03040042 (5) CITY OF CUPERTINO �aa *'^ meg #�� �Yf%' y�y�°�H�X,��AkzTT'�
BUILDING DIVISION •',PER T '"`eON'T" ACT INFO
BUILDING ADDRESS: _ DUSITYANT PANDYA PERMIT ND03040042
NER'S NAME: - PERMITISSUEDATE
DPANDVA
PHONE: SANITARY 904. C N ROLNO. ,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB. MECH
0 0 0 0
BOO LICENSED CONTRACTOR'S DECLARATION - Job Description - "-
I hereby affirm that I am licensed under provisions of Chapter 9(commencing -
with Section 7000)ru Division 3ofOO Business and Professions Code,and my lieenx is
�n„ Inmnmmearaercen. DECK REPLACEMENT
n,gam Licenu Class Lk.# g,11❑�/ n Ol
F .Dale rSDE ar __.^...... , _'�I'ti'1—�4_ �ooY.....�_...___�..
ARCHTfECTS DECLARATION
_ ..
1 undersand my plans shall he used a public records '----•---—'
c Licensed Pndesairml
3 OWNER-BUILDER DECLARATION ®1���® �1k�.-
<f 1 hereby affirm that I am exempt from the Contractor's License Law for the ® ING
O O following mason.(Section 7031.5,Business and Profs tions Code:Any city or county
$� which inquires a permit to cnnswet,alter,improw,demolish,or repair any structure -
_zY poor as I%issuance.also requires the applicant rorsuch Permit to file a signed statement
< that he is licensed purmantto the pnvisiom ofthe Cornsum rs License law(Chapter 9 Sq.Ft. Floor Area Valunon, .
y (commencing with Section 7000)of Division 3 of the Business and Prefessons Code)or
.- that he is,exempt therefrom and be buns for Ne alleged exemptlon.Any violation of n�,1sv7.r�,�I,, - -'
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3`Ya61a-/+m..sl el`0 0 Occupancy e '
not more than five hundred dnn...(S5oo). P Y •]P
❑Iluo mrufthepmpmy,ormycmployceswiWwagesu Neirsolecompenudon,
aillde thcanak.andthestructure is not Intended mutilated forage(See.7W,Business - Required Inspections
and Professions Code:The Connector's Licensees Law donot apply a an owner of e- q - - -.
pmyeny who buildsarimprows tiercon.andwhodoessuch work himselforthrough his - �-
Ownemployces,provided that such improvements see not intended or offered forale.If. - - `-• - "" .. - .- .. _. ..
however,Ne building or improvement is sold within one year ofcompledon,the owner. - - -
builder will have the human of proving that he did not build or improve for purpose of
sal..).
❑1,as owner or the propeny,am exclusively contracting with licensed contractors to
construct the Project(Sec.7044.Business and Professions Code:)The Contractor's Li
cense Law does not apply tom owner of pmp.ny who builds m improves themon,and
who contrac%for such Projects with a contractor(l)licensed inch..Or in the Contrmme. .,:w ..._......
License Law.
Iamexemptunder Bea .B&PCfor Nismuon
mer Data
WORKER'S COMPENSATION DECLARATION
I hereby affnm under penalty or perjury one of da following declarations:'
❑I have and will mainmina CerdMaaof Consentmself-insumfor Wor esCompete
anon,a provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worked Compensation Insurance,Is;requited by Section -
37W of the labor Code,for the perfootanec of the work for which this permit is issued.
My Worker's Compensation Imumnce urti.r and Policy numMr am: - -
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - -
(This section need not be completed if the permit is far one hundred doll=($Ia)
or less.)
1 sonify that in the performance of the work for which this permit is issued.I shall not
employ any person in my mamorm as to become subject to the Workeri Compemation
Laws of California.Date _
Applicant - .. ..
NOTICE TO APPLICANT:IL after making this Oci ificate of Exemption,you should - — - -'
become subject on the Worker's Compensation proviaim.of the labor Code.you must
.Jz
forthwith comply with such provision or this permit shall he deemed revoked.
ZQ CONSTRUCTION LENDING AGENCY
[-r v 1 hereby aMrm that them l..e.nmuction lending agency for the p.rrormmc.of
Ne work for which this permit Is issued(Sec.3097,Civ.C.)
GQ Leodues Nunn
D
z Lcndet's Address
U Q 1 certify that 1 have read this application and=ma that the be.Information is
gy F correct,I agree to comply with all city and county ordinances and sato laws relating a
p building construction,and hereby authoou mpresenutivs or this cityta truer upon the
above-mentioned property for inspection purposes. '
(We)agree to ave,indemnify and keep harmless the City of Cupertino against
pFy CA liabilities.judgments.costs and expenses which may In my way accrue agmpal dela City
in V^
APPLICANTUNof the granting of DERSTANDSANTAND WILL COMPLY WITH ALL NON-POINT Issued by: - Date
SOURCE REGULATIONS. -
Re-roofs
Signuure ofAppliaRDale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the epplicatt ar rmumi building e.Chapter
or handle Health and
fined Suction
thin 32(.)?nue Municipal Code.Chapuer 9.13,and the Heals and Safely
de, 0Yc.lssu(an - All roofs shall be inspected prior to any roofing material being installed.
r ❑Yes ON.
Will the applicant or fuaa building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamolunis air ci naminams as defined by the Bay Am.Air Quality Management all new materials for inspection.
District?
❑Yes r-1 No
I have mad the hazardous materials myuimmcna undmChopmr 6.95 or the Califm
ria Hwlth&Safety Code,Sections 35535,25533 and 25534.1 micemod thatifthe building
does not cumemly haw a anent,door it is my miporoibility a muly the omupanl of the
requimmem;which must be met poor on issuance of a Certificate of Occupancy. Signature of Applicant Date
owner or authorized agent Dal. All roof coverings to be Class"B"or better
t.
STRUCTURAL PLANS & CALCULATIONS
for
Rear and Side Decks a lk
22681 San Jua ��
Cupertino, CA 9 14 pz 7.003
PPR APPROVED;
IN ACCORDANCE WITH T E CITY OB
® CUPERTINO C N RDINANCE9
^ nr ATE
SIGPdED�,
This set cl pia and specifications MUST
be kept on the job at all times and it is urr+
lawful to make any changes or alterations
on some without written permission from
the building Dept., City of Cupertino.
•
Content Page The stamping of this plan and specifications
SHALL NOT be head to permit or to be art
Framing Plans and Details R1 to R6 approval of the violation of any provISIGN
Calculations C1 to C4 r ,nv City Ordinance or State Law.
Prepared by:
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