03020116 (2) 129M r=
CITY OF CUPERTINO °�')' -res .' s rya"hnetZm��," .a +f+, ,i� '"4
BUILDING DrvlsloN PERMIT CONTRACTOR INFORMATION:;
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auILDINGADDRESS: DIJOSEPHS PLUMBING PERMIT NO 03020116
OWNE'R'S NAME: 205 WYANDOTTE DR PERMIT ISSUE DATE
MANJU KAPAIGIKAR
(408) 365-2058 SANITARY NO. 7 2 CONTROL NO.
lin
HITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i0LICENSED CONTRACTOR'S DECLARATION' Job Description
i1 hereby affirm that 1 am licensed under provisions of Chapter 9(commercing P
Section 7WI)of Division 3 of the Business and Pro@uinns Code,and my license is
+ nRnaeanamrrzm'' REPIPE/WATER SERVICE
g? License Clan Lia.X
Doc Contractor
ARCHITECTS DECLARATION
i 1 understand my plans shall M used as public records
10 Licensed Professional
•N OWNER-BUILDER DECLARATION
iE 1 hereby affirm that I ram exempt from the Contractor's License Lew for the
o O following reason.(Section 9031.5,Business and Professions Code:Any city or county
12 which requires a permit to cimUmet,alter,improve.demolish,or repair any structure
-Z� prior In its iexuance,also requires the applicant rorsuch Permit to lite a signed statement
< ,hat he is licensed Punuanue the provisionsof the Comactm's License law(Chapter 9 Sq.Ft. Floor Area Valuation
e�m (cote mincing with Section 71)(s)or Division 3 of the Business and Professions Code)or
Ne,he u exempt themfmm and dte buil far dre alleged exemption.Any violation of 36908022 . 00
Section 703 1.5 by any appliesem ron permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not more than fiw hundred dollars(5500).
❑I,u owner of the pommy,or my employee with wage as their able compenation,
will do the work and the surctom is not intended or offered fouale(Sec.90th,Business 2U2 — d
said Profusions Code:The ConuacmYs License Law doe nut apply m an owner of 301 — ROUGH B I N
property who builds orinapmves Hereon,end who di work himsel(br through his Own employees,provided that such improvements to,not intended atonement for sale.It. 502 — FINAL PLUMBING ENERGY
however,the building or improvement is said within one yeu of completion,the owner
builder will have the burden of proving that he did not build of improve for purpose of 507 - FINAL PLUMBING
ale.).
❑1.as owner of the property,am exclusively contracting with licensed coniracma to -
constmet the project(Sec.7Ua4,Business and Profwiom Cade:)The Con racwre Li.
coma Law does not pply to an owner of property who Wilds or improve themon,and
who contracts for such projects with a eonuactor(s)licensed pursuant to the Contractors �®
License law.
lam exempt under See. .B&PCfor this rtuan �tt
Owner Due APR 2 2p03
WORKER'S COMPENSATION DECLARATION
1 hereby affiant under Penalty of perjury One of the following declarations:
I have and will maintain a Certificate of Consent to sel6insurt for WmIsaa Compete-
.,;an,
omp te-atian,as Provided for by Section 3700 of the Labor Cade,for to pian man.of the
weak for which this permit is inued.
❑I have end will maintain Workers Cbmpeoadon Insunntt,as required by Section
371W of are labor Code,for the Rdarmance of the work for which this permit is issued.
My Workees Compensation Insurance carrier and Policy number art:
Csnicr: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
'COMPENSATION INSURANCE
(This section need not becompleled if the Permit isforme hundred dallare(SIRI)
or less.)
1 certify thus in the perGmoance of the work for which this permit Is issued.I shall ma
employ any person in any manner an u u become subject to the Workee'Comp ovition
Laws of California.Da¢
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of EsonnPian,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
ti O
CONSTRUCTION LENDING AGENCY
'rr aN-a Ihereby 9Man that there is a construction lendingagency fnrthe Performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
= Z Undeh Address
U 0 1 certify that I have mad this ap,lieaion and sum that the abnve information u
I+. F conch.1 agree to comply with all city and county ordinances and cote laws relating to
DU building Conswction,and hereby authodae mpreenutiws of this city to enter upon the
C[1 above-mentioned pmPerty for inspection purPmea
G (We)agree m save,indemnify and keep hannku the City of Cupertino against
N liabilities,judgments.costs and expenses which may in any way simple against mid Cl Ly
U Z in cnnsequencc of the grami ag of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZARDOUS
Signature of ApplinDDataHAZARDOO US MATE RIALS DISCLOSURE Type of Roof
Will the applicant or(court building e,Chapter
or handle Health a material
a defined by the Cupertino Municipal Code,Chapter 9.12,and the Health end Safety
Code.sncdea 25532(,)7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea ON. P P � Y g g
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
notstrict7
❑Yes CNo
1 have read the haardtms materials mquimmenu under Chapter 695 of the Califor.
Id.
Heath&SafctyCode,Smi 2550515533wdZ53.1undna Nui(dc building
cunen0y hoca¢nanduirements which must he met prior to issuance of a Ccrtificao of Occupancy. Signature Of Applicant Date
Owner or authorized agent Data All roof coverings to be Class "B" or better