01050057 •/TY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
nm nNcnDljl+ �}+09 PINF_VILLE AV A PERFECT CI_IVIATE PE"Mn'NO, 01050057
OWNER'SNAME. AFIILICA1'1ONSFIALABA JAIN 4799 LYRIE _N � 3/`001
41 Ik
HONE: 4082269990 SANT FARY NO. CONTROL NO.
C m Z A RCI I ITIiCI'sCNO I NEE RBU I LUNG PERMIT IN1 O
0 0
S[ ❑❑ IILDG LLIiCT I'LUM13 h1GCll
=c LICENSED CON'TRALTOR'S DECLARATION Job Description
lin5 1 hcreh ILrm,hal I am Iiccnad under - f Chu mr9 ommambin
O y r Pms1sinns o p 8
°mI=J MirSection]teplmnivininn3rrnnaBa,meaawrrara�im'„n.1e dmyh,a.,e CONDENSING UNIT ADD ON.
is in fall lincc unA e ` �2315`a + .
K S rate CI ' Iillsp
6 a N Dam . Cunauanr
ARCHI'1'EC'I"s UIICLARAI111
F"a 0 1 underuanJ my plan,shall he umd w puhlic mnnJs
uw
,alp ip Licensed Prufcvnional
Oat I an,IIUILDr:R D[Ce Contractor
W Z 1
hereby un inn that 1 an,cacti... x ra,h,G,son,Co. Any c Irw for the
F 7 Y M116 ire luras c souritnt ]IIt tr llnxincen ro, Pndcssiom CrNc',And eco or anm,y
Ja wh h 1 nt,r :, 1 he P J ,list r'' 'ay smcarc
c.3°O their t o nI, rectum'provisions
Poi , an ptunit I t g J Chadalcucut
(thert cont I with
pursuant m p .iof c , Inc 1 w (Chapter
nsCrar° Sy. FL Floor Area Valq�tp
(commencing wth Se eget ]ne)of Division 3r f theme alleged ea and i o.Any vi Cala b�tl VJ0
or,hat he i, 31.5 b ,hcrefrm and me hostr faro theppi team
Any l violation
of Section]N L5 by any applicant for a recruit subjeea me applicant lir a civil penalty
of not mere than eve nanama.Bram a500B, APN Number Occupancy Type
❑I.m nI r
he ppr.
eno ter enmloyc, whh wager,ter vile ennrpm.,mion, 36913016. 00
will doINwork,and the nvueane is BEI Intended ,,ot�fered Por 701E(Set.71144.
Brom,..end pool...lon..Code:The Convector,License law dew`s nor apply,n:rn Required InspEC11O11S
owner of propcny Who builds or harrier.thereon.and who dew,such work h arsch 303 — ROUGH MECHANICAL .
or rough his awn employees.provided that such improvement%aro not inn adM lar
offend for sale.a.Orel the Wilding or mrpmvemen,i.e.nld%;thin ane year of 304 — ROUGH ELECTRICAL
ianeempl .tireowner,bild505 — FINRL ELECTRICALer will have the burden of proving that he did nm wild lar
improve parpo.c n
01.a. nflhe au,sm,,; a,w.av,Ir cra ir...og wpm licensed cnanm m.,o 508 — FINAL NF_CHA TICAL
m,mawihe per cd IS,,7044,Easiness:end I'mrm,inm Calc:)"I he Coinmc,ors
Uoun e Lrw da ten appy lir bn uwncr of pr`pery who bund%lar millrace,Oil
and who contracts for such prjecs with a umtrbcmgx)licensed pursuam to the
Control Licenm Irw.
❑1 ar es,rnpt cera.Sec. .B&r c roe this mason
Owner Umc
K
WORKESCO DaueAI'ION DECLARAI'1f1N V
1 h,mhy a1Ymn under penalty of perjury lane of the kilowing Jeelamtive,:
❑ 1
have and will maintain a Cenilic:n,of Cnavan hr.veli-insure for Worker's
Compensation, as provided for by Section 37W of ,he "No Coda far ,be
performanee of the work for which,his permit is ioued.
❑1 have and will noduarn Worker's Compcmalion Insurance.lav required by Section
37I0 of rbc LNot Cada,for the perforniance of the work lot which this Iwrmi,is
issued.My Workcr>Compcnsv,inn Insunmcn cnrriter,Ian¢d`'�ll�y II�� se-are:
'ohCarrier -X17My No.:FR WORKERS
CCfff Nl'II
IC
A9 ON(1P I:%IiMPI'[ON FRO WORKERS
COMPENSATRIN INSURANCE
ofiis Seaton need not he crnnplred if the pennh is fnr one hundred dollars
IS 100)no Icss.)
I drily for in,he perfonurace od Tho work for which this permit in ismed.I
Nall nen cri ioy troy pasrm in any run ncr so as m c,on,s,IbcO to the W..W,'
Cnmpemaamt Law.W ewiforil Dare
Applicant
NOTICE 1 O APPLICANT.1(,alcor nsaking obis Ccnifi<ate of 1:collation.you shwlJ
becomesubject ,the Worker,,Cmnpermaimt previsions ofthe lal Cod,you area
Q O forthwith comply with such powioir m m this permit ohall h deemed mvoked.
(~ srZ).r that duct,cRUC1l11N L..iou cG Ar,IiNCY
I mbyall lhonhis a rob..t(Scen I,nding ngn¢y xnnhc Pcrfummnc,
Exurb work Our which cols Pcnnit iv'msueJ(Sec,3119].Ci¢Cd
6. Q Lender's Name
;D L Lendar',padre..
U Q 1 maturity that l have mad,his application and state that the above information is
Las l.. core..I agree to comply with all city and county ordinances and orthe laws relating
Q C.> to building conquer ion.and hereby an,hmice mincomllives of Nis city tenter upon
p] the ria no..n..it i )properly for insperion ally o.
(We)agmumsace.'mdamnify un I kmP fa l...the City of Cupcnino rodeo
Z liabilities,judgment.,cags and expanses whalb stay In tiny wad accrue ngaln,t.aid
U z. City in conwywance of the printing of this permit tD
APPLICAN"r UNDERSZAND `
S WII.LCOMPLYWIT11ALlNNPOI 'r Issued by: Date
souy_'l:Rr rt 65639.1. Y:
s�gn3tJ,�of nppheanJcnntmrm uric - Re-roofs
HAZARDOUS MATERIALS DISC[.OSURE
Will,heappherm lar lhmre banding m,apom gorcor ahe mnromnaaancri:l Type of Roof
to Oil by Nc l}teen'....MO al Calc,Chapter'9,12,null me I ladm ao I Sump
Code.section 2553200:' ` -
❑Ye, two All roofs shall be inspected prior to any roofing material being installed.
Will the cep,licam or fumm WiIdingrw,upam use equipment or dil which If a roof is installed without first obtaining an inspection, 1 agree to remove
ern barurdausair armami ,ddn,d by the Bay Amu At,Quality him
h .,cmcm
�graric„ all new materials for inspection. Applicant understands and will comply with
C1 ar No all non-point source regulations.
I have read the haranlnus muteriids requir,mm„undo Chapter 695 0l'it,,
California Hcuhh&Safety Cute Senior.25505.25533 and 25534.1 mtdeotan l that
if,he building docs no,currently have a tun:mt that it is my re mr,ihilitymnmity the
bee...mot the requirements which maw be me,prior to Issuance of a Ccrili,are of
OCo,pancy' Signature of Applicant Date
osl�4l_
0 arrhoo7cdag,.at Date All roof coverings to be Class "B” or better
OFFICE
•/TY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
nm nNcnDljl+ �}+09 PINF_VILLE AV A PERFECT CI_IVIATE PE"Mn'NO, 01050057
OWNER'SNAME. AFIILICA1'1ONSFIALABA JAIN 4799 LYRIE _N � 3/`001
41 Ik
HONE: 4082269990 SANT FARY NO. CONTROL NO.
C m Z A RCI I ITIiCI'sCNO I NEE RBU I LUNG PERMIT IN1 O
0 0
S[ ❑❑ IILDG LLIiCT I'LUM13 h1GCll
=c LICENSED CON'TRALTOR'S DECLARATION Job Description
lin5 1 hcreh ILrm,hal I am Iiccnad under - f Chu mr9 ommambin
O y r Pms1sinns o p 8
°mI=J MirSection]teplmnivininn3rrnnaBa,meaawrrara�im'„n.1e dmyh,a.,e CONDENSING UNIT ADD ON.
is in fall lincc unA e ` �2315`a + .
K S rate CI ' Iillsp
6 a N Dam . Cunauanr
ARCHI'1'EC'I"s UIICLARAI111
F"a 0 1 underuanJ my plan,shall he umd w puhlic mnnJs
uw
,alp ip Licensed Prufcvnional
Oat I an,IIUILDr:R D[Ce Contractor
W Z 1
hereby un inn that 1 an,cacti... x ra,h,G,son,Co. Any c Irw for the
F 7 Y M116 ire luras c souritnt ]IIt tr llnxincen ro, Pndcssiom CrNc',And eco or anm,y
Ja wh h 1 nt,r :, 1 he P J ,list r'' 'ay smcarc
c.3°O their t o nI, rectum'provisions
Poi , an ptunit I t g J Chadalcucut
(thert cont I with
pursuant m p .iof c , Inc 1 w (Chapter
nsCrar° Sy. FL Floor Area Valq�tp
(commencing wth Se eget ]ne)of Division 3r f theme alleged ea and i o.Any vi Cala b�tl VJ0
or,hat he i, 31.5 b ,hcrefrm and me hostr faro theppi team
Any l violation
of Section]N L5 by any applicant for a recruit subjeea me applicant lir a civil penalty
of not mere than eve nanama.Bram a500B, APN Number Occupancy Type
❑I.m nI r
he ppr.
eno ter enmloyc, whh wager,ter vile ennrpm.,mion, 36913016. 00
will doINwork,and the nvueane is BEI Intended ,,ot�fered Por 701E(Set.71144.
Brom,..end pool...lon..Code:The Convector,License law dew`s nor apply,n:rn Required InspEC11O11S
owner of propcny Who builds or harrier.thereon.and who dew,such work h arsch 303 — ROUGH MECHANICAL .
or rough his awn employees.provided that such improvement%aro not inn adM lar
offend for sale.a.Orel the Wilding or mrpmvemen,i.e.nld%;thin ane year of 304 — ROUGH ELECTRICAL
ianeempl .tireowner,bild505 — FINRL ELECTRICALer will have the burden of proving that he did nm wild lar
improve parpo.c n
01.a. nflhe au,sm,,; a,w.av,Ir cra ir...og wpm licensed cnanm m.,o 508 — FINAL NF_CHA TICAL
m,mawihe per cd IS,,7044,Easiness:end I'mrm,inm Calc:)"I he Coinmc,ors
Uoun e Lrw da ten appy lir bn uwncr of pr`pery who bund%lar millrace,Oil
and who contracts for such prjecs with a umtrbcmgx)licensed pursuam to the
Control Licenm Irw.
❑1 ar es,rnpt cera.Sec. .B&r c roe this mason
Owner Umc
K
WORKESCO DaueAI'ION DECLARAI'1f1N V
1 h,mhy a1Ymn under penalty of perjury lane of the kilowing Jeelamtive,:
❑ 1
have and will maintain a Cenilic:n,of Cnavan hr.veli-insure for Worker's
Compensation, as provided for by Section 37W of ,he "No Coda far ,be
performanee of the work for which,his permit is ioued.
❑1 have and will noduarn Worker's Compcmalion Insurance.lav required by Section
37I0 of rbc LNot Cada,for the perforniance of the work lot which this Iwrmi,is
issued.My Workcr>Compcnsv,inn Insunmcn cnrriter,Ian¢d`'�ll�y II�� se-are:
'ohCarrier -X17My No.:FR WORKERS
CCfff Nl'II
IC
A9 ON(1P I:%IiMPI'[ON FRO WORKERS
COMPENSATRIN INSURANCE
ofiis Seaton need not he crnnplred if the pennh is fnr one hundred dollars
IS 100)no Icss.)
I drily for in,he perfonurace od Tho work for which this permit in ismed.I
Nall nen cri ioy troy pasrm in any run ncr so as m c,on,s,IbcO to the W..W,'
Cnmpemaamt Law.W ewiforil Dare
Applicant
NOTICE 1 O APPLICANT.1(,alcor nsaking obis Ccnifi<ate of 1:collation.you shwlJ
becomesubject ,the Worker,,Cmnpermaimt previsions ofthe lal Cod,you area
Q O forthwith comply with such powioir m m this permit ohall h deemed mvoked.
(~ srZ).r that duct,cRUC1l11N L..iou cG Ar,IiNCY
I mbyall lhonhis a rob..t(Scen I,nding ngn¢y xnnhc Pcrfummnc,
Exurb work Our which cols Pcnnit iv'msueJ(Sec,3119].Ci¢Cd
6. Q Lender's Name
;D L Lendar',padre..
U Q 1 maturity that l have mad,his application and state that the above information is
Las l.. core..I agree to comply with all city and county ordinances and orthe laws relating
Q C.> to building conquer ion.and hereby an,hmice mincomllives of Nis city tenter upon
p] the ria no..n..it i )properly for insperion ally o.
(We)agmumsace.'mdamnify un I kmP fa l...the City of Cupcnino rodeo
Z liabilities,judgment.,cags and expanses whalb stay In tiny wad accrue ngaln,t.aid
U z. City in conwywance of the printing of this permit tD
APPLICAN"r UNDERSZAND `
S WII.LCOMPLYWIT11ALlNNPOI 'r Issued by: Date
souy_'l:Rr rt 65639.1. Y:
s�gn3tJ,�of nppheanJcnntmrm uric - Re-roofs
HAZARDOUS MATERIALS DISC[.OSURE
Will,heappherm lar lhmre banding m,apom gorcor ahe mnromnaaancri:l Type of Roof
to Oil by Nc l}teen'....MO al Calc,Chapter'9,12,null me I ladm ao I Sump
Code.section 2553200:' ` -
❑Ye, two All roofs shall be inspected prior to any roofing material being installed.
Will the cep,licam or fumm WiIdingrw,upam use equipment or dil which If a roof is installed without first obtaining an inspection, 1 agree to remove
ern barurdausair armami ,ddn,d by the Bay Amu At,Quality him
h .,cmcm
�graric„ all new materials for inspection. Applicant understands and will comply with
C1 ar No all non-point source regulations.
I have read the haranlnus muteriids requir,mm„undo Chapter 695 0l'it,,
California Hcuhh&Safety Cute Senior.25505.25533 and 25534.1 mtdeotan l that
if,he building docs no,currently have a tun:mt that it is my re mr,ihilitymnmity the
bee...mot the requirements which maw be me,prior to Issuance of a Ccrili,are of
OCo,pancy' Signature of Applicant Date
osl�4l_
0 arrhoo7cdag,.at Date All roof coverings to be Class "B” or better
OFFICE