03060189 CITY OF CUPERTINO red`:- "'
BUILDING DIVISION PERMIT CONTRACTOR INTr'ORMATIO�N``5�'}z�,
�.&:.. r, •:e.4; ,4ss.. 'qtr 0 t`u.lam ..a
a UIGDINGADDRESS: DESHPANDE SIDHAKUMAR G AND 'PlNO03060189
'7.5 6 ORGIOP-ANIDE 1:11
ER'S NAME: PERMIT ISSUE DATE
10NE:' SANITARY NO. CONTROL NO:
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSEDCONnRdorderSDECLARATION JobDescrip'l-09 1 Mrcby of LIC that 1 em CONTRACTORS
under provisions of Chapter 9(commencing
� E with Section 70(10)"(Division 3a1'NC Business end Prafessimu Code.and my license is
Lifail e Clas eR"'' DECK REPLACEMENT
In- """""°° JUL 0 3 2003
F o Dau Contractor
nF ARCHITECTS DECLARATION
C 1 understand my plans shall he used as public records
a Licensed Pmfcsaiunal
BUILDING
5 OWNER-BUILDER DECLARATION
E 0 0 I hereby afbrm than 11. exempt from the Contractor's Co e:Any c ty a for the
m� following reason.(Sccuun 71131.5.Business sutl w, a moll Code:Any city nr county
5— which squires n permit re mnnrwL pplic improve,h remit t nr repair any tatement
0a prior In its issuoncc.also rcyuims the applicem for such permits°Olcasigned smnement Valuation
ea that he is licensed pursuamwthe provisions"f the Contractor's LicenuLaw(Chapter Y Sq.F[.Floor Area
ls-$ m na rdwncing with Section 7WR of Division 3 of the Business and Professions Code)or
Net he is exempt therefrom sod the breis for the alleged exemption.Any violation of 36218021 , 00
Section 7031.5 by any applicant for a permit subjects the applicant o A civil penalty of APN Number Occupancy Type
nor marc than five hundred dollen(S50%
0 L as owner of the pmpeny,or my employees with wages As their sale compensation,
will do the work.and the structure is not intended or offered for sale(Sm.7014,Buramms 101 — d Inspections
and Profusions Code:The Comimme.License Law dace not Apply m an owner of 10 2 - PIERS p
proi who builds or The
thereon.and who does such work himself or through his
awn employees,provided that such improvements Am not intended or offered for wic.It. 103 — UFER
however,ON building or improvement is said within one ycu of completion,the owner-
builder will have ON burden of proving then he did not wild or improve for purpose of 104 - REBAR
105 - ANCHOR BOLTS
0 L as owner of the property,am exclusively contracting with licensed concretion to 10 6 - SEWER & WATER
consider the pmject(Sec.7044,Business and Professions Code:)The L'om aemrs Li
arae law does not apply in an owner of property who Wilds or improves tbemon.and, 202 - UNDERFLOOR PLUMBING
who contractsfar such projects with a contracui licensed pursuanuo the Convector's
License Law. 203 - UNDERFLOOR MECHANICAL
I am eaec
mpc under Sec. .B A,P C for this reason
WO , em , / /,,,` 204 - UNDERFLOOR FRAME
ORKERS OMPENSATIONOECLA nerd 205 - UNDERFLOOR INSULATION
_1W IhembliApr under penalty of perjury ON of the fallowing ecclarnioos: 3O1 — ROUGH PLUMBING
❑Thaw and will meinuin eCeniBcamof Coruenuaulf-insure far WarkcrsCompen- 302 — TUB & OR SHOWER -
suiom,As provided for by Section 3700 of the labor Code,for the performance of the 303* - ROUGH MECHANICAL
work for which Ibis permit is issued.
0 I have and will maintain Workces Compe atian Insurance.As squired by Section 3 04 - ROUGH ELECTRICAL
37M ofthe Labor Code.for IN performance of the work for which this permit is issued. 305 — FRAME
My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(ro. c,i.nneed not wcomplemdifrhePermit isfor onehundred dollars(3100) 309 - EXTERIOR LATH
or Ices.)
I wnify that In he performance of the work tar which this permit is Wood,i shall Out 310 - INTERIOR LATH
employ any person in any manneran um become subject to the Workers''Campcnsatlan 311 — SCRATCH COAT
Laws of California,Dau
Applicata 313 - ROOF NAIL
NOTICE TO APPLICANT:If,after making this Ccnifieaue of Exemption,you shouW 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker'°Com penmtion previsions of the Labor Cade,you must
0z fanhwimcomply with such provision orthis permit shall Ndeemed revoked. 502 — FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
E:•y+ Ihereby aRnmchat there itsmnswninnlendingagencyfor the performanceof 504 - FINAL BUILDING ENERGY
C' me work for which this permit Is issued(Sm.3097,Civ.C.)
DLcadersA
z 505 - FINAL ELECTRICAL
� t`n°ertAdde°"" 506 - GAS TEST
U 0 I eenlfy that 1 have read Nis Application and scam that the above infmmatian is 5 0 7 - FINAL PLUMBING
F torten.l agree to comply with all city and county ordinances and sou laws misting to
Qbuildingconswction,andherebyauthorizeuprcunuciwofthiscitywcnteruMnIN FIN MEC CAL
Wabove mentioned pmperty for inspection purposes.
0. (We)Agree to save,indemnify and keep harmless the City of Cape
nino against 0 9 F I y
.F".r cn liabilities.judgments.costs and expenses which may in any way accra againatsu,d City 5 NG
U in consequence of the&mating of this Permit l./
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date
SOURCE REGGUULLATIONS.
Re-roofs
ep'�A 1`� "
Sinuur FP 6 U,
& ✓ c`aHAZARDOUS MATERIALS DISCLOSURE - D°" Type of Roof
Will the applicant or future building occupant store or handle haysrdaus material
As defined by the Cupertino Municipal,Codc.Chapter 9.13,and the Health and Safety
M0hAALC.d.,Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes �u
Win me Apppaant or future wilding o edpant use equipment or device womb If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardnux air conemimm s a defined by the Bay Area Air Quality Management all new materials for inspection.
DixuinT
❑Yes (fU'N .
I have mad the haraNuus mawriab rcquimments under Chapwr6,95 of the Callrof-
nialiwlthASafetyCa ,Se6ans25N15,35533and25534.1 understand Natifthe building
does not cumencly have a tenant that It is my responsibility to noufy the occupant Df the
requiremmeent,ts which must M met pfio wissuancc ofa Ccnincauof Oc tip cy. Signature of Applicant Date
07/ Signature
Owner or authAll roof coverings to be Class "B" or better
ori'rcd agent Date