00070159 CITY OF CUPERTINO
Buu.DING DIVISION PERMIT CONTRACTOR INFORMATION: .
BUILDING ADDRESS: PERMI"INo.
OW NER'S N'ANIE APPLICATION SUIT DATE
1043 NOVEMBER DR 00070159
qNp. SANITARY NO. CONrROI.NO,
SINGH 07/5/2000
a-V ARCHI'I'FZC1717NGIN1717R. RUILDING PERMI f INFO
y BLDG 1?LIEC'I' PLUMB MIRBI
V¢a
FN% LICENSED CONT Rd undo,SDIiCLARATION - JOIJ DetiCllptlOn
O y_ hereby.Jfirin tout I um IianncJ under pmvi,ioa,of Chupmr 9lcninmcnei
with Scetinn 7lNNq of Uivixion7orlhc Bunincw nnJ l'n,fcsslona L'nde,unA it,license
6 i.in full rnrce am ')feel /
z 6 Lia,nc ,I
3 a Dale J'r'nv� Cmnr:aanr .
ARCHITECTS DIiCLA6 1
C�°g I,Indervh.nd.nypwnsa1,a116,nsalaspnbha,vrnlJs FURNACE/AC
soy_
I,iccnwd Profcsinnal
OWNI:I-BUILDER DFcI,ARA1 ION We
u=w I hereby ullhm That 1 am exempt from me Contractor's Littnse Isw for,he
following manna(Scclinn 7031.5.Baines,and Pateaniom Code:Ali,city or county O
�'k O which require,a pronto n,const to,alta:unioun ,dcninli.h,m oa uir uny an cton,
Lam prior to los issuance.ala,requimsthe applicant for such permit to file asigned.statement
that he In lianncd aismlmm the pmv.nlonsof the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(v rpwncing with Section 7(NIB)PIf D virion 3 of the Business and Pool�,,lons Code)
or that he is exempt lin mrmm and the basis for do,alleged exemption.Any violation
of Sermon 7131.5 by any a,llcam for a permit sable,,the applicant to u civil penalty
or Pat none than five hundred don,($5(Nu, APN Number Occupancy Type
0I,asowns of he pmpany,or my employees with pi as thciraole.nn,penwhnn. $1
will do the work,and the ammlum is not intended or moral fin sale(Sec.7(44,
Budnce.a and professions Code:The Contractors License CPw does not apply In an Required Inspections
or prnpeny Who build,nr i.,.pmves mer«,.,,and no does inch work hhnwil 3Fs21 Fr@@9. @@
or mmugh his own employees.provided sumprnvIau that ch ims are nal lmcnded ar
offered for sale.If,hammer,the building or impmvcman[is sold within one year of
n...I,nn,the nwncnbulldcr will have the harden of pro Ing Ihet he did n,[bnlld or
impoopAni rswe"fsale., 2204 UNDERFLOOR FRAME
❑La,nwl,er .1 [in prnl,crly.Pur,xelasi,ulrennlanngwi,hlian,wdconlpcuasm 301 — ROUGH PLUMBING
conwma the p ISI(Sec.71W,Business and Professions Cnle:)The Contractor's
Ticeresc Law does out apply to an owner of progeny who brilds or Proproses themon. 303 — ROUGH MECHANICAL
and who cm,(me,la,van, pnijet,will, a con'nmloil) licensed fuu,now In he
Cbmractoe,License La, 304 — ROUGH ELECTRICAL
01 on exempt trader Sec .B K PC for this mason
505 — FINRL ELECTRICAL
ownerlyase
WORKER'S COMPENSATION DECLARATION 507 — FINAL PLUMBING
Ihereby amnnunder penalty ofperjury one othe following decimation 508 — FINAL' MECHANICAL
,b
1 base and will maintain II Cendicate of Consent to self.inxure tar Workers 514 — FINAL PUBLIC WORKS'
nmpcasaion, as provided for by Section 37M of the Labor Code. for the
perGmnance of the wink for which Imo pennit is ia,u,,k
❑1 have and will maintain Worker's Compensation Insurance,as required by section
3410 M the Lahnr Code.nor the perfonmmcc of the work for whim this pori,N
,euW. NS Aer' ,s lion par°ncc,anirand l' i(y nu Be I
arta',��firyll N��I[V hll"f1OV�1�1!.�'NL�I4U—VV
COMPENSATION INSURANCE
This.section need not be completed if the Iwnnil is for one hundred doll,
(SI INI)1n l,as.)
I aenifv that in the perronnance of the work for which[]its peril is issued.I
shall not employ any la'rnnn in any manner in as In become subject u,the Workers
Compcnna,lnn Laws al Calo(onia.Dat, .
Applicant
NO[IC17'1'O APPLICANT':IL of ler waking this Ccnincam of Escrolion,ynu should
heemne subject to the Worker's Omniwnnnion provisions of[he Labor Care,you lots[
QQ h,nhwah emoply wish such a
provisions cr this .,it shall be damsel mvaked.
F
CONS'rRUCI'ION LIiNDING AGENCY
a ' I hereby elfin that them in a connotation lending agency f be performance
of the work or sun h di,pcnno i,.,nual(See.3pa7,Civ.CJ
0. Q Lender.Name
= z Lcndcr',Address.
U O 1 cenify that 1 have mad[his application and state that the al,ove information is correct.1 aglow n,comply with all city and county ordinance,and sate laws relating
,building coast...lion.and wre,amhnrimP,PP,srwlniveiof,hi.ePY ,,enter upon
the nine..wined pmpcny for impcetion pmryses.
tr 0. (Will agree to save,indemnify and keep harmless the City of Cupcnmo against
V) liabilam,juAgmen,,cont,and expenses which may in uny xny accrue agaiml aid
U z City in comaplcnee of It gm sing of this pe tri[. GILJ
APPI.ICANTUNDERSTA ' Aj'1D5rI�I OMPL WrlYLL NO "POINr Issued b Date
SOURCE REGULAT � y'Sigmnnre of Apprmal,Vcn [ r DaateRe-roofs
IIALARUOIJS MA'rBR1A1S UISCLW
will the applicant or future Wilding lwcupanl store or handle hvmdou,ma„nal Type of Roof
o,JctP ed by the Cupcnlnu Municipal Code Chupmr 9,12,and the llcullb and Safety
Cola Section 235320)7
Ores 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ar furore huildingleen,PP use ego,oc,ol or device,whir If a roof Is installed without first obtaining an inspection, 1 agree to remove
emit bueardous air conumina,nn as defined by the Bay Area Air pual sty Management
Disldetv all new materials for inspection. Applicant understands and will comply with
0lit, 0 N all non-point source regulations.
I have rad the haaoNou,lowalnls mqui...ncot,uudur Cholla 6,95 of Ili,
Calimmia llahh k Safely Code.Sections 25505.25533 and 25534.1 understand that
if the huilding does not,,cooly hove a tenant,mo[it is say msp nsibili,y to notify he
'cupuirn
anl ol'the rnt mut,which must be nett prior to is,unnml n nCs,rii,am of
occupancy' ' Signature of Applicant Date
Owneror amhndeed Than Dan. All roof coverings to be Class 13” or better -