03020030CI'T'Y OF CUPERTINO
BUILDING DIVISION PERMITCONTNNNL"CT0RINFORMATION:�s,
BUILDING ADDRESS:
PERMIT NO.
7401 PLUM BLOSSOM DR
010200 0
OWNER'S NAME:
APPLICATION SUB DATE
RATNAJEE ARUMILLI
02/10/2003
SANITARY NO. CONTROL NO,
ARCHI'IECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB
MPRH
0
T�
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am under provisions of Chaplet 9 (commencing
Job Description
Bie
(if fire
Division 3nl the Business and Professions Code, and my livens is
withSectionforce
w,p
FINAL
andkl)nf
Liecn.la and III
ENTRY WAY
ADDITION/REPIPE
�®
S13
Class
Contractor Date aSDECr
As ECsS DECLARATION
OCT�I 2 7 2003
shall
I understand my plans shall M used as public records
L balk<,
Liecnud Pmlce Tonal
OWNER BUILDER DECLARATION
1 hereby affirm 1 exempt from the Connector's License law for the
BUILDING
followire reason. (Section 7DL5, Business and
on 1. Any city nr county
nasi
which
which h,or
eller, improve, dic sh, or repair any structure
improve.
requires a Permit re cores
it, the
poortoit,cense ee,assnrequires the applicant for suchract Lice resigned statement
h pear
is wdpSectiouamc me
Conbaetotend
Sq. Ft. Floor Area
y�"], 2\(a�l®LIO❑
(comthat mencing
(commencingwith ofprovisions ion(3 ofc Professions
Division3 ofthe Business Code) or
CMG) nr
Any
vi
that he is exempt therefrom end me buil for the alleged exemption. Any violation of
heefro and the peon.
Section 703 1.5 by any applicant for a Permit subjects Ne applicant o a civil Penalty of
or
Occupancy Type
P Y YP
not more than five hundred dollen ($500).
0 I, as owner of Ne property, or my employees with wages as their able compewtion.
will do Ne work. and the strucmrt is no, intended or offered for sale (Sec.Jo44, Business
and Professions Code: no Contactors License Law does not apply to an owner of
L 0 1
—
aired Inspections
102
- PIERS
properly who builds or improves thereon. and who does such work himself or through his
,.a employees, provided that such improvements arc not ioundcdoraffered far sale. If.
103
— UFER
however, the building or impmvemenl is sold within one year of completion, the owner,
builder will have the burden of prnving that he did not build or improve for purpose of
104
- REBAR
anile.)'
105
- ANCHOR BOLTS
[P 1, as owner of the propertyam exclusively contracting with licensed contractors it)
106
- SEWER & WATER
consumer the pmjecr (Sea 70na, Business and Professions Cade:) The Canuactars Li
cenaelawdoesnotapplymanownerofpropertywhoWildsorimprovndumon,and.
202
- UNDERFLOOR PLUMBING
who contacts for such project, with a contractor(s) licensed pursuant to she Coma,boa
License Law.
203
- UNDERFLOOR MECHANICAL
KI am eaemp neer c. B&PC far Nis..ayn
204
- UNDERFLOOR FRAME
o r `k °ate .2-/1* 9>
205
- UNDERFLOOR INSULATION
RKER'SC PIiNSAT10NDECLAR
301
- ROUGH PLUMBING
I hereby affirm under penal ofperjury one of the following declarations:
3O2
— TUB & OR SHOWER
C]I have and will maintain a Certificate of Comenuo self insure for Workers Condom-
action, as provided for by Submit 3701 of the Labor Code, for the performance of the
3 03
- ROUGH MECHANICAL
workmrwhichthisp.ifisi:<aed.
304
- ROUGH ELECTRICAL
❑ I have and will maint,in Worker's Compensation Insurance, as required by Section
305
FRAME
37fl0of the labor Cadc, too the performance of in, walk for which this permit is issued.
—
My Workers Compensation Insurance carrier and Policy number are:
306
— HOLDOWNS
Carrier: Policy No.:
307
- INSULATION
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
308
- SHEETROCK
(TTismien need nm Mcompleted if the permit is forane hundred dollars ($10))
309
- EXTERIOR LATH
Iran`)
310
- INTERIOR LATH
1 certify that a theid Performance of me work for whim mit permh is sCom ensu not
Inner
employ anYM rain an teas ,hecam suni amlhc\ prkcrs'Cnmpcnafion
311
- SCRATCH COAT
Lx of Celifn u.
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
App 1C„^
IS C o PP A :B, atm akmglhrsCcmficatcofExcm�uan,youahnulJ
hernm sooner m the Worker's Co n Iron provisions alitLIM"Code, you man
forthwith comply with such provisions or this permit shall he deemed mntked.
502
— FINAL PLUMBING ENERGY
'I'RUCI']ON
503
- FINAL MECHANICAL ENERGY
CONS LENDING AGENCY
I hereby alarm that mere is aconstmnion lending agency liuthe Performaneea
504
- FINAL BUILDING ENERGY
mewmsName ehmiap mhisiaaed(se.3l ,.civ. c.)
the w 's Name
505
506
- FINAL ELECTRICAL
- GAS TEST
Lender's Address
I cenlry mat 1 nave sad this application and ante that me .hove information is
507
- FINAL PLUMBING
correct. I agree to comply with all city and county ordinances and stoic laws relating to
building construction, and hereby suthnris mpresenmives of this city to enter upon the
FINAL MECHAN CAL
above-mentioned psopcny for inspection purposes.
O 9
FIN
(We) agree to save, indemnify and keep may in an the City of Cupertino against
inlilies, judgments, cbst,and of thisexpenses mit. mayin any way acme ngainslsaid City
' cn syucncc n(the graining of this permit.
APPLICA T UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT
55
Issued by:5
A NG. /
WORKS Da[ r
'7
SO R�^F.QjU—LATIONS.
Re-roofs
/ate =;� 2L
Signature of ApplicanVCoanor
HAZ RDOUSMATERIAISDISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant store or handle haicadous imperial
as defined by the Correction Municipal Coale. Chapter 9.12, and the Health and Safety
Code, Section 25532(.)?
'fPkNI
All roofs shall be inspected Aorto an roofing material being Installed.
P P Y g g
P❑Yes
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use cquipmcm or devices which
it hazardous air contaminants as dermad by the Bay Arta Air Quality Management
all new materials
for inspection.
District?
b
❑Yes 14M,
1 have read me b loodous materials requirements under Chapter 6.95 of the Califon
nialicahhgt Safely Cade, Sections 255)5.25533 and 25534.1 undersand that if lM Wilding
Jmz note nllyh sxa¢non t, thin it is my resporans'rs noes I ysMrccupent of me
require swhich esti be mel prinrloi sue cc nfaCct'Gca— upan,y.
Signature of Applicant Dale
rk.`2 (4h
All roof coverings to be Class "B" or better
crormahorircdagent Date