02070103 INO
CITY
ofcDSOt IVIiiN PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS:
11515 SUNSET SPRING CT ACTION TEAM INC PERMIT N 82070103
OWNER'S
hAGRAWAL 1278 ALMA CT APPueAT�ej
AJAY S)"I T12002
PHONE: (408) 629-4433 SANITARY NO, CONTROL NO.
OO ARCHITECTYENGINEER: BUILDING PERMIT INTO
<U BLDG ELECT PLUMB MECH
,S?i, LICENSED CONTRACTOR'S DECLARATION _I� p
-e Iheebya ntha lam liccns derprovis:ons of Chopmr9 fcommmcing ADD A. 0 TO EXIS"i'b � s 1ptt�n.'�� y�LED
with Section] of DirisionJ of thcB nessand Rol'cssions Code.and ylicenw
H S� full torte ellen. CC r
as z< Llan Class 2U Lis.g O�-L 4 6
o`u t. � o �HITEG so �AT`o ,tea . JUL 2 3 2002
�Y
O I ubdc,,..d my plans shall be,used m public records
,,ci Licensed Professional BUILDING
DECLARATION
I hereby M.that I am exempt from the Contra..,s License Low for the< $1600 follmving reason.(Section]031.3,Business and Professions Code:Any city or county
c,3 0 which requires a Permit to construct,alta,improve,demolish,or repair nay structure
is m p its issuance,alw rtquimstheaPPPl1icam for such permiue 0leasigrcd smtemcm. - .. _ __ _ _ __ _ ______ _
e. nm toidpaased puri;646 ro ilmprovlslons or the Contractors License Law(Chapter 9 ((Flb®r./CI'� ,` :.,,.: µValuation
Npa he
(so
mmencing with Saban]OW)of Division 3 of the Business and Pwfessiom Code) l J'` ; : y \; .,a , :lt],P, i t..
or ZI- is enempi ther4roni sand the basis for the allcgca ezmnpinn.Any violation
of Section 7031.3 by any applicant for a parrin subjects the applicant to a civil penelry-
lofbutmorethahftvehundreddollus($300). 30 APN NR&DE'lH MECHAN ... .,, Occupancy Type
0 1.as..a,of the ropmy.or my employees with..,a,as that,sale mirperticanim. 304 — ROUGH ELECTRI AL
will do the"work:and the ts,come is not intended-orbRetcd for'sale"(Sao:7014:' _
FiNAL
'Bitsiness and Prafesaions Code:The Contractor a License Law does not apply m an [lolls
owner or pro,i Who builds or improves thereon,and she does such work himself 508 — FINAL M tC
or through his own employees.provided that such improvements arc not intended or
owmcr,the building or improvement is sold within one year of -- - - "- -" _ _.. _ ......
completion.
nate.If.h ,•,li_.?, \„ .. ._r.... ._ .. ..
completion,the pose of wilder will have the burden of proving that he did not build or
improve for purpose of Lite).
.crus . .._....__..., resod .......... . - _ _prop.. .....__. ___..__. ._ _ . .. _
' ❑Las owrcrefthe propmY.am exclusively with littnud comrxtorsm . ..-_... ._..._.._. ..error._.
- _ ., • . .,, i•tl,...T , ..-__.._ perp.perp_
construct the pmjcm(Sm.7 W .Business and Professions Code:)The Contractor's , ,,C: , al,
License Law does out apply to an owner of propcny who builds or improves thereon•
and who.contracts for.such projects with a.contracmr(s)licensed puramm to the. ...... ..
01 am exempt
pt uncle Law..
❑Lemacmpt under Scc. - tBAPCfar this rtawa ' �'. '. . ,(ir
_ Owti. . . Detd, .. . . .
'WORKER'S COMPENSATION DECLARATION
I hereby a?rtn under penalty of perjury one of the following declarations:-
❑ 1 have aMwill maintaina Ccnificam of Conserv to Lilt-insure for Worker's '
Compensation, as
-provided for by Section 3700 of the Labor Code, for the
Performs.of the work for which this permit is issued.
01 have gtdwill mamiein Worker's Compensation Insurance,Lis required by Section
3]00 of the Labor Code,for the performance of the work for which this pcmdt is
i - isiu d My W ke's Co 'pc sewn 1 tumnm c m and Policy number are:
C <r 4✓/VL:Cc'f1.2 �IO r � .L
✓' 10ERTIFI 1 'S 'Polity No:: 005 6..
.. - .. . -
CATION OF E%EMPTIO OM,WOP RKERg',t' )ti tv[� - .1 ` \)^i t�Y.t l.t.l : :, I: •i.N l., ..
T
" COMPENSATION INSURANCE" "'
. . ...._ ....__._'._•_ '-.... ........
.' hta 4m.on-hare not be comvleieE trine pemnt star ane hundred dollars " , l .p,
is1M)or les.)
-_•. ..
-if;
_ _._ ._ 'his
_ ...........____.._..___.._.. perp _.. ..
L,no ccr thm'intrsnin26Ynce ofthe-nam to be6me subject
to the,orkeJ :l .i '.'•sL ".•� _, __--__
L,raw employany perwn'in any mariner so ss to become subject m the Workers' '
enact stun Wws of Cal;fomia:Date
Applicant- t t.__ ._• - .. ._...... .. _.. ._
NOTICE sTt]APPLICANT:es after ranking thisvisiosof of Exemption,you should
become subject to Mc Workers Compensation Permit shall
the Inbar Coda you muss
z 0
forthwith co ply ith h,provisions or this perm-shall bed - -revoked. ..._. _-.-perp.. _
(~ 4 r,.r , � s- ", CONSTRUCf10NLENDINGAGENCY - 1'' '1' '
1 hereby of firm that there commission led 8 8 Y f th performance, t
War,, ofthe work forwhich this Permit' issued(Sao.309] Co,C.) a ,perp
Name .e,._ perp .... .........._ _., a __.>.
a. —
Z I<n,d.etl Adndifryess
U •_'. .. , .'. ,. . - .r'.-.
[hail have rand this application and am a fli above mfinm ation is
fss corricl l agree to comply,with all city and county militiamen and.state laws relating
Q' mbuildinganumet on;and heieby amhonic representatives of this city to enter upon
} W the above-memioned Property forin,,c,ioe purposes,
E'er,ck (We)area to are:indemnify and keep harmless me City of Cupenino`agaimt
rr rn' liabilities,judgments,costs and eaperses which may in any way come agdns,said
U Ta. City in consequence ofBalintniingoftbis permit.' " /'
APPLICANT VNDEI Yp.vS•AND WI O.MP•LY,WITH ALL N NpOI�]Q
q S _ r0 Issued by: Date
t ry o Appl can ommn D m..:; Re-roofs .. . ..
y RIALS DISCLOSURE, '
g occupant store handle hazardous mammal Type Of Roof
asid =Pp HAZARD MAode Chapter912 and lb,H IN and Safety .%• ,, •,. •, •,t.
Coda Saide.271320.) M_ C'. ,. ty " .. 11 a.a v s •. , . t '.'• ,i t
Il the Ic tmfum bu building
Catacomb apd
e `, ' _ -.All.roofs.shall,be.inspected prior-to.anyroofing material being.installed.
. I. Wi11the appli (ca,future building compact use equipment ordevi¢swhich If a roof is installed without first obtaining an'inspection;9'agree to remove
Disuict.' defined by the Bay Arca Air Quality Management ,
crypt hesardo a coram t
all new materials for inspection. Applicant understands and-will__comply. ith
l °V`sLir '�" .',. - - all non-point source regulations._ _ —
w+-� 1 he rtod'the hazvdw materials require.ents under Chapter 6.93ef the
Celiro uil in does
of cur Code, 735 min it i33 and 23334.I undersand thn
iftAe building dos not currently haveemnenq tat it my rmpon}ibility to notify the - - -
occupe t (Ne requlrt n N It muii be'met p o to issu c,a f e Cenifit.te of
Signature,of Applicant Date
e6 ad
8
e, - Da,e• All roof coverings to be Class "B"or better
INO
CITY
ofcDSOt IVIiiN PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS:
11515 SUNSET SPRING CT ACTION TEAM INC PERMIT N 82070103
OWNER'S
hAGRAWAL 1278 ALMA CT APPueAT�ej
AJAY S)"I T12002
PHONE: (408) 629-4433 SANITARY NO, CONTROL NO.
OO ARCHITECTYENGINEER: BUILDING PERMIT INTO
<U BLDG ELECT PLUMB MECH
,S?i, LICENSED CONTRACTOR'S DECLARATION _I� p
-e Iheebya ntha lam liccns derprovis:ons of Chopmr9 fcommmcing ADD A. 0 TO EXIS"i'b � s 1ptt�n.'�� y�LED
with Section] of DirisionJ of thcB nessand Rol'cssions Code.and ylicenw
H S� full torte ellen. CC r
as z< Llan Class 2U Lis.g O�-L 4 6
o`u t. � o �HITEG so �AT`o ,tea . JUL 2 3 2002
�Y
O I ubdc,,..d my plans shall be,used m public records
,,ci Licensed Professional BUILDING
DECLARATION
I hereby M.that I am exempt from the Contra..,s License Low for the< $1600 follmving reason.(Section]031.3,Business and Professions Code:Any city or county
c,3 0 which requires a Permit to construct,alta,improve,demolish,or repair nay structure
is m p its issuance,alw rtquimstheaPPPl1icam for such permiue 0leasigrcd smtemcm. - .. _ __ _ _ __ _ ______ _
e. nm toidpaased puri;646 ro ilmprovlslons or the Contractors License Law(Chapter 9 ((Flb®r./CI'� ,` :.,,.: µValuation
Npa he
(so
mmencing with Saban]OW)of Division 3 of the Business and Pwfessiom Code) l J'` ; : y \; .,a , :lt],P, i t..
or ZI- is enempi ther4roni sand the basis for the allcgca ezmnpinn.Any violation
of Section 7031.3 by any applicant for a parrin subjects the applicant to a civil penelry-
lofbutmorethahftvehundreddollus($300). 30 APN NR&DE'lH MECHAN ... .,, Occupancy Type
0 1.as..a,of the ropmy.or my employees with..,a,as that,sale mirperticanim. 304 — ROUGH ELECTRI AL
will do the"work:and the ts,come is not intended-orbRetcd for'sale"(Sao:7014:' _
FiNAL
'Bitsiness and Prafesaions Code:The Contractor a License Law does not apply m an [lolls
owner or pro,i Who builds or improves thereon,and she does such work himself 508 — FINAL M tC
or through his own employees.provided that such improvements arc not intended or
owmcr,the building or improvement is sold within one year of -- - - "- -" _ _.. _ ......
completion.
nate.If.h ,•,li_.?, \„ .. ._r.... ._ .. ..
completion,the pose of wilder will have the burden of proving that he did not build or
improve for purpose of Lite).
.crus . .._....__..., resod .......... . - _ _prop.. .....__. ___..__. ._ _ . .. _
' ❑Las owrcrefthe propmY.am exclusively with littnud comrxtorsm . ..-_... ._..._.._. ..error._.
- _ ., • . .,, i•tl,...T , ..-__.._ perp.perp_
construct the pmjcm(Sm.7 W .Business and Professions Code:)The Contractor's , ,,C: , al,
License Law does out apply to an owner of propcny who builds or improves thereon•
and who.contracts for.such projects with a.contracmr(s)licensed puramm to the. ...... ..
01 am exempt
pt uncle Law..
❑Lemacmpt under Scc. - tBAPCfar this rtawa ' �'. '. . ,(ir
_ Owti. . . Detd, .. . . .
'WORKER'S COMPENSATION DECLARATION
I hereby a?rtn under penalty of perjury one of the following declarations:-
❑ 1 have aMwill maintaina Ccnificam of Conserv to Lilt-insure for Worker's '
Compensation, as
-provided for by Section 3700 of the Labor Code, for the
Performs.of the work for which this permit is issued.
01 have gtdwill mamiein Worker's Compensation Insurance,Lis required by Section
3]00 of the Labor Code,for the performance of the work for which this pcmdt is
i - isiu d My W ke's Co 'pc sewn 1 tumnm c m and Policy number are:
C <r 4✓/VL:Cc'f1.2 �IO r � .L
✓' 10ERTIFI 1 'S 'Polity No:: 005 6..
.. - .. . -
CATION OF E%EMPTIO OM,WOP RKERg',t' )ti tv[� - .1 ` \)^i t�Y.t l.t.l : :, I: •i.N l., ..
T
" COMPENSATION INSURANCE" "'
. . ...._ ....__._'._•_ '-.... ........
.' hta 4m.on-hare not be comvleieE trine pemnt star ane hundred dollars " , l .p,
is1M)or les.)
-_•. ..
-if;
_ _._ ._ 'his
_ ...........____.._..___.._.. perp _.. ..
L,no ccr thm'intrsnin26Ynce ofthe-nam to be6me subject
to the,orkeJ :l .i '.'•sL ".•� _, __--__
L,raw employany perwn'in any mariner so ss to become subject m the Workers' '
enact stun Wws of Cal;fomia:Date
Applicant- t t.__ ._• - .. ._...... .. _.. ._
NOTICE sTt]APPLICANT:es after ranking thisvisiosof of Exemption,you should
become subject to Mc Workers Compensation Permit shall
the Inbar Coda you muss
z 0
forthwith co ply ith h,provisions or this perm-shall bed - -revoked. ..._. _-.-perp.. _
(~ 4 r,.r , � s- ", CONSTRUCf10NLENDINGAGENCY - 1'' '1' '
1 hereby of firm that there commission led 8 8 Y f th performance, t
War,, ofthe work forwhich this Permit' issued(Sao.309] Co,C.) a ,perp
Name .e,._ perp .... .........._ _., a __.>.
a. —
Z I<n,d.etl Adndifryess
U •_'. .. , .'. ,. . - .r'.-.
[hail have rand this application and am a fli above mfinm ation is
fss corricl l agree to comply,with all city and county militiamen and.state laws relating
Q' mbuildinganumet on;and heieby amhonic representatives of this city to enter upon
} W the above-memioned Property forin,,c,ioe purposes,
E'er,ck (We)area to are:indemnify and keep harmless me City of Cupenino`agaimt
rr rn' liabilities,judgments,costs and eaperses which may in any way come agdns,said
U Ta. City in consequence ofBalintniingoftbis permit.' " /'
APPLICANT VNDEI Yp.vS•AND WI O.MP•LY,WITH ALL N NpOI�]Q
q S _ r0 Issued by: Date
t ry o Appl can ommn D m..:; Re-roofs .. . ..
y RIALS DISCLOSURE, '
g occupant store handle hazardous mammal Type Of Roof
asid =Pp HAZARD MAode Chapter912 and lb,H IN and Safety .%• ,, •,. •, •,t.
Coda Saide.271320.) M_ C'. ,. ty " .. 11 a.a v s •. , . t '.'• ,i t
Il the Ic tmfum bu building
Catacomb apd
e `, ' _ -.All.roofs.shall,be.inspected prior-to.anyroofing material being.installed.
. I. Wi11the appli (ca,future building compact use equipment ordevi¢swhich If a roof is installed without first obtaining an'inspection;9'agree to remove
Disuict.' defined by the Bay Arca Air Quality Management ,
crypt hesardo a coram t
all new materials for inspection. Applicant understands and-will__comply. ith
l °V`sLir '�" .',. - - all non-point source regulations._ _ —
w+-� 1 he rtod'the hazvdw materials require.ents under Chapter 6.93ef the
Celiro uil in does
of cur Code, 735 min it i33 and 23334.I undersand thn
iftAe building dos not currently haveemnenq tat it my rmpon}ibility to notify the - - -
occupe t (Ne requlrt n N It muii be'met p o to issu c,a f e Cenifit.te of
Signature,of Applicant Date
e6 ad
8
e, - Da,e• All roof coverings to be Class "B"or better