02020035 (4) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR MORMATIO. .
BUILDING ADDRESS: PERMIT NO.
10960 SANTA TERESA DR 02020035
WNER'S NAME: APPLICATION SUB DATE
MOHAN RAM P AND SHEILA 02/08/2002
ItV PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT(ENGINEER: BUILDING PERMIT INFO
m u F BLDG ELECT PLUMB MECH
y a
Z H C I hemby afi'no hal I am NSED liensedLunder provisions
DECLARATIONons of Chapter 9(commencing Job Description
In t:-iwith Section 7000)of Division 3 ofthe Businessand Professions Code.And my license
in ton(tore dna efr D 2��� 5L} EL.
x s-, Liens Lia a
0,U O Dae C nas or
O ARCHITECT'S as or
1 underemnd my plans shall W used as public rtcar s �.aaooa5
G
al Licemed Profc.simnal AUG,0 L
o OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am1. exempt from the Contractor's License Law for the BUILDING
?< followingprMason.permit
]Wstr Business and Professions Code:Any tiny orcounty $28300
Y CF C which requires a permiw to ronnrvn,alto(,improve,demolish,or repair any swaum
Z. -Prionoits issuance,also rzquism the applicam for such permiuo 6l<aaigned mumrn
Wt hais Bcesurd puauanuo Ne provisions of Contrectds Uccnx law Chapter Sg Ft.,Floor Area, s
(commencing with Section 7000)of Division 3 of the Business and Professions Code) ?� i.�• a Valuation
m that IM ii rxcrtipt th reform end me Wsis far the alleged masngibn.Any violation 35 6'13 0 0 3''I'0 0•-v 1'a'of Section 7031.5 by any applicant for a permit subjects the applicam no a civil penalty
.mr nlat m0.than five hundred do]]...($5W). APN Number Occupancy Type
oLu.awnet arthe m.ar int la ee�whh wet<a..mei(anle cum Dan, 101 - FOUNDATION
Pd to Y YemP Y g petro
will rc the work,and the urb:The is not intended at offered for sale(Secy 7864,Bto - PTERS
—
ownier ofdna Poxary Who b Cad:Th<C°nwhereo,and s Law etas naw appb m an Required Inspections
owner of progeny Who bullas or improves thereon,end who does such work himself 103 - UFER
or through his own employees.provided that such improvements ere not intended or _1 4 - — REBAR
"oRcidd for
We.If,however.the building or improvcmcbi is sold wimin one year of -- -
completion,meevner-buaduwill have the burden ofproving that hedid not Wild or 105 - ANCHOR BOLTS
improve for purpose of sale.).
10.6 =.._.SEWER . &._WATER .'_. _..
0 1.As owner of the propertY am exclusively contracting with licensed contractors I a 202 - UNDERFLOOR PLUMBING
construct the project(Sec.7064,Business and Profusions Code:)The Contractor a
adwhLicense lawdetfapplyman air of a.comywha Wilds or 203 - UNDERFLOOR MECHANICAL .
and who convects for,such.projeas.wim a conwaor(s)licensed pursoam ao.me ._
. Conlmd°ia License Law. _ . ,... .. .. .... .. .. ._. ._.. .. -.
❑I am mcmp,under Sce. ,B&P C formic moon 204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby affirm under penalty of perjury one of the following dalantiom:
302 - TUB & OR SHOWER
Iffy 303 - ROUGH MECHANICAL
❑ 1 have end will maintain a Certificate Consent to self-insure far Worker's
Compensation, as provided for by Section 3700 of Ne labor Code, for the 304 ROUGH ELECTRICAL
performance of me work for which this Permit is issued. . 305 - FRAME
l have and will maintain Workeh Compensation Insurance,as requirca by Section 306 - HOEDOWNS
X100 of the labor Code,for the performance of the work for which this permit is
,y iAs Ad My Workcr'�Compcnmtion Lnsun r,ierand Policy number eR:' 307.- —. .INSULATION ,
.o.. ..._.. ._. ...........� .. _ .
OOG1d IoY._.._ _
_
308( SHEETROCK i;.,•t
e.men
�a'4 "CAT,
OF EXEMy ON FRAM WQRKERS'; - V /.N I . s � tot • '.. '•
COMPENSATION,INSURANCE - ..30.9..__..._&XTE I.OR_J.ATH_-......... ... ...._._.....— ' -.._...... -
•7'1' Irbil tact ion need rdta,Completcdifihepermitisheoa,handled dollaa 310: INTERIOR LATH -
E100fofrs) 311 - SCRATCH COAT '
I certify that in the n in any ma n the work for which this ct to the
issued,l 313 - -ROOF NAIL
A'hell pent employ any person m any manner so m m become subject,o Ne Workcri
lampcnaaeam lawn of California.0.?e SOI - FINAL ELECTRICAL ENERGY
Applicant
NDncETOAPPucANr.If.After
mpensMaking mi.CemineudEsabrCrell,yoush.tild
you
502 - FINAL PLUMBING ENERGY
z bet:lawsthco ply thewith
suchprvoionsorthisPer itshalafthe laWdCvoked. most 503 - FINAL MECHANICAL ENERGY
O O ronhwim comply with such provisions or this garment shell be domed revoked.
Z2 . -.. .. - - - -504, - FINAL- BUILDING ENERGY,
'^ ^ CONSTRUCTION LENDING AGENCY ''
'',I hereby affirm that there is'a construction lending agency for mi performance 505 - FINAL ELECTRICAL ' t
of the work for which Nis permit is issoad(Sec.31)97,Civ.C.) '
- ' 506 - GAS TEST -
y.❑ ' L<ndar's Name..,._ .. ....:..,.s.., .. _....... . ...... .. . '.:�. _.
D z Lbdcr' Adclocss 507 - FINAL PLUMBING
U'O i cemfy that I have sea this application and auto that the above information is 508 - FINAL MECHANICAL
W-Est conal.I agree to comply with all city and county ordinances and auto laws relating
O_rJ to Wilding conauucuon,end hemby AUNorire mpmxnutivm ofthis city m enter upon 509 — FINAL GRADE
y:k theeWxe-me a ppapemmrinspecbmnpurpaxs., 510 - FINAL PLANNING
es,judgments.
dgme ts.cost indemnify and keep harmless me Ciiy of Cupertino a said,
W liabilities,judgments.casts and expenses which may in my way stria against said C WORKS
V•7J.. City in CANT UND of Ne gaming mf Nix per,ntL '
APPLICANT VNDERSTANDS A D COMPLY 7TH ALt:NON-P 1 (�
t' SOURCE REGULATIONS: $/�1 Issued by: Dale
Signature of ApplicanJConwnor' Dale;" Re-IOOfS
IjAZARDOUS M RIALS DISCLOSURE
' w,n'we.pyBmntarmmrehaaaingarouwntnota«.wmale.n:.a:eoo.m.weria ...Type of Roof.
as ac6ned by me C Nino Mumcipsl Code,CTapw 9.12 end the Hr Lh and Surety --
CoaaSectiont 1a)7' -..j5y..i.r•;-} ^ -
❑Yes'C ";"' �: r.•::: All roofs sha]l_bc inspected-prior to,any roofing material being_installed._. _
Mti6 We appiiwn,or future Wilding occupant use ceopment or devices which If a roof is installed without fust obtaining an inspection;'I agree to'retnove
emit haaudous air contaminants As defined by me Bay Arta Air Quality Management
r District? . all new materials for inspection. Applicant understands and will comply with
°v i �ie� "all non-point source regulations.
1'h (rad ma hixardous maenads na,m rrobas under Chapter 6.95 of the
California Health&Safety Code Sekuom 8505,15533 and 25536 1 undmund that
f the an 6 g does urn curtcmly have a mnanL mal nus my rtsponsibibty to nIII Ne — - - - -
cupknt Of N'regm net whu must h ton pnm to issuance of a c-,".. m of
aw° / Signature of Applicant Date
Owrerm,u?no�"er!•• a,�. All roof coverings to be Class "B" or better
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