02040007 CIi BUILDIING DIIV�'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
7585 RAINBOW DR A & H HEATING 02040007
OWNER'S NAME: APPLICATION SUB DATE
KUMAR 770 CHESTNUT ST 04/02/2002
P.HONE: (408) 279-0722 SANITARY NO. CONTROL NO.
r9no ARCHITF,C MNGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
H I hereby it Not l am licensed under provisions of Clarifier 9(commencing lob Descrigtlo
Ell t:
with$action]000)aBusiness esN Professions Code.and my licence REPLACE, Fu1;Il, A'CFi, _ Ij
Lin ran mrtt.na ane 4 _ --�
icense CI 6s Lic.x O
1 a �n ARCHITER'S DECLARA o
j-y 5 I unders,antl my plans shall be used E public records
r
1 6 p 4 Licensed Professional ±
t:RG`
OWNER-BUILDERexempt frond
-_ ..
res I hereby affirm that 11. exempt from the ConwclCode:Any c Law for themy -
t]�< whichfolloinquiresa permit
]o3L5, t,alter. and professionsh,ornycity orcounty _ - _. �/ '� -
C which requirtsnpermit mcon.theralms,improve,aeermit1 are a aimed statement$ ..pdonoit.ituradPuwrequimnheapplicentfar wchpermi$ohne Uw(Cammem - OOO - -
thbt M1gdliccicth Section 7NepmD¢omof Ne the B.pm/s Ltcenselaamr.CWs) t S /� (1Qr{�0R yS./� Valuation
(cam he Isatemp$eno 7ooh)ofhe basisor t the ButinessaMPti.Any vi Code) ' t_t i''�523'Y' y`a`Y-+ -\UlC��?,4�;�I,A\.P�t:
m thatio Is attempt any applicant
and the baste for the subjects
th tl ddnpn t to Any l pennon
-of Section]031v5 by any epplicam for a pcmdt aubjcas the applicant a civil prnelty-
of not mom than five hundred dollar(s70o). 301APN 4MU6r-I PLUMBIN "'f"'r''`- Occupancy Type
°I.as owner of the properly or my employees with wages as their sole compensation.
will-do'the'work:end the strutlure'is nofintended or b(feredfor sale(Sec:]044; -
Bu610aa6 and'professions Cade:The Convector's License Law does no,apply to an 304 - ROUGH ERJRP9FRl1Jfi*&tions ' ' • '
r f property Who builds or improves domain,and who does such work himself 505 - F I NAL_ELECTRICAL_
owns o
or iamu h his own employees,provided that such impma is sol arc nm intended or
co.friamidmpletion,
or sale.If,however the will
have t er ice en of Prov n sold within one year of 507 - F I NAL PLUMBING
completion,the owner-builder will have the burden of proving that he did no,build or
impraveforprwarcifs.la). 508 - FINAL MECHANICAL
awnsthe p(Sec.7 am exclusively convening with licensed contractors to . . •.l
License thedoes
project(Sec.]044,Business and Profeshons Code:)Theimproves
ves tnreon, ,y
License law eaea nm e 1 to an owner afron h bailee or ice si t to We r
...end who.conmaence La s�isch.praleet.wiN�.cwitryaLmps).Bcested pursuant w We. ....
�-, o l soeclOrtpainae L.W. .
❑l asn,exem t unser S<c." �" ` " -Bgr P C for Nit reawn
_
owner.:v
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe ja y one if the following declarations:
Cl 1 have an l'will maintain a'Ccnificare'of Consent to self-insure for Worker's
Compensation, as provided for by-Section 3700 of the labor Code;for the
performance of the work for which this permit is issued.
Cr}i vc end will meimain Workei'eCarpsa wain)vunnce,u requited by Semon
- - 3700 of the Labor Code,for,the pe3rprona a orthe'work for which his pentds,is
Issued My Woskee,Compc rc
tin btesae carrier and Policy number are:
... _ ,.
N f�i'(Ozo�7 ."
tl..0 t•"CERTIFICATION,OF FJ(EMPf10N PROM WOR t"•, ?� .+.. i`.1.. 5 ."i'it)lt �S k ?i�,i. •' !r` lt,;t
COMPENSATION INSURANCE 4 " -
''I r(TIin aecbdn need not becompined d the permit is for one hundrtd dollen 'r x ' ''' "' -' ] s�'` t
(5100)or less)
1tterrify mplr Nat m she pert mietma f Neo-ark f Ne tht permit a issued.) -
shall not employ any penbn n any manner so e6 to become subject to the Woriceri '
Compcnssdon Lewes of Ctlifoside.Okm; ""' ^'
_Apt rte'.. .. . . .-. .. _. .... :__:... .. - . .
N CE TO APPLICANT IL are,ressalF tht Certificate 0=2,"M
f Exemptmn you should s I
became subjen to the Workers Compensation provssime of the Labor Code.
ond th comply••.tJh(such previsions roRvUCs oTnIOs oNr LEsNPDaINmG
t Ahall NbeCYdomed rero-keyou must
st
_ 1 hereby alrrm Nat the a co'wn on IoM g agency for Ne perfotmence
of Ne work fat veli ch Ili
� H
LeneireN vie .`" ' :.'. ••_• . . ..
D,z
V'0 . I cespfy Nat 1 have nod thio aPP,lintion and sat¢IMI the above information is '
' (L'�y` e&ifeai.1 agree to comply with ell city vnd 5qumy ofdinenea end stem laws rahning
�.f„) tpbuilding canawction;and hercoy euthorlu rcprcsenmivra Of Nis citymenter upon
Cl'��..tt Ig] the ebovementionW,pfoperry(or inspection puryosn..,
g.. (We)'ogrte id ave,mdemdify and keep hermlesa the ity of Capenlno egagainstIn
ttrr y liabilities,judgments,cost end expenus which.may in any way weme against said
V, Citp i eonsequende of Ne griming of Nis normo ' '` '' O
APPI:fCANT UNDER NDS' 3 LL COMPLY WI'M ALL'N :POII:T'''
c un�i•Is. •' ' ' '' y f� Z D Issued by: I fate
Signa rtof�lpplfexn✓Contrecmr . ,��Ja�� :��,• ly Date Re-roofs
HAZARDOUS MATERIALSTERIALS IS7l CLOSURE
Will
the applicant or fumre building oceupant port ar handle h®aMaus mpedal Type Of ROOF.
as defined by,the Cupertino Municipal Code Chapter 9 I3 and the Health and Safety
Code Scotia 25P4,11 -stir tri,' " ` . 1♦ u, ti: Lia '�4'�t57ix ' ry; �, ._.
ED Yet x ) y 4 - ...A.11 roofs shall be"inspected prior to any roofing material being installed. _,
vela n .�ppplicantT future buildugrecupant uegmpmens cede t'e.which If a roof is installed without first obtaining an inspection;I'agree tdremove
em t hazmd,dnX I'm mm renis as defined by the Bay Aria A Quality Management
Distrall new materials for inspection Applicant understands and will comply with
°Y l` all non-point source regulanons.
iI have read the hamandous materiels requirement ander Chapter'6.93 of the
California Health&Safety Code,Sections 1550525533 and 15534,1 understand that
if the buildings does not currently have a tenant,that it is my responsibility to notify the
adcupant of the requirelnirnts which must be met prior to issuance of a Certificate of
Ottup cy
Signature of Applicant Date
amuroMilhonziff agent `? ,, --- — ; Dme All roof coverings to be Class "B' or better '
OFFICE '--