05080241 CITY OF CUPEWfINO a rax "
BUILDING DIVISION PERMIT CONTRACTORINFQRMATION
BUILDING ADDRESS: PERMIT NO.0 5 080241
1031 NOVEMBER D
IER'S NAME: PERMIT ISSUE DATE
SADANAND D. KARVE 09/27/2005
ONE:
SANITARY N0, CONTROL NO.
ARCHITECfrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION lob Description
C 1 hereby affirm IMI I am licansed under provisions of Chapter 9(commencing
U with Section 7")of Division 3 of Mc Business end Prolesimns Cade,and my license is
: „ inrmlmrceonaerrea ADD 41 . 50 ' MS BEDRM-PHASE 2
L4eneaaz' " SEE PERMIT 05080240 PHASE 3
a` Dam Contractor $t #05030111 PHASE 1
"£ ARCHITECTS DECLARATION
C< 1 understand my plans shall W used az public recordsIr
a.
v.0 t' Lccnsed Podcssionel
3 OWNER-BUILDER DECLARATION
ON
z o I 1 norchy.(firm on 11. exempt from the Contras,Co L ceps city
o for tne O following moon.Permit
t Ronstr Business and improve,
detioli Cafe:Any city of county OCTla 1 2(0 Z00[
zoo
which reyuims a permit ox construct,pare improve,demolish.at repair any amenti m sI
y z i that Wi licensed
p also m to Me ffic.ppProvisions
of par Rich Me Contrcrmi0a fiensele is LneJ ammmcnM [tP 19 0 0 3
< (comma cingwJpursuanuotheprovivioion3of eBusi ccs n'acnseMw(Chapmr9 Sq.FL Floor Area ') [yfjllq� + r i j1Valua[i$
2y 0 (commencing wiN Section]000)of Division 3nf the Businessand Professions CaJc)ur ! 1 •�� E-41,
..
that he is exempt therefrom and the basis for the alleged exemption.Any violation of ill!1SSkCCCC �,I 1=7
section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number — "`0ccd ane Type
not mom man five hundred dollen(nook 36216004 . 00
P y yP
I,as ow nor of the property,army employees with wagee as lneir mic compensation,
will do Ihewe t and me swcom,is not intended or offend for sal.(Sec.7061,Businw
and Pmfcssions Code:The Cenuazmr's License Law does at apply ban owner of Required Inspections
property who bufldsor imprnvs,Ihercon,and who does suchwork himself or through his
awn employees,pmvidcd that such improvements are not intended or offeral for.vk If.
however.the Wilding or improvement is sold within one yem of completion,me owner-
builder will have the Wrdea of proving that he did not Wild m improve for purpose of
sale.).
1.as owner of Inc property,am exclusively conning with licensed contractors to
onswct the project(Sec.7044.Business and propositions Code:)no Court Li. _
cense Law dors not apply to an owner of property who Wilds or(reproves Marton,and.
who consacsfar such process with a comeactor(s)licensed persuam to Mae Committees
sesw.
am eaempt under Sec. .B&P C for this moon
r s etda�nav d k0 0k Dam912x 03-'
WORKER'S COMPENSATION DECLARATION
1 notably affirm under perW ly of perjury one of the following declarations:
1 have and will maintain a Certificate of Cannot to self-insure for Worked Compen-
sation,az provided for by Section 3700 of the IaWr Codc,for the perfamana of the
work for which this permit is issued.
❑I ban and will maintain Worker's Compensation Initiation,as required by Section
3700 of the Mbar Code,for the performance of the work forwhich this permit is issued.
My Workefs Compensation Insurance carrier and Policy number are
Cartier. Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(This section need not he completed if to Permit is foronehundrod dollars(SIM)
or less.)
1 ccnify Nat in the performance of the work for which this permit is issued,1 shall or
employ an, .an in any mannerse become subject rola Wornoi'Componsa0an
Laws of California Dale R 1'J � ! eYt--
Applicant mdn g�pw v�o�.c(
NOTICE TO APPLICANT:If,after making this Certificate of Eacmption,you should
become subject to the Worker's Compensation provisions of th.Ishm Cade,you muss
.,O fotawith comply with such provisions or mis(ermil shall be deemed awaked.
z CONSTRUCTION LENDING AGENCY
(-+ Iherebyarm that Nen u a mancrotinn leading agency far the performance of
fY 7 me work far which this pemlil is issued(Sec.3097,Civ.C.)
Itl Q Lcndcr's boom
=Z lender's Address
U Q I certify dust 1 have mad mix application and sum that the shove infmmatiun is -
UL f-' camel.1 agree to comply with all city and county ordinances and sole laws relating to
O U Wilding construction,and hereby authorise mprcaenlatises of this city to enter upon the
W above-mentioned property for inspection pbpases.
LL (We)agree b save,indemnify and keep harmless Mhc City of Cupmino against
IA liabilities.judgments,costs and eapnses which may in any way snot against said City
C)z APPLICc of Me goicaling of this Permit.
ANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 2�(GS
S *��_ ouref-of Ap!s` Re-roofs
Signewrc o(ApPhcaHmntrU ARticbr Dele
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(Muse Wilding occupant store or Modic hanrdons material
az dc.Z,by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
.Scctiea nslz(aY.r p p y g being installed.
El yea SfNo All roofs shall be inspected riot to an roofing material beim
Will mea applicant or future building occupant ua.a If a roof is installed without first obtainingan inspection,I agree to remove
PP g p equipment or devices which P
7d=
hazardous air contaminants ns defined by the Bay Arca Air Quality Management all new materials for inspection.
rict?
❑Y.. Flu
I have read the hvaolousmamrialsroquiremen s underCMpar6.95 aline Caliper,
nix Safely Coale,Sccvons 25505.25533 and 25534.1 undentand Maul&Wilding
not curen0y haw a tenant that it u my responsibility,to noufy the occupant of me
ire,mhn-s which mull no met prior to issuance of a Caurcam of Occu r Signature of Applicant Date
R 2QS^ All roof coverings to be Class"B"or better
mer tar authomcJ ag.nt Dale