01110088 CIBUNc DI ON ERT
IL PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10057 SCENIC BLVD MANOJ TRIPTY GANDHI 01110088
OWNER'S NAME: APPLICATION SUB DATE
Adak MANOJ TRIPTY GANDHI 11/20/2001
I PHONE: SANITARY NO. CONTROL NO.
{o ARCHITECT/ENGINEER: BUILDING PERMIT INFO
g u BLDG ELECT PLUMB MUCH
a$ 1"--1 L J LJ L J
m 2 LICENSED CONTRACTOR'S DECLARATION
- hon
2—C 1 hereby aRinn,M1a 1 am licensed under provisions of Chapter Description
9(commencing P
=m_t-w x;mSection 7")ofOnism.3Core Bnsim,,a adProf e»him,Castle.and mylicense CHANGE TO GAS COOKTOP.
Y E ism full force and effect.
a s Liam"Clas. Li,,.e ADD 25 FEET GAS P
Date Contractor {.D
LL rn ARCHITECT'S DECLARATION
.2 05
5 1 underwand my plan%shall he used as public records NOV or
o o Lmensed Profewirmal 2001
°•o OWNER-BUILDER DECLARATION
1 hearty affirm,hat 1 oto cumin,form the Contractor's License law for the
t?a following reason,(Section 7031.5,Business and Profeasloms Code:Any city or county BUILDI
sc
which requires a permit to Chalter.improve.demolish,or repair any nmeare
H
3 er poor t t Iso req ,M pini cam f M1 pe i,to fie a signed statement -
..._... . . ..
morn licensed p' .mhn,thcprov. ns of the Contractor'sUc<nsclzw(CTapter) r,t `,r ,. ,_S F,t..FloL hillP
(Commencing 'd 5hero therefrom
an the Division.1 fth l s n innitkan.Any
no ns CodN s t1" Q'f tz', f •_ .:1+:1 P.; .1�.;,, 8UBIIOn
ormgio is ocmbt anyapomand the basis for the alleged aeicant t.Anyviolation -
-of Section 1031.5 iv any applicant for a permit subjects the applicant a civil penalty- hill
or not more than rave honored dollars(sslxn. umber , , , . 'sf. Occupancy Type
O 1,ox owner of,he property,or my employces with wages as their sole compensation, 06
will do the work,and the wrucmre isnot intended or offered for all(SIC,7(W4,,-
Business and Professions Code:The Convector;License law does not apply to an 202 - UNDERFLk)G0re0hL%gBrkNt -
owner of prapeny Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements are no,intended or . .......... -3 01,_r.. ROUGH_.PLUMBING-
offered
for vie If.hou'eWing vea the b u p is m sold on
w thin e year of
Completionthe owner budder will have me burden of proving that he did not tri Id or 3 - & OR SHOWER `-
improve a ,pose nfsam.). _ 502 _ - - - - _ - - --
FINAL PLUMBING ENERGY
aver o(mep(SPenyam Business
and mraaingwi Codc:)eTh Cmmmors 506 - GAS TEST fYrG
an:we,the project(sac 1(144.Business and Professions Code:)The Conmctmn,
who builds nr iso mgecn. 507 - FINAL PLUMBING
mid �c I does not apply m an owner of 4 opcny proves
C and W.co mcts(or such Projects with.a comramrls).licensed pursugrt.m ma..
cnmra�mrs i se
Ole. hunter Sec. r'- BA P C for this reason
Owner " a ..__..
RKER'S COMP SATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 1 have and will maintain a Certificate of Charisma, to self-insum for Worker;
y Compensation, as provided for by Section 37M of the Later Code, for the NOV 2 0 2001
efformance ofth work for h h I.his permitis mstical.
O 1 have d lvill maintain Worker's Compensation Insurance.as restaired by Section �� L
3700 of the Lattice Code,for the perfartmance of tire work for which this permit n ` , aV to I��\ By t_illi L
issued.My Worker's Compensation Insurance came and Pol y ter arc
.. 111111{ q .._.. _
Carrie CERTIFICATION OF EXEMPTION FROM WORKERS', t- ` 1 ' S 7 i. .t �� FA12r Q LOO U s t
COMPENSATION INSURANCE
s+"
(This sen recd nn,he completed if the permit n for one hundred dollar --
is100)orlas) t
[. n(Y that in me performaae of,h'work for which m Permit :issued:I n" ,
hall ter employ any Person in any mother ans as to become subject to,he Wodkac z
Compensation Laws of Calilirmia.Date. "
NOTICE TCANT If. making this Certificate of Exempt on should
tern.e ohjectmmWorker,Compensation lacari,mars,of the Labor Cot you most
C fonhu ith comply h such
pmyt,iors or his par shall M deemed revoked.
mo 'x"CONSTRUCTION LENDING AGENCY a
:4:5: ' l h<rcby tiffirmwhich this there is al..ad Sao.
leading C i C.)y for the pedoimance : •a
,.. of the work for xhich this pear,;,is issued(Sec.3091,Civ.CJ -
:L1 Lender's Addie. . :.. ..'• ..
Lender's Nam
V I ceni(y that 1 have read this application and note that the above information is
Lr+.E„ i'mrreci.I agree,o comply with all city end county,vidin...I,and stge laws relating
G to budding comstrvction.and hereby authorize representatives of this city to enter upon
,be above-mentioned property for inspection� lampous..,,,'.96 (We)agree to save.indemnify antl keep harmless the C'ny of Cupcnino agaims,
W liabilities.judgments,costs end expenses which may,in any way acme again said
U z City in consequence of,hgrgni
e ng of this permit. ia
"
APPL.IC NT'U DERSTANDS1AND WIL. OMPLY WITH ALL NON-PoiNT
SOURCE - T .'S: '" a Issued by: Date
grinmre' "NASA OUS MATERIALS DISC " "-'Uam Re-roofs
'ICter
CLOSURE " ' '
Will the app.cant m boom building ouvpant store or Kinetic lhaurdwv anumnal Type of Roof
- s dIfired by the Calpinian Municipal Code Chapter 9 13 d the Health and Safety :
t
Cade.Section 253321g? / •. t •. ":.. I - ..
°Vc All.roofs shall be inspected prior to any roofing material-being installed. .,,
Will the applicant or.future wilding occupant use.equipment or devices which If a roof is installed•without first obtaining an inspectiori;I agree to remove
emit hssardoue air I m edinacy as def by the'Bay Area Air Quality Management
District? y all new materials for inspection. Applicant understands and will comply with
°v t ' °No. .' all non-point'source regulations.
1 h vie mrd the'hicomam,mitlehid,hattlimorents undo Chapter 695 of the
California Health&Safety Code,ScNons 25505,25533 and 25534.1 undemmnd that
ff!��bu mmgdsmell nyh hmnt mat mY respon bltyt nmi(Y mea t equ harem h ch stbe t p , t sun,ce at a C n!thea of
p `y� tSignature of Applicant Date
g\a-,(,norf.ed,seem 1,' D.e All roof coverings to be Class"B"or better
.:_ .. .'�.. ,..• :. .. .. OFFICE
r yr.