01110071 CITY
DIGi� OND
INIVISSINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10231 WESTERN DR WESTERN EXTERMINATOR 01110071
OWNER'S NAME: APPLICATION SUB DATE
PRASAD RAYASAM S AND SITA R 1611 TERMINAL AVE 11/15/2001
PHONE: (949) 261-2440 SANITARY NO. CONTROL NO.
al.41 ARCHITEC-UENGINEER: BUILDING PERMIT INFO
iti m( BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
5 v? Job Description
1 tion 7 a)opt thin 1 am licensed under provisions of Chapter radio,
lcre.,r
„t "imse<ti�n]B�u)nroishmm.3onneennm<..a ana/r�rnfex.inn.ena<.nndmyuan.e TILE SHOWER REPLACEMENT.
is in full ,.y�p �, EC �IG�� z-
on< Lkcr. lam CYtS tsVi Lic.N
i O O N Date Conlmaor
a RCHITF.0 usedasDECLARATION
I and<�mna my plain nnau the used as public rcrnaan
smr�
i o ce wwa m
Lira rr,resxi,n
i
eLL OWNERBUILDERDECLARATION
= 1 hereby of,on that 1 n
I m exempt from L
the Contractor's License w for the
f i C following reason.(Sudan N3 LS.m Business and Professions Code:Any can or rummy $3 5 0 J
whmh qurt pc It .t ct h mprove,demolish pa y.t wre /
n 3°.`'Pnwt t Iso q m pal nt lm aucnperna's License
signedstatement .._
Nmha r ee'sMp rsuaottoto pm of of the manesLc V (ns Cor) Valuatio
Rom nrgwmhserr oul'anor0bamnonttneBusmes aimr.Anonnenael f �,}"��, p'3' t}!6 I :�3, Z.1'T.'{�'?(i.1,
or mat io is 31.1 b ahny apps lmd the basis for me alleged uempmon.Any l violation
—M Section]831.5 by any mpplicam for m pemtis subjects the eppli<am m a civil penalty
[of nofmore thanfiveWanted dollars a5oo). 1020"PN DATION " Occupancy Type
01,as owner of the property.or my employees with wages as their sole compensation,
-
will'do the work:and the stmctum-is-not intendedor offered for sale(Sec.70LI.
Business and Pmessinos Code:The Contractors License Law does not apply to an 103 - UFER Required Inspections if
owner of fail Who Wilds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided that such improvememn art not intended or
of&ird for oak.Ir,however,me building or inSpFovnnem is mrW witnir one year nr - - 10 5 - ANCHOR BOLTS
completion,the owner-Wilder will have the burden of proving that he did not build or
improve for purpose of sale.). 106 - SEWER & WATER
.. . or,asownet ufthe pmperty,amexcw.aveycontracting with licensed contractors tn 202 = UNDERFLOOR PLUMBING___ ___ `_. ..__..._.___ . .
Li"rotmrt me project(See.]toe,Business and Professions Code:)The Commcmra - '
cense Law does not apply to an owner or property who builds or improves themon, 2 03 UNDERFLOOR MECHANICAL""
and wno.conameu for.such,projects.with acommrmos)licensed purauaat.tn me. ._ .._ 2 04 ' - UNDERFLOOR" FRAME ----"—
_ .._-.. .
' — Conha<wra License Law.
o ❑I am exempt ander Sec. - .B&P C for mis,rerson 205 - UNDERFLOOR' 'I'NSULATION
Own;, - Dme 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby alum under penalty of yerfiry one of the following declarations: 303 - ROUGH MECHANICAL
( 0 1 have and will maintain a Certificate nr Consent to self-mature for Workers 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37M of the Labor Code, for the
pettotrwnce of the work for which mis permit is issued.
305 — FRAME
❑I have and will maintain Worker's Compensation Insoame.as required by Section 3 06 - HOLDOWNS
1. 37M of the Labor Code,for the performance of the work for which this permit is 3 07 - INSULATION
issued My W rkcre Compensation Instmom e a Policy umber am
q .san 'p /1. 308, --. SHEETROCK
t arne,U tOxwr-kysp�)t&}Polley No�'lWG/0/4DSt ,•,t v 1' <fr '•.i! u —
CERTIFICATIONOFEXEM"IONFROM,WORKERS' t rA3rO9' °- EXTERI'OR�LATH
,COMPENSATION INSURANCE:'."_ ' <
_. _....-. 310-1:=;INTERIOR-LATH..
1. a(Tbisneriodneeano,the'mmp1.mditinnprom,isfor onehundred doom. 311 - SCRATCH COAT II k.
-
(5I001orlesxJ
l<mify That in tic perl'omo rce or the'workfor which this pemam k i,med,'I. . . .�.. 313- - ROOF -NAIL...
shall not employ any pan in any common,
so as to become subject m me Wwkens 5 O 1 - FINAL ELECTRICAL •ENERGY
w
ComApplicant omlbwsdtca0r,mta.Da¢ 502- -- FINAL- PLUMBING ENERGY - - -
-
NOTICETOAPPLICANT.If,aftermaking this Certificate or Exemption.youshould503 - FINAL MECHANICAL ENERGY
p0 fortnwitthmi`n�l,withs�n`Poisonsortth�pe.itshaliuee�anaRvoku�°must, .504-- -.. FINAL BUILDING ENERG`,C. _
he penes' prmm�mes
hereby. . . _. __ ..... _. ...
- "" "'CONSere is a ON LENDING AGENCY
" 505 - FINAL ELECTRICAL
".� orkfowhich this there is amned(Sm. lending01 rvgency for the performance —
W he work nroi:perrnisinwea(sec.31n7.cm.c.) 506 GAS TEST
Q Lender's Name'"'`.• _ _ _
p Z L<meera Aeertss� � � - s.,.� � �. ,. _ - 507 �- � FINAL PLUMBING. .
U I acnify that I have mad this application and state that the above information is 508 - FINAL MECHANICAL
correct.1 agree to comply with all city and county.orditunces ani state laws relating 509 - FINAL GRADE
Q [) m building construction:and hereby authorise icprc.senmtives of this city to enter upon
g� me.bo meareetocavprtymnifyndlacohamlcvs 510 - FINAL PLANNING
F.y• e - " t save,mdemnifyantlkeephanotinan way certain
514 - FINAL PUB IC WORKS
h liabilities,judg a.cos¢and cxpenus xhi<h may in any way serine against said
V v Cisy in conseq of the gmming of Thin peemil.
AITLIC NT VDERSTAN[ 'A NO WILL COMPLYWITHALLNON-PONT Issued b r Date +
SOU CI RF a'I TIO . (y" - t" + Y
Signa eofAppmanVCcomon. I . ,DatJc'V Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
appbcxmt r human mi Wild, pa t t or handle hicaundoxis mamnal Type of Roof
is def red by the Cupertino Muniespol Code Chapter 9.12.and the Health and Safety
Code'Section 255321n1 fi dl4f V' ?tr �at,y .. :'. ' .f•�. . .. ._..
ones N _ All.roofs shall be inspected.prior to any roofing material being installed.
Willmeappliramorfmmebuildingoer....are equipment or devices which If a roof is insialled without first obtaining an inspection;I agfee'to'remove
emit heaardou.cmr emnumiwnu as defined by the'Bay Area Air Quality Man6gmdent
Dismict3 " all new materials for inspection._Applicant understands and will.comply,with,_
r ,vest " , all non-point source regulations, .
I he a mad'the hoz matenalrequirements'und Chapter 6.9i 'f the
Culifomia Hcnith&Soley ode,Section,
25505;25533 and 25534.1 understand mat -
ifinebuildipi,doesnorcu mlyhave a tenant.than itis inensparod,I ym illify the
tidcupam he quirem !s which must be met p m m issuance of a Ccrtificmc of
=; °Ceupa--Hcy Signature of Applicant Date
I- 5-wneVn authorizedagemt ' - G All roof coverings to be Class "B" or better
I _ _ OFFICE