02080148 CITY OF CUPERTINO - �
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIUII.DING ADDRESS: SADANAND KARVE PERMIT NO.
1031 NOVEMBER DR 02080148
`VNER'S NAME: APPLICATION SUB DATE
SADANAND KARVE 08/26/2002
"ONE: SANITARY NO. CONTROL NO.
AROUTECIENGINEER: BUILDING PERMIT INFO
BLDG ETF.(.T PLUMB MECH
�00 LICENSE CONTRACTOR'S DECLARATION )Ob Description
w 1 herchy,affirm that 1 um IiccnuJ under provisions of Chvpmr Y(commencing
with Section]IXIIB of Division J of the Businessand Professions Cm1c,and my license is
t „ inWlLfnrceadd effect. ADD ELECT CIRCUITS (BACKYARD)
OZn4 License Clava Lia#
F,q Dale Contractor
F=Q ARCHITECTS DECLARATION
3 y 1 undcrsund my plans 0.11 M used m public records
O�
ori LL 0 Licensed professional
OWNER-BUILDER DECLARATION
!� 1 hereby affirm that 1 a.1. cxcmp from the Cssions Code:IAny c Law for the
m a p O which ire requires
(Section 71onstr Ovalness and Professions demolish,orAny city rat county
n'K$� which its is .permit recores the,.fleeimprove,h Permittnrrepairanyed aWctmc
1- that
its issuance,e,also myothe thovisio ant farsoothe sucContrarmiuLicen eLaw material
< (commencing
licensed rSectio uotha Of Division 3 Ne Contmnss License LawlChorur9 Sq. Ft. Floor Area $ls�k(31tlOn
N t=-'� lurmmes exempt
Seetiord and of basis for
oft alleged
exe anJPn,fAny vi Cade)or
_ Nn be is exempt therefrom and 0u hose fox the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of -i bkWNA%eP U Occupancy Type
not more Nan Bus hundred dollars($5110).
❑I,as owner ofthe property,or my employees with wages as their mile exmpemudon,
will do the woh,and dm svucwrtis not intended oroffercdforaale(Sec.](W4,Business ons
,p �g �..
and professions Code:The Cmitnectore License Law does not apply m an owner of 304 - ROUGH 9111 RITKLI
property who builds or improves Human.and who doessuch work himself or through his
own employees.provided that such improvements ma not intended or offered frown.If. 505 — FINAL ELECTRICAL
hmvewc the building or improvement is sold within an year of compledion,the owner.
builder will have Ne burden of proving that he did not Wild or improve for purpose of
sate.).
❑1.as owner of the property,am exclusively contacting with located contracwrs to
construct the project(Sec.7044,Business and Professiors Code)The Contractors Li-
REscam,law does not apply to an owner of progeny who Wilds or improves Merton,and
who contracts for such projects with a conwaor(s)licensed pursuant 1 Ne E..
License Law.
❑1 am exempt under See B sk P C foter Tele .mayWORKER'S COMPENSATION DECLARATIONI hereby affirm under penalty of perjury one ofthe followingdeclan❑ I"wand will maintain a Cenificate ofCoacm to self imam fm Worke
aation,as provided for by Section 37M of the Tater Code,far the perrormmee of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Cute,for the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Camicr: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu action need not be ccmpleud if the Permit is for one hundred dollars($100)
,it It
)
I certify that in the Performance of the work for which this permit is issued.I shall not
employ any penin in any manner so av to become subject to the Workers Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicau of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O ,Z, forthwith comply with such provisions or this remain shut W deemed revoked.
OCONSTRUCTION LENDING AGENCY
(—a I hereby affirm thm there is a consrucdon lending agency for the performance of
a 7 the.,it for which this permit is issued Ism.3037,Civ.C.)
ALender's Name
a z Lender's Address
U p I sentry that I have mad this application aad me.that the slow information Is
fi F con teL.I agree to comply with all city and county one amors and state laws reading to
U building construction,and hereby authorim rcpreummives of this city to carer upon the
above-mentioned property for inspection purposes.
(We)agree m save,indcmni fy and keep harmless the City of Cupertino against
y liabilities.judgments,cuss and expenses which may in any way accrue against said City
U Z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
RC-TOOTS
Signammof ApplicaRDO Date
HAZARDOUS MATERIALS DISCLOSUREhandl Type of Roof
Will the applicant nr Muni building occupe,Chapteorer
or huddle Health angnitions d
az Je0nc0 by the Cupeninn Municipal Code,Charter 9.12,and the Health end Safety
rde,Section 25532(.)! All roofs shall be inspected prior to an roofing material being Installed.
❑Yea ON.
P P Y g g
Will tW applicant nr future building uccupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminator as debncd by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Y. ❑No
1 have rcuJ the harmonious materials mquircmcros under Chaplcrfi.95 of the Califor-
nia11ca11hlESafety Cock,Sections 25505,25533 and 25534.1 understand than if the building '
does not currently haw v motor.that in is my responsibility m nor I tM Occupant of the
mquimmenor which mum W met prim to issuance of a Coal Toone of Ovupancy. Signature of Applicant Date
Owner or authotited agent Dare All roof coverings to be Class "B"or better
BUILDING DIVISIOIN�
. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1031 NOVEMBER DR SADANAND KARVE 02080148
APPLICATION SyB DATA
o Ai 1. KARVE 08/26/2002
�qqq PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: d - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
' TJ LJ I-1 L.J
z I
N= LICENSED CONTRACTOR'S DECLARATION w'f- JJO SCP On
Z_ 1 hereby aRres Nat I am licensed under provisions of Chapter 9(commencing AD ELECT C I .S B KYARD)
With
Sctian 70IX1)ofDivisionl of Nc BusinessvM ProfessionsCWe.and my fico. -
eFc h l: is in full force end effect. ,� "
9 sLicense Class Lic.N
5016 o Dale :., Qamtaewf •'
ARCHITECT'S W se DECLARATION s t�
C 4` 1 undemand my plans shall be used m public records �^'} 3• l
yr .
i 1i ¢p O Licensed Professional
cg OWNER-BUILDER DECLARATION
1 hereby affirm on 1 ern exempt from the Contractors :A n c Law for the
?
followingtimsmoon.permit
7onstr Business and Professions Code:Any oily or county $1000
F O
which rcq sees a perm i s construct,t,alter,Improve,demolish,or repair any stricture
° 3$ pdorfoitiss arca.al q ' thappbcani fur such pumi¢afilaaugnW saterriem - -- - '- n '-
NgfbetligwitpSoctiot7060)ofDivision3o the
eBusines mid
dProswonsCer9 a, p �3659•lr6•dCIRpT;;��a tt , Valuation
or tnmhe'hiawith ScionNW)ofhe baisoofe aBusulessaydkat.Anyvi Code) I�•(y,a g.�. „ _ tiT t,.h 'q y'jy.f w.
of Section s exempt tang Mli and the basis for the alleged hitenan.Any l pennon �I
of not Section iv mpdred d ll for.permit subject the applicam w e civil p y Type
) t of not mom than five hundred dollar,(ssw5. 10 3APN l�Ipg�r _ Occu ane •7 e
01.osowncrof the propeny,ormy employees with wagcsas their sole compensation,' 304 - ROUGH LE TR
'will do Ne work:and the swcmrt 1,ft.,immrdW or offered for.1.(See Is out i SOS - FINAL ElIEWdad�Ctlons"' `t
Bupinas end'Profeourn,Cede:The Contactor''"u"T's Law dens not apply w an
owner of Propenymho builds or improves thereon,and who does each work himself
or Through hie own employ es
provided ihm such improvement arc not in or _ _ __ _. ....... _._._.,`........_ _ -
'offered'far is
a L;however,the building or imp year of -
roimp..is
sold within one ..,
completion,she
owner-builder will have the burden of proving that he did not build ser
improve for puryou of sale.).
_..__. .__... .____... .. _._.._._. .____ ._.—_ _..
❑Luowner ofthe p(Sm.lam Business
withlicemehe Contewtso
-
construct theLaw
does
n (Sm.7044.outlets and erre who
Cade:)The Conductor'.'
an cine law does not I an owner th propene w o builds aid l Hereon,
net , eased ursuaism the _ ____• ,`! � � ..._..___..__ __....... _.. - -
- c epuY to h improves
_,md.who.conuans for. ch procts.wiN/'.n.cunuector(s),I¢ p
CIma rsnunderse Sm,,. g.�I`2lD"' �.-�62`,B&PCfar Nis rtason \\
'TtI I am exgmpt under 5+cd: .. ('
WORKER'gCOMPENS ON DECLARATION
' Ileemby affirm under penalty of perjury one of the fallowing drclaetions: �b✓ / \
I ❑ 1 have and will maintain o Cenificme of Consent w self-insum for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
perfamance of the work for which this permit it issued..,
01 have end will maintain Worker's Compensith n Insurance,as requited by Section
3700 of she Labor Cade,for the performance of the walk for which this permit is
'ssaued.My Workers Compensation herumme came r and Policy number am:
„ '; 1 f •CERTIFICATION OF E%EMP'f10N FROM WOR%ERS' t,
.., :.p. .r...., ..,, COI-.., ATION.INSURAN.C.E.`.
"'
(Mia.''d6h bma not be completed if the permit is for ane hundred dollars
(5100)or less.)
'1 1 cony that in the piarbournarce,of the rk for witich th permit is issuedI z.. •• i -•••' '
'iliII not employ any pce n n soy ne i tib at to the Workers
Co P as aN Lewi f C I f aa2fy(� ']
AA��BcWpffnttii
+ . me subject
If afar makingnp CemRc a fE pro you should
Q 0 be me sub/acs m the Workers Compcns t an provisions of the Labor Code,ymi must
forthwith comply with such provisions or this permit shall W deemed revoked,
CONSTRUC'nON LENDING AGENCY -- 1
[^ 1 hereby alTmm there that is a comxwnlen
din,i I 'ng ag rcy for she performance
sof Ne work for which Nispermitis issued(Sm.3097 Civ.C)
Q 'Londe Name•- /)()
na Lenders Address s a - //V'`//`•—.
V Q 1 currifyagree thin 1 base read tall sty andu o and store then the above information is
W tobuilding
1 ogres to comply with all city and county ordinances s and sate laws elating
. 'Q. the 21huse-mentioned n,and bertbyauthnrineuposemativcs of this city to coercion
r� the aba(We)agree
to properly for inspersion purposes. t
��ss 1Cn eWel ogre'to save,indemnify and keep homy in the City of Cupertino against,sid
fry liabilities,judgments,cost and granting
of this
which may in any way accmc against said p
. V � City in consequence of the greening of ibis pemot. v�
. � APPLICANT UNDERSTANDS AND WILL COMPLY WRHA_LL1CON-POINT -'ESsuedb ; Date
sOtlRc. .GULATIONs; 8.'24/ y
WI IcanPcmo m,, Dene Re-roofs
amu
HAZARDOUS MATBRI DISCLOSURE
the applicam or Tulare bu'Id' cupant scare ar Wasib-h ustake x mstenal Type of ROOF
as defined by the Cupen o M_a c ode Chopte 9.13,and theHealth and Safety 'l p ,,.+ - - s -^
Cod_OSection 213121n1s _ N ii.11 � ,. e`. . a {',I' { 51 I 1:Y7
All roofs shall be inspected prof to any roofing material.being installed
Will she applicam or fuwe buildin upam use d{uipmam or devices which If a roof is itistalled'without first obtaining an inspection,`I agree to remove
mrmha—.M asm,mumminant as den by the Bay Area Air Quality Management
District?
Ya - n all new materials for inspection.,.Applicant,understands and will comply with
all non-porn[source regulations.
- rf hove Health
&Safety
Code. mmedab 505,M33 a under 4.1 un 6.95 of the
if
the mil Heahh s Sofcur Code.have
Section.5505,t itis and 35534.I understand Nm
if the building does not currently haw a tenant that itis my mponsibility so notify 0a
occupant of the requirements which muss be,met prior to issuance of a Ceri fici a of
om.panc.
8'ulye Signature ofApplican[ Dae
t
_
aamorhea ager Dae All roof coverings to be Class"B•'or better
OFFICE _-