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03060189 (3) CITY OF CUPERTINO red`:- "' BUILDING DIVISION PERMIT CONTRACTOR INTr'ORMATIO�N``5�'}z�, �.&:.. r, •:e.4; ,4ss.. 'qtr 0 t`u.lam ..a a UIGDINGADDRESS: DESHPANDE SIDHAKUMAR G AND 'PlNO03060189 '7.5 6 ORGIOP-ANIDE 1:11 ER'S NAME: PERMIT ISSUE DATE 10NE:' SANITARY NO. CONTROL NO: ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSEDCONnRdorderSDECLARATION JobDescrip'l-09 1 Mrcby of LIC that 1 em CONTRACTORS under provisions of Chapter 9(commencing � E with Section 70(10)"(Division 3a1'NC Business end Prafessimu Code.and my license is Lifail e Clas eR"'' DECK REPLACEMENT In- """""°° JUL 0 3 2003 F o Dau Contractor nF ARCHITECTS DECLARATION C 1 understand my plans shall he used as public records a Licensed Pmfcsaiunal BUILDING 5 OWNER-BUILDER DECLARATION E 0 0 I hereby afbrm than 11. exempt from the Contractor's Co e:Any c ty a for the m� following reason.(Sccuun 71131.5.Business sutl w, a moll Code:Any city nr county 5— which squires n permit re mnnrwL pplic improve,h remit t nr repair any tatement 0a prior In its issuoncc.also rcyuims the applicem for such permits°Olcasigned smnement Valuation ea that he is licensed pursuamwthe provisions"f the Contractor's LicenuLaw(Chapter Y Sq.F[.Floor Area ls-$ m na rdwncing with Section 7WR of Division 3 of the Business and Professions Code)or Net he is exempt therefrom sod the breis for the alleged exemption.Any violation of 36218021 , 00 Section 7031.5 by any applicant for a permit subjects the applicant o A civil penalty of APN Number Occupancy Type nor marc than five hundred dollen(S50% 0 L as owner of the pmpeny,or my employees with wages As their sale compensation, will do the work.and the structure is not intended or offered for sale(Sm.7144,Buramms 101 — d Inspections and Profusions Code:The Comimme.License Law dace not Apply m an owner of 10 2 - PIERS p proi who builds or The thereon.and who does such work himself or through his awn employees,provided that such improvements Am not intended or offered for wic.It. 103 — UFER however,ON building or improvement is said within one ycu of completion,the owner- builder will have ON burden of proving then he did not wild or improve for purpose of 104 - REBAR 105 - ANCHOR BOLTS 0 L as owner of the property,am exclusively contracting with licensed concretion to 10 6 - SEWER & WATER consider the pmject(Sec.7044,Business and Professions Code:)The L'om aemrs Li arae law does not apply in an owner of property who Wilds or improves tbemon.and, 202 — UNDERFLOOR PLUMBING who contractsfar such projects with a contracui licensed pursuanuo the Convector's License Law. 203 - UNDERFLOOR MECHANICAL I am eaec mpc under Sec. .B A,P C for this reason ^,��/ 'em , / /,,,` 204 - UNDERFLOOR FRAME WoRlc Ex'stCOMPENSATION OECLA noN 205 — UNDERFLOOR INSULATION _1W IhembliApr under penalty of perjury ON of the fallowing ecclarnioos: 3O1 — ROUGH PLUMBING ❑Thaw and will meinuin eCeniBcamof Coruenuaulf-insure far WarkcrsCompen- 302 — TUB & OR SHOWER - suiom,As provided for by Section 3700 of the labor Code,for the performance of the 303* - ROUGH MECHANICAL work for which Nis permit is issued. 0 I have and will maintain Workces Compe atian Insurance.As squired by Section 3 04 - ROUGH ELECTRICAL 37M ofthe Labor Code.for IN performance of the work for which this permit is issued. 305 — FRAME My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (ro. c,i.nneed not wcomplemdifrhePermit isfor onehundred dollars(3100) 309 - EXTERIOR LATH or Ices.) I wnify that In he performance of the work tar which this permit is Wood,i shall Out 310 — INTERIOR LATH employ any person in any manneran um become subject to the Workers''Campcnsatlan 311 — SCRATCH COAT Laws of California,Dau Applicata 313 - ROOF NAIL NOTICE TO APPLICANT:If,after making this Ccnifieaue of Exemption,you shouW 501 - FINAL ELECTRICAL ENERGY become subject to the Worker'°Com penmtion previsions of the Labor Cade,you must 0z fanhwimcomply with such provision orthis permit shall Ndeemed revoked. 502 — FINAL PLUMBING ENERGY z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY E:•y+ Ihereby aRnmchat there itsmnswninnlendingagencyfor the performanceof 504 - FINAL BUILDING ENERGY C' me work for which this permit Is issued(Sm.3097,Civ.C.) DLcadersA z 505 - FINAL ELECTRICAL � t`n°ertAdde°"" 506 - GAS TEST U 0 I eenlfy that 1 have read Nis Application and scam that the above infmmatian is 5 0 7 - FINAL PLUMBING F torten.l agree to comply with all city and county ordinances and sou laws misting to Qbuildingconswction,andherebyauthorizeuprcunuciwofthiscitywcnteruMnIN FIN MEC CAL Wabove mentioned pmperty for inspection purposes. 0. (We)Agree to save,indemnify and keep harmless the City of Cape nino against 0 9 F I y to liabilities.judgments.costs and expenses which may in any way accra agar ,dCity 5 NG U in consequence of the&mating of this Permit l./ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date SOURCE REGULATION�S. / // CCs//s�� ,,�,/(/L�a4" 6 U> Signator�p'2 i,.AVC"nuactW Dau Re-roofs ✓ HAZARDOUS MATERIALS DISCLOSURE - Type Of Roof Will the applicant or future building occupant store or handle haysrdaus material As defined by the Cupertino Municipal,Codc.Chapter 9.13,and the Health and Safety M0hAALC.d.,Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes �u Win me Apppaant or future wilding o edpant use equipment or device womb If a roof is installed without first obtaining an inspection,I agree to remove emit hmardnux air conemimm s a defined by the Bay Area Air Quality Management all new materials for inspection. DixuinT ❑Yes (fU'N . I have mad the haraNuus mawriab rcquimments umkr Chapwr6,95 of the Callrof- nialiwlthASafetyCa ,Se6ans25415,35533and25534.1 understand Natifthe building does not cumencly have a tenant that It is my responsibility to noufy the occupant Df the requiremmeent,ts which must M met pfio wissuancc ofa Ccnincauof Oc tip cy. Signature of Applicant Date 07/ Signature Owner or authAll roof coverings to be Class "B" or better ori'rcd agent Date