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01010089 croFcI1PFN RTNo BUILDING PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10570 WHITNEY WY 01010089 OWNER'S NAME APPLICATION SUIT DAI'Ii RAJ TASH 01/22/2001 • PHONE. SANITARY NO. CONTROL NO. O a'Z ARCH]'1'ECl/ENGINEER: BUILDING PERMIT INFO m BLDG ELECTPLUMB MECH ai P O y LICENSI:U CONnoal to de, DECLARATION o RATION ,lob Description O 4='❑ hcrehy ahinn and ant oldie f diecr under powisiunx tel.is Chir 9 eonmmcense waw with 1.11 force an 1 of Divininn i of the Buxinevs and Profensionn Cala ireful,license '< murnnearde1rc01' CHIMNEY REPAIR z"a a License Clas Contract o p 6 U Owc Con CLA X t Fa G ARCHf❑here asCLSRAabro 5y `) 1 understand mY Plans shall he used a.Public mmods th ce p O Merced Professional °' a OWNER-Bl OIiCLARAI'ION I harehy albite,Ihnl 1 a:n exc:npl fron,the ContruaoC x License Law In the t=z< following reason.l5enion 9031.5.Business and Po,l ..lods Code:Any city or county Y S G which requires a permit to construct,alter,improve.:lcniolish,or repair nay.structure - ce print,its isxuvnce.alm requiresthe applicant forsuch lxmnino file a signed slnlantent — .ha he is licensedforwardtouepravisinn.oftheC...pawrs,LicenseLa.(Chapter4 Sy. Ft. Floor Area Valuation (cnmmencin6 with Section 9000)of Division 3 rf the Business and Pose,,wa Code) h 0 or that he is exempt flu rearm and the basis for the al legal estua fan.Any vi.l.tion Y of Section 7031.5 by any applicam for v permit subjects the applicant to a civil penalty m not mane than five hundred dollars($500) A PN.Nu mber Occupancy Type ED1.it,owner of ate prnperty,or toy ctnplayeex ,,It wage,;is dhcir sole cnrpcamin,• 36939023. 00 will Jct I1W walk,and lha soo,bon,is not intcndal or oll,red far sale ISco.7044, tiosi nese and Pnd'mslo.I,Code,The C,ntmrtndv 1.ica,.e Law docs not apply to au Required Inspections errr or propcny Who huilds ter on,....1hcnon,and whn does such work hinnelf nnnugh his own ettytloyces.provided that such improvements are nal intended ter 101 — FOUNDATION aRered for sale.If,however,the(wilding or intprovancnl is sold within one year of — t mnpletion.the owner-Molder will have the Eroded of proving that he did not build ter 312: CHIMNEY REBAR & STRAPS �ngmve for pan's.dale.). 514 — FINAL PUBLIC WORKS ID L asu. r ofnh ;,in proryny ,clusively hath.clin,wish licensed to n menta m tructt heproject(Seo.7044,Bas C and Pru@ssinns xIaJ The mmi Contns I.mIcaue Law docs teat apply In an owner of property who huilds or improve,.hereon. sluI who uwnma lot such pmjcrs"Ill a connumnr(vl lirenvd punnrn m.hc Cor.tire License Law. ❑1 um exempt under Sec. ,B A P C for this mtthou owner Date WORKER'S COMPENSATION DECLARATION ,r I hereby a1Emt lender penalty of perjury one of the fallowing declarations: • fel have and will provided a Cby Secti r(Cogent mer Labour lin Work the G ryaamion, as pmviJvd for by Station 371X1 of lM1e Labor Cafe, lot' .hc lwrlamauce of the work fol which ibis penult is Issued. `l have and will maintain Worker's Compensation Inttrun.e,as required by Section \(INI of the LaM,r Cls.Iter the perGm the nI di work fm which this permit is ... M WadJ�e�r s(Com�pcnsajappJ aevrritII'n�licY[nru'�fmM`rurc:p- Citrine T G ,ns obey Na: l�T`lV r©> . CER I61(AfIfL OP :%EMlzl'ION MAIM Wl3RKER5' COMPENSATION INSURANCE I Lik.wcctlon nccd not W cuntplarA it the pamil is foronc hurdled Jollaot ($100)ur las.) I certify(hat in the pnab blrOnce of Nc work for which this permit is issued,I shall not employ tiny pennn in any manner so as n,beeonle subject In the Wnden' Cnmpeaatiat Laws of Califomit.Date Applicant HIM ICE TO APPLICANT:IL after making this Cenifewc of Esemptind,yrs should become subjecto the Worker's Compensation provisions of the lara bCode.you trust - Q Q hrdwith comply with such prnv isions or this pcmtit shall Ile deemed mvuked. G rrn F r.i CONS'1'RUC a'han'br"DING AGENGY thereby clams that Nuci vs nmxu teen.raiding tgcncyfor the perlbrnn.su W tel.he work for which this permit is isxncA(Sec.11197,Ci,CJ 6. z lender's Name � L I<ndeCxnadrr>.. U 0 1 terrify.bar I have read this applicilirn and ,are that the those infnnnminn is fes F coram.1 agree m....ugly with all city and county ordinance,and ,are la.,relating Q U to building construction.and hereby authorize Np¢scntativew of this city to enter upon } fol the ahove-menuoned prolwrty for inspection purry,ses. F ti. (We)ugree to rave,indenmi1,and kos,Ituadasx the City of Cupertino against r hILaM1illI ry . it tcrb, nal,:.ml.span"'whiN on"in tiny way nrcne again'said U 7.a Cilyinmtws nuc"mming of the.permit. soil. N NDIT S , COMPLY WITH ALLNO 'r Issued by: Date / 2'v—<9/ Si,tit nearApph.anOcanmaa ,Dim Re-roofs HA%ARIX)US MATERIALS DISCLOSUREandl Willy the Cf vm no Poem Wilding Co e,Chapter unre2,and the HeaNtwn Safely Type of Roof m J.haeJ by the 32(x)inn Municipal Code,Chigoe 9.12,and tM1c Health and Safety GxIS Section 25532(x)'! ❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed. Will the.mpheanafrounebwlding n..tq,tin ac ec cipn,tam d.9ima w ldch If a roof is installed without first obtaining an inspection, I agree to remove .aril ha.wdoun air conlan.inams as deBred by the tiny Area Air Quality Managanen. Di'rllrr all new inaLoials for inspection. Applicant understands and will comply with ❑Ye. ONo all no p t source regulatiyns. 1 have read the hvarduus.naterials mqui¢mem.under Chapter 6.95 of the Calif radia Health k Safety Cure.Sections 25505.25533 and 25531 1 understand that /—,!9� if the bnildlng Jt p not eurfently have a tatam,that it is my responsibility to notify the ,wcupant [ ul etas which mast he met prior ,,isx.anee of n Cenireme al - acdury len. —2--20 C Si attire ol'Applicant Date v naronrtired agent [)are roof coverings to be Class "B" or better OFFICE