Co :Any cense Law Ina the
w�p0 follwhich
greresa Permit to onstr t.alwssand improve,
demolish.
or Any city strutme,
°'_$r which requires a Permit m encs the altee impose,demolish. fie asir any smxmte
rE < pdmmoiucensed issuance,
perms inquires moist alofant fns such Permit file Lw(Cha mem
m Not he mmen ingwidpSectiouothnpmnsision3 of
as Can uiness ndProlesw(Chepmr9 Sq. ea Valuation
F that W I.ex with Section of the alleged
Business and Vis Cndc
s g )' Code)or 36611167 . 00
Net be is exempt Ihcn:frum end the Aasis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for apmord,subjects the applicant In a civil penally of APN Number Occupancy Type
Sol more to..five hundred dollars($500). 101 - FOUNDATION
3:02 PiERS
I,azuwner of Ne property,ter my employees wish wagceaz Neil sole compcmetinn,
will du die work,end she awnum is nm intended moffercd fouele(Sec.](194,Bmioeu
and Professions Code:The CompalLicense law does nos apply w an owner of 103 - UFER Required Inspections
propeny who builds or improves thereon,and who does such work himself or through his
ton employees,provided that such imprownsenu are not intended or offend for sake.If. 104 — REBAR
however,die building or improvement is odd within one year of completion,the owner 105 — ANCHOR BOLTS
builder will have the Wi de s of proving that be did not Wild or improve for purpose of
.m.). 106 - SEWER & WATER
0 L as owner of she property,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
construct the project(Sec.7W.Business and Professions Code:)The Convector's Li.
cense Law does not apply to an owner of property who builds or impruvca tercon,end, 203 — UNDERFLOOR MECHANICAL
who contracts for such projects with a contracrons)licensed normal to the Contractor's 204 - UNDERFLOOR FRAME
License Law.
O l am exempt under Sec. ,B&P C for this reason 205 - UNDERFLOOR INSULATION
ar Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penally of perjury one of the fonowing decimations: 303 — ROUGH MECHANICAL
O l have and will mninuin a Certificate of Consent to for worker's Compem 304 — ROUGH ELECTRICAL
.Iran,as provided for by Secunn 3701 of the Labor Code,for dm performance of the
work for which this permit is issued. 305 — FRAME
0 1 have and will maintain Worker's Compensation Insurance,az required by Section 3 06 - HOEDOWNS
3710 of the Labor Code,for the performance of the work for which Nis permit is issued.
My Worker's Compensation Insurance carrier and Poll, enumerate: 307 — INSULATION
orrmn
dm
.� 7/3-99-4G 308 - SHEETROCK
CERTIFICATE OFE(EMPTI FROM WORKERS'
COMPENSATION INSURANCE 309 - EXTERIOR LATH
mis section need not Wcompletee perm
d if thit is intone un
hdred dolldm(Mf0) 310 - INTERIOR LATH
"'Ie9s.) 311 - SCRATCH COAT
I cenify Not in the performance of the work for which this permit is issued,I shall not 313 - ROOF NAIL
employ any person in any manner so as to become subject to she Work i-s Compensation
Laws of Califomia.Dam 501 - FINAL ELECTRICAL ENERGY
ApplicanNOTICE t mould 502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICANT:11:Direr making this Gestin c of Exemption,ad you
become subject y the Worker's Compensation m hal of the deemed
Cade,you must 503 - FINAL MECHANICAL ENERGY
O O forthwith comply with such provisions or this firma shall W deemed mvnkcJ.
'zt„I CONSTRUCI'IONLENDING AGENCY
504 - FINAL BUILDING ENERGY
[—i IherebyanionNatthereisaconswctionlendingagencyforthepesfmmaneeof 505 - FINAL ELECTRICAL
W > the work(orwhich this permit isissucd(Sn.JB97,Co.CJ 506 - GAS TEST
wn
Da Q Leers Name
6
i IandersAJdrtss 507 - FINAL PLUMBING
U O 1 cenify Nm I have Mad this application and sum that the above infmm®ien is 508 - FINAL MECHANICAL
(~ enarecl.I agrcc m comply with all city and county ordinances and suit laws relining Its
building convection,and hereby ewhurim representatives of this city to enter upon the 5 FINAL GRADE
abovo(We) grapropertyfor inspection r rtes. M1
p' a (We)agree to.ve,indemnity end k cp harmless the City of Cupertino against 10 FIN PLANNI G
I^ liabilities,judgments,costs and expenses which may in any way same against said City 5 F N U LI WORKS
U 7 in con"tance of the granting of this permit, l�J1 l/
F7 APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU0. GULATIONS.
�f4h, Re-roofs
Si _tnr"f HAZARDOUS MATERIALS DISCLOSURE Dust, Type of Roof
Will the applicant or future.building t' pant store or handle hareNous materiel
41 JefineJ by the Cupertino Muncipal c.Chapter 9.12,and sbe Hcellh and Safety
m.Section zss3na)+ All roofs shall be inspected prior to anyroofingmaterial being installed.
pros p� P P g
Will the applicant tourc building pans u.cquipmentor devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air cumaminams m deft y the Bay Area Air Quality Management all new materials for inspection.
District?
C yes t
I have aced to nrdnusm u:nabmquinmmB under Chapter 6,95ofthe Califor-
taunts
lN&Safra ,Section 8515,25533 and 255th.l understand Bull if the Wilding
does not cunt ha a tenant,Not iI is my responsibility m nodty Nc neupmt of tc
requirementshie uat metprimhllmumaofa CeNficate of Oeeapaney. Signature of Applicant Date
Z All roof coverings to be Class "B" or better
O r car m ale