02100163 CITY OF CUPF.R'1'INO ''? W
BUILDING DIVISION PERMIT CONTRACTOR INFORMA
RTION:
BU A ESR I VIE R SIDE DR A PERFECT CLIMATE PERMrrN02100163
owrF'rl.,NNEMORE E J AND GULSHAN G rR10570 S DEANZA BLVD APPLICATIp"QFFY2002
orZONE: 408) 861-9545 SANITARY NO. CONTROL NO.
ARCHITECTMbIGINEER: BUILDING PERMIT INFO
SLUG ELECT PLUMB MECH
0 0 0
w00 LICENSED COMAACfOR'S DECLARATION
<�� I nemny alum mal I am licensed under promdons of chapter 9(sommeodng NEW FURNACE Job Description
wilh Sco.9inn 70gBof Division 3af NC Buxincssund Professions C�We.und my license is
n full Inrtc anti sf
ZOO? License Clues Lic.M
02 0 Da¢ Conlmclolr�_ r-9UMA0,E53
y't-� ARCIIIIECTS DECI.ARAf1 N
K C w< 1 am1d,cmd my plans shall M recd as public rccmds
N w0f Licensed Prufmsiinal
DEC 12 2002
S OWNER-BUILDER DECLARAT[ON
P u6v'j r I hereby.]firmtha 1 am exempt from the Contractor's License Law fur the $4373
te o 0 following reason.(Seaton 91131,5,Business and Professions Calc:Any city it county Bo A l ®�is,�
which requires a permit to eonatnmd,alter.improve,demolish,or repair any suudde V I�
1d—' poor its issuance,alsorequires the applicant for such Permit to file a signed natement
1-z< IhotheislittmcdPursuannnlheprovisiunxnitheCnmmaudsLlcemclaw(Chaptery 3gg6R2ffIdr0Afa9 Valuation
Wm
_C (comencing with section'IOIXBot Division Sof the Busincaad nPndessions Coub0or
W 3$
that he is exempt therefrom and Ne heads for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a Peri)subjects the applicant to a civil penally if PN N Occupancy Type
not mare than fiw hundred dollars($509). 303 - ROUGH MECHANICAL
I,as owner of the puperty,or my employees with wages as their stile compensation,
will dmhe work,and the showum,is no]intended or offered foraale(Sec.70,14,Business bks T}� qR�g
and Professions Code:The Contractor's License Law Jens net apply to ins novo,of 505 - FINAL
INAL 7✓a�, y;rtions
property who builds or improves thereon,and who does such work himself or through his
Own empmyers,provided that uch improvements are not intended or offered((it ale.If, 507 — FINAL PLUMBING
however.me building or improvement issold within one year ofcompletion.meowncr. 508 — FINAL MECHANICAL
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
I] I,as owner of me properly,am exclusively contracting with licensed contractors to
consumer the project(Sec.704L Business and Professions Code:)The Conlractor's Li.
cense Law does not apply In an owner of property who Wilds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant o Ne Contractor's
License Law. _
1 am exempt under Sec. .B&P C for this rcaom
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of the fallowing deduadinnx:
1 have ad will maintain a Certificate of Comeal,,self-insure for Workefs Cnmpen-
aalitn,as provided for by Section 3700 of the Labor Code.for the pi formance Of the
work for which this permit is issued.
and will maintain Worker's Compensation Insurance,as required by Section
Mf me LaborGWe,it,,the terfnfmancrof the work for which this permilis issued.
orkcr's Com '�nsa(��'Pn��,,l,ns,,u��nncc canier and Policy number am:
Cumlcr.��{Irl
AIL. M IIUN Nn: II SE_
TTiIPI ATE OF E%EMPP Aix FROM ORKERS
COMPENSATION INSURANCE
(Thisseclitn need nil be comPICIed lithe Permit is for one hundred dollars(SIO(d -
a less.)
1 certify that in the performance of the work for which this Permit is issued.I shall not
employ any perm.in any manner m as to become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT If,after making this Cer ilicate of Exemption,you should
become subject m the Workers Compensation provisions of the labor Code,you must
�z forthwith comply with such provisions or this permit shall he deemed mvoked.
zO CONSTRUCTION LENDING AGENCY
l.. .N-' I hereby afford Nal mets is a ennslruenin lending agency l mthe performance of
6i > me work for which this fermid is issued(Sec.AMP.Civ.C.)
W Q Leader's Name
U z Lcmlers Address
1 eenify Out 1 have read this application and sW W thin the ubive information is
W (•" correct.l agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby aulhorimreprstoodives of this c ily to enter upon the
} W above-mentioned properly for inspection purposes.
H D. (We)agree In saw,indemnify and keep harmless the City of Cupertino against
h liabilities,judgmenu,ensu and expenses which may in any way accme against said City
U in eom Bence egranfing this permit
^-� APPHICAN N ERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale (�
SOURCE REG 1 TIONS.
Re-roofs
Signature or Ap is Contractor Dole
IAZA@DOUS AT LS DISCLOSURE Type of Roof
Will mea and or rumrc hu ingi 'upam sure or handle ha,anious material
as defined by me Cupertino Municipal n c,Chapter 9.12,and the Health and Safety
oWctlinn 25532(ab! All roofs shall be inspected prior to any roofing material being installed.
❑Ycs - No
Will the applicant But building occupant uxequipment or tkvices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hma does air conte Dant as dined by the Bay Arca Air Quality Management all new materials for inspection.
Dlsulcn
❑Yes it
jn� .
atlmc hvardn -ma rialsmquirtmcnLsunWrChapter6.95oOhc Califnr
niadctycodc Sa'om 25A15.255JJ and255JJ.l unJcrsmnJ maliflhC hmilJing
msdy haw round,mut it is my no,onnibilidy m notify tMoccupantofthe
hich musNMCIpriortoMtenscOfxCeNBcateOfUccupancr. Signature of Applicant Dale
lz)031 I All roof coverings to be Class "B" or better
0
wner or aumiriad agent I thim