02040121 (2) CUPE
CITYBUILDI G DIVISION PERMIT CONTRACTOR INFORMATION-
BUILDING ADDRESS: PERMIT NO.
10303 DEGAS CT AMRITPAL KALLA 02040121
OWNER'S NAME: APPLIC IONSyBDT
AMRITPAL KALLA 04�22IM62
14WONE: SANITARY NO. CONTROL NO.
O eeZ ARCHITECT/ENGINEER:
O O BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
U r I L'] L I
D i LICENSED CONTRACTOR'S DECLARATION
z m 1 be«by of irm Thn 1 am licensed under provisions of Chapter 9(commencing Job Descri tion
„f5 wiNSeaion]BO)ofDivision3ofine8usincssondPmressi...Code.and mylicense BATHRM & KITCHEN REMODEL.
is in full force and erten.
0 e U License Class Lir.a
Data Cum Tar PWL
3'=G ARCHITECT'S DECLARATION
C5 1 understand my plans shall be used n public records
Yao Licensed Professional AUG 2 i 2002
oa OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt form the Contractor's License Law for the
h z a following reason.(Section 7031.5.Business and Professions Code:Any city or county BUILDING
1'�DI�� 6 2 5 O O
s F D which rebates a h,or repau any nNcome O U $
perm(( from applicant
forsuch Permit dcmohs
63$ -pdmmt ssane.olsoreq_ smavipiocam for Contractors
Bleee Law
(Chstatement - _ _ __.._ _.. _
(bathe Inn. itpursm nq the Drb t ions; the theBusies L n nm Low ons,C 9 -
Imhat he g_ m Section am and
fbe basis
a of the Business and Profession Code) �`•;'_ 13,�� b LY Y1'Qr.`Ple rr;y y r ,••,a ^Valuation
ar ores io rs 31.5 b tang applicant
li and the bass far he alleged exemption.An Inion '• ' "" - •' -` 's-
y ata '
-of Section]OILS by any appli<am for a permit subjects the applicant ro n civil penalty
tofnormn:ethanflehundreddoRm.a5om. 10 1APN NXV-*DAT ION +`+T::t, Occupancy Type
Las n ormeprop or my employees xamwages a.theirsolecompensation, 102 - PIERS
w l_ad d;�a,b,k:and the.tmnare is not mended°r nee,ed-rorelr(Sao.]aw,
'6dsin2u and Pmressions Code:The COmmactor s License Law does not apply m 10 3 - UFER an Required Inspections' � -
owner of progeny Who Wilds or improves dterem,and who does such work himself
nr m sugh m.own employees.provided That such improvements are not intended or 104 - REBAR
._'offend for sale.If,however.the building or improvemen(is soldd-within one r _......_—.__._.
nom Inion,me owner-Wilderwill have the WNenof y`n° I05 - 'ANCHOR"-BOLTS-" -
p proving matnedianatbaudor 106 - SEWER & WATER
improve for propose of sole.).
❑1:as owner of the Progeny.ora exclusively contracting with Gomm<ommnorsw --- - -UNDERFLOOR- PLUMBING'---";•�-:�—.-:(::-'.---------
_ _ construct the project(Sth.]Baa,Business one Profession:Core:)The Commmor'r 2 O 3 - UNDERFLOOR MECHANI CALF.-''
Licanm Law d s not apply To an owner M progeny who builds or improves Thereon, . -
' _nod who cora cu"M inch pojecu with is conumor(s)licensed-pu wM m d«..
re ___--204-._.._UNDERFLOOR- FRAME ->--------=-------..._.__—,_.___--
:S Contractors U crud ..
❑lune em't 7pe, as A ' s a P C for this reason 205 - UNDERFLOOR. 'INSULATION
act
DaTeeyy '�//J's/vL 301 - ROUGH PLUMBING
WORT R COMPEIySfsT10NDECLARATION 302 - 'PUB & OR SHOWER
Inmeby Mo.Orderpenmtyafarjueyorl�ofthefonawingdeaar,rana:- 303 - ROUGH MECHANICAL
,J j. '•0 1 have and will mainuin'a'Ccniflc;m of Consent io self-insum for worker's 3 04 - ROUGH ELECTRICAL
h1 Compensation, as Provided far by Seen.. 37W ofthe"IaWr'Codr, for he 305 - FRAME
- _ performance of due work for which This permit u issued..
❑1 have and will.' Armin Worker's Cdntpen'uuiddlnsurance,as required by Section 306 - HOLDOWNS
37ao or The labor code.far he arfom,.ma of The wark'm,which This parrim is
307 - INSULATION
astud:Ma 1` Policy number
y kc s Compc u lnum c arae d
am
CERT;IFl,t CAOFI IFROM w:oRCER '
COMPENSATION INSURANCE- Tra t 309 - ') $T�2IOR .Li TH
._.... . �-_INTERIOR LATH--__--V-_--__ __.__. ..___.
(11t m n
read not W mmplmetl if the geneses rs for one hundred dolhrs l
rno0)mleaa) _ 311' - SCRATCH COAT -
![ T'Tariff,that n m parr - �anne k io Wren m pe .Ti :axed 1 -
am n ploypby� an�(wp :o rax each «T mewrkra 501 - FINAL ELECTRICALENERGY`-
o situation Laws Cel f �4(tat /_- [� Z �`�y�
e ' - A ! ./ - - _. ._. 502------- FINAL PLUMBING. ENERGY
PLIC barter iuming n CnfmaofEaampaon.you should
must 503 - FINAL MECHANICAL' ENERGY
become ben mtI Nod It Com -nkatc. -`•
1 pe pro nsl deemed Coalued. us
ZO ran mcoplywdna nproao rmapmtnill-_ --eemvokea 504 ____F,INAL._BUILDING ENE_RGY
CONSTRUCTIONLEIIINGACENCY505 - FINAL ELECTRICAL
7 1 he mby aP that mem is a co suuclon lending agency fm the perfommnce N _
W .. urine work far which this pemM s 'deeds« 309]Cn•c> 506 - GAS TEST -
W..Q "Umdr Nm
ae ._ ._..W._ :......_.. -._.__.__ -
;D1z Lend :Add s
507__-" FINAli-PLUMBING' -
V_O 1 certifyThat Ihave mad This pplcato d late 0.1,MjW form ton is 508 - FINAL ME(JHANICAL'
.F correct 1 agrea m comply with all city'and conary,orifinances and state laws ralatiog 509 - FINAL GRADE
O.,U to Wildingxsvxuctmr�and hereby summarize mpmsentauvesofThismytocmerupon
i'st 510 - FINAL PLANNING
_ the pupeny for inspersion purposes.
a 1")amee osave,mdem'vifyand keep harmlesi,Me City of Cuperiinoegeimt 514 - FINAL PUBLIC WORKS
L.-T i liabilities,pdgmc(s,cosu and expenses which may in any way seem,againn said
V. City I mnsT, car the gram g f 'is poor t '
APPLICANT, ER$'r \D 10 'RLCOMdLY WfrH ALL NO\- �r r •/)/
soDRceREc A'no.s r' •> i - yPoi/ l Issued by: Date
m of Appl camOLO frac r _ ( _', a /
` HALkR US MATERIALS DISCLOSURE - Re-roofs
W 11 me a Cupertino
m furore ip Code,
Clue t no«o hull haaamous..'coal
C defined by tti 3 yen Municipal Cod Ch par 9 17 d The Health d Safety ` 'pe of Roof -
Code Section 255311,1+ t y T ('• ;-. a r f : ., .• � _ _ _ _. _ ..._
_All roofs.shall.be inspected poor-to.any.roofing matenal being installed. _
will adm apcimnt f r, Wddngmc a rayAma ip oto aeveerpmah If a roof is installed without fust obtaining an'inspection;I agree to remove _
nit havrdous av c n«mma¢ der W by Jin Bey Area Air Quality Man gemcM g
m"] 1 .all new materials for inspection..•Applica nt understands-and will comply with
❑Y no '.. r all non-point source regu]atlons "
_. �.._.
*-- alit m. e h d chard s tronals req+25533 d 2c,4 pm,6 95 of me it
`
Col Tara e H a1Th Be afety Code Sections 8505 15533 nd 8536 1 nde rand that
dmc building dove arc rrently�1 e(enT mat(smY rtsPom bl iyt nmify
_ oc,vpant of me«q +CY. rem u /Nc ustye m t p o to issuarns,ova Carl of I - -
II 2L�pZ Signature of Applicant.
Date
°g=' All roof coverings to be Class "B or'better
womb Th z D m
OFFICE-- . .