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CITY OF CUPERTINO
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CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
861 ROSE BLOSSOM DR
ASKER JUNAID
01100075
,OWNER'S NAME: i
,ASKER JUNAID
APPLIC TION gUB DATE
10 10/2001
SANITARY NO. CONTROL NO.
ViPHONE:.
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ARCHITECT/ENGINEER: !
BUILDING PERMIT INFO
'
BDG ELlICT U B E H
- - L I .I
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby .Hiro that I nm licensee under provisions or Chapter 9 (commencing
with Section 7M) of Division 3 of the Business and Professions Code. and my license
ADD 248 SQ.FT.
is in run fora and effect.
(BEDRM & BATHRM )
License Class Li,. ro
Dom Comma,.
ARCHITF.Cf'S DECLARATION )
Public reNs I
I undcisaind my plans shall be used m ro
�t�/� .Li
FINAL
M� �i
E13
Profession. )
I
OWNER -BUILDER DECLARATION 'MAY
1 heathy affirm that 1 am e,empt from the Contractor's License Law for the
1 9002
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following reason. (Section 703)5, Business and Professions Cuda: Any city or county
L 1 L
q perms m robs truer don, improve, aemolish, or repair any structure
a Pe
1e mesa 'requires
rat
fires
PhicMnic els the applicant for such Pundit to file a signed statement-
/.; \� 60r'Are lj;`q T k
?! �a-j,/I LAT �1
Valuation
Out he; u'licensed passu eprovismns of the Cnntmcmrs Licenx Luw(ChuMer9
am to to
(commencing with Section 71)(10) of Division 3 of the Busip s Professions Code)
end
or that he is exempt meefrom and the basis for the alleged a turliti6e. Any violation
`, L. \ t- V -. .t
of Section 703 C5 by any applicant for o permit subjects the applicant to a civil penalty
. of nes tame am five noedmd data. ($500).
APN Number
" • • Occupancy Type
(nsow.armftne propery,ur my employees with will. as theirsnle compensation,
- DATION
10 2 - PIERS Required Inspections t
illi do the work, and the vicariate is at intended or affirm! fur It (See. sin7044,-
Buess and Professions Cale: The Contractor's License law docs not apply to an
owner of p,.,oy Who muds or imp.... there.., and who does such work himself
or through his own employees. provided that such improsxmems are not intended or
103 - OF ER '
'offered for sale. If, however. the wilding or impravemcm is sold within one year of
_
104 - REBAR
completion, the owner -wilder will have the burden of proving that he did not build or
improve forpurPoae ofmle.).
105 - ANCHOR BOLTS
01. as owner of the property, am xelusi.dy contracting with licensed conaeaors to
106--'- SEWER- & WATER
consumer the project (Sea. moa, Business and Profession,. Code:) Tic Cumeao'a
2 0 2 — UNDERFLOOR PLUMBING
License Law does not apply to an owner of property who builds or improves thereon.
ana.wb. uu r for such projacta with a camncmr(s) licensed pmsmat m the
.c
_...— _ 2 03- — UNDERFLOOR MECHANI CAL —
c.nttacmr, K bow.
°lame, ae ie B&PCfor this reasod
204 — UNDERFLOOR') -'FRAME„ "
oriner Dam~ j0/?i51O'�
tKER'SCOMPENSATIOND(:CLAR'i1'ION
205 — UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
' Ihere affirm underPenaltyofperjuryoneofthefollowingdecltrations:
302 - TUB & OR SHOWER
° 1 have n will maimem a'certificate of Conserv io self -insure for Worker's
'
303 — ROUGH MECHANICAL
Compensatio as provided f« by Section 37W of the labor Code, for the
Performance of the work for whl.nthis siamn is issued.
304 — ROUGH ELECTRICAL
°1 have acid will Wromm Worker's Compevntioo'Inmari as equina by Studien
305 — FRAME
37W of the Labor Code, for the Performance of the work for which this permit is
306 - HOLDOWNS
Comatoset oats c l y M1e nor
"
ss ed MY WCERT
307—'- INSULATION
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Carrier t "Policy Na,
T
.-. 1' 1
'I 308 t�f>\SHEETRrOCKx ;. at
ION FR I(ERy51',
COMPENSATION NC
- .' - -COMPENSATION
ATION I10NFROCLT`, "
-. - 309.:EXTERIOR LATH ---
mit; section need not be completed if the permit is f e hundred dollars
310 INTERIOR LATH!
(sloo>.rlesa.)
d'certify thus in the of the for which this —it it Issued,)
'311- — SCRATCH COAT
, tirmirmince work p
shah nest empmy;any Person in any manner ro os to xcome mbjea tame warkas
I:'.,;
313 - ROOF NAI L;t! , r
compensaron uwsar cafir.mra: Dm`
501 - FINAL ENERGY
Applicant
1NOTICETOAPPLICANT.If,af¢rmaki.g,hiseenificaeufE,cmtiumyo.ahould
-ELECTRICAL
- -
SO2 - FINAL PLUMBING ENERGY •'
;become xubjecuo the Workers Compensation pr.vinonx of the �bor Code, yodmust
forthwith comply with such provisions or this permit drill the, seamed revoked.
503 -. FINAL MECHANICAL ENERGY
""•' ' CONSTRUCTION LENDING AGENCY' •' -'
504 — FINAL BUILDING ENERGY-,-
' I M1eo:by affirm that them is a immovction lending agami for the perform.rice
"
•'
505 FINAL ELECTRICAL
onnd,workf«wmch tMxpennit isixxued(See3097,Civ.C.),
—
Lende'sNmne..... „_.,
-
_oxer ..
506 — GAS TEST
1<nacrs nadress -s -
•.
507 — FINAL PLUMBING' '
1 certify that 1 have rend this application and state that the above information is
comet. 1 agree to comply with all city and county ordinances and sure laws elating
508 - FINAL MECHANICAL
to wilding consmaion,ana hereby u«nonm representatives orthis city to contraption
SO9 - FINAL GRADE
the above-mentioned property for inspection purposes.
(We)agree r.save, indemnify and kccp hmmlcsi the City of cciariinougainst
510 — FINAL P ING
liabilities. judgments, costs and expenses which may in any way, accrue against said
City in consequence of the granting of this permit.';" ' '
514 NA WORKS
APPLICANT UNDgRSTANDS'AND WILL COMPLY WITHALL NON:POINT'"
Issuedb : DBIC
Y
SOURCE REGULATIONS.-
Sig namre of Applicnt,cmuisto, Dnc',"':
Re -roofs
MATF.RIALSD
"' DISCLOSURE
Nlltw at tufa wading pant t«c«M1d th M1amrdws
Type of Roof .. _ - .-• - - - - -- - -- -
Caperrbrf
Safety
asdfedhYtheCupedt Municipal Chapter9.12, and the Health and Safety
Code S coon 25532(1 +
f �. ,•.-,,r„ .• r`•:';?l::"o. 't�?,•
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All roofs shall be inspected prior to.any_roofing material .being installed. .. _
Will theppbc t future wua n para use equipment devices which
If a roof is iristalled'without first obtaining an inspection',•T agree tolreinove
em t haxatdo s r cam is ea def the Bay Ara Air Quality M agement
D ma /
all new materials for inspection. understands and will comply with
°Y I
,Applicant
all non -point source regulations.have
read the lira, .a'metends mr,hainenm under Chi 6.95 of the
California Health & Safety Coae, Si6tions 25505.25533 and 25534. 1 understand that
if me W lldingdoer not carte ly have a tenant. that it is my responsibility m notify the
domform of me enol« ren mesal pros tO lxr.aMt Of a Certlflcate Of
_
' °""p'"`y
Signature of Applicant Date .
owner pr ..manic -ge - - ,. Date
All roof coverings to be Class,`B" or better
i..--.• • . _. ,.
; OFFICE .. _