02070004 (2) CITY OF CUPERTINOCONTRACTOR INFORMATION:
DIVISION
RUIPERMIT
3biWT4"DI§HDOWHILL LA DESHMUKH RAJIV AND ANJALI PERMIT'62070004
T7E' I_IKH RAJIV AND ANJALI APPLICA77AJATlAyt2002
PHONE: SANITARY NO. v� CONTROL NO.
z Z ARCHITECf/ENGINEER: BUILDING PERMIT INFO
da daFO BLEG ELECT' PLUMB MECH
Had
NEE
i LICENSED CONTRACTOR'S DECLARATION
Ivo hcrenyaffirmthmlamliansedtdmhm,mvisiomnfChapmf9(commencing ADD 55 SQ. FT. /,KtMf1'EWt1QEMODEL
rte^; with Section 7000)afDivixianSat the Bmida,and Prof=..on,Code.°nd my license ��t1t1 9�
in full farce and effect. �R�r11
i
:.P,< License Class Lid.k
O u Datecommcmr 2002
1 ot; ARCHI'1'EcrsDECLARAFION OCTI 2 $
5 I und,,n nd my plaas shall b=used m pnnlle memda
I p Licensee Professional
OWNER-BULDERDECLARATION
frlI hereby arm at 1 am eert from the Commena dee Law r = BUILDING
$40000
r z` following mason.(section 7031.5.Business and Pro&ssians code:Any city or county
E D .hien m4arms a permit in cdm moct.alter,improve.demolish,or repair any structure
prior to
its issustnce,also requites the applicam for such permit o file a signed statement - -- - - - -
d3- that be iilieenscdpursuant to(Leprawomnfthe Comradmr'sLicense Law(Chaper9 r a-; , , „ Valuation
ening with Section 7")or Or, 3 of the Business god professions Cade) _ '1 12 . ') ".� � 1'x t � , ..
m mai he is cxercipt therefrom and the basis for the allrgied exempiibr,Any vielm inn
of Section 7031.5 by any applicant for a permit subjnts the applicam to a civil penahy
of not more than five hundred dollars 65001, APN 102 PIERS
Occupancy Type
-
❑Las owner orthe add
the structure, my lois a.,in who wage fe ed f sole m(Sec.704cl.
will , the work,and n,ConeC not intended Or License
for sale aged,THA,
m,tum ss and eny o'honb ewe:rbc cues thereon,
,and w o:w doe,inn apply m an 104 - REBAR Required Inspections
r of proPefy ansa naeax or itnpmx=.mera,n,ane who saes such work himself or Nmugh his on employees...twirled that such improvements arc not intended or 105 - ANCHOR BOLTS
offered for sale If,however,the building or improvement is sold within one year of
complain heowner-builds 11havcI atdenafI in, that he did no build or 106 _ SEWER & WATER
pis ' pa o,eorxale.y , Vf��� 202_ UNDERFLOOR_ PLUMBING
rafthe f nyanexemr lyconaaingir;,basedcontactors1O 203 - UNDERFLOOR MECHANICAL '
con uum the projec IS .71}W.Business and Posessions Cade:)The Contactor's
License Law dues as ly m,an owns,or popery who builds or improves memO°' 204 - UNDERFLOOR FRAME
and who.commcts for such projects with a contracmgs)licensed pursuant m the ._
Contra ,r1Lice 'aLaw. 205_ — UNDERFLOOR INSULATION
01. x<mps under Sre.B&P C for this reason 301 - ROUGH PLUMBING
�. _ t
nm sORKER'SCOMP�ATIIONDECLARATION 302 - TUB & OR SHOWER
I hearts}a man and,,perahy or pmjory on<o the following declarmiaas: 303 - ROUGH MECHANICAL
A. ❑ 1 have and will maintain a Certmdm=of Consentm s=lam.are far wafk<rx 3 04 - ROUGH ELECTRICAL
;} Compensation, as pmsidcd for by Section 3700 of the Labor Code, for the 305 - FRAME
pirrofmande sir me work Por wmm,nd.petmn is n.oed. 306 — HOLDOWNS
❑1 have and will maintain Wmkcr's Cann,maaion Insurance,as required by,Section 3 0 7 - INSULATION
.0 37W of the Labor Code,for the performance of the work for which this permit is
- i..oed.My"'imine,Co:npemamnm.amn=ecarderand Policy number am: 308 - SHEETROCK-
.Policy No.: -' , -3 09 <- ,EXTERIOR LATH . .
, CERTIFICATION OF EXEMPTION FROM WORKERS"
.'COMPENSATION INSURANCE . 'y _ __-....._310,_--,_-INTERIOR_.LATH.--_.
(Th tion need not be completed if the Permit is for one hundred dollars 311 SCRATCH COAT .
($'b") he'..) 313 - ROOF NAIL
I terrify that fire performance oftne work for which this retain is issued,I 501 - FINAL ELECTRICAL ENERGY
,shall not employ any rowan in any manner so as to became subject to the Workeri 502 - FINAL PLUMBING ENERGY
Compensation'I..s oT Cahoon,Date
..Apphd°"' 503 - FINAL MECHANICAL ENERGY -
NOTICE TO APPLICANT.If,after making this Cenificam of Exemption,you should
zbecome.subjectto the Mother'sCompensation provisions ofthe Labor Codgyoumust 504 - FINAL BUILDING ENERGY
O forth»nth comply with such provisions or this Permit shall be seemed tevaked,
z 505 - FINAL ELECTRICAL
'v
CONSTRUCT ION LENDING AGENCY' SO6 - GAS TEST
Q I heron ffir,that there is a comuucubo n dinga mance le agency for the perfor
W ? tie«°N me, wnm tni.p mtri.i.med(sed. B z,cin.ca „,-_ - 507 -- FINAL..PLUMBING .
Z) z Lender's Address 508 - FINAL MECHANICAL
U O 1 aniry that 1 have mad this application and state that the above information is 509 — FINAL GRADE
W t:. cr i.I agree to.comply with all city and cri my ordinances and state laws rdming
O r� mbuddingcommmction,andherebyautumns,r=pasentatLesofthiscitytoenterupon 510 — FINAL PLANNING
heabase-amnuamedproPeryformspectinn —
H 6i (Wa)agree to save.indemnify and keep harmless the City of Copcnino against 514 FINAL PUBLIC WORKS
Z? liabilities.' gmcros,cost,anJ expoxs.fish may in any way acne against said
V z try in f the gra 'ng of thif.
APPI i UN'DERUAND. \ND W1/LLL 'mMPLY\1'TH ALL NBN:POINT Issued b : r Dale
so tCE ,IJLAT ONS .:_I! 'M^ Y
tgnamre,ar Applin nt/ nntaaar '���. Date Re-roofs
RDOUS MATERIALS DISCLOSURE l
_ - 'wllthe uppllc or future building occupant store or handle hazxrdcasmaterial Type of Roof -
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Station 25532(a)?„
❑re. ^o Na �'` 'r'rj'', All roofs-shall be inspected.prior to an material beim
P P Y roofing-material g- g installed...._. _
.N,lil'he tankers'o,future building Occupantuseequipment ordevices which If a roof is installed without first obtaining an inspection; I agree to remove
emit Landaus sir comurnami ,as defined by mem
e Bay Arca Air Imarlay Managent
District all new materials for inspection. Applicant understands and will comply with
/ Cl all non-point source regulations. ,
1 have read the br ardour materials regmfemems under Chapter of the
Cnl,famia Health&Safdy Code.Sections 25505,25533 and 25534.1 understand thin
If the building does tint came.1,have o tenant,that it is nsy me,a nalaility m fairly he _
occupant he acorn. fs,Inch mus a met prior to issuance of a Certificate or
Gauss Y.
r Is ,� Signature of Applicant Date
p aamod ed a emr v�•v ,Date All roof coverings to be Class "B" or better
.. ... ... .. ... .. OFFICE