01020038 (2) CI'RINN
YOFUPERTNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; MI's
20309 SILVF_RADO AV SHARMA SURENDRA P RGAPAL010200 8.
OWNER'S NAME. API'LICATIONS B2")
SHARMA SURENDRA P AND D RGAPAL �c1t17/2mm1
PHONE: SANITARY NO. CON'I'ROL NO.
QmzWWZ❑ ARCHITEOGWGINEER: 1 BUILDING I'ERMITT FO
jLDG ELECT
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�N= _ . LICIaNsrucorvruneTOR'sDECLARAr1oN Job Description
I hereby allinn'ad 1 am licensed unJer provisions It Chaplet,9(commencing
d
OyF.�i wi ,Sa,,6,m7bXH or Division J tiro he Business end Professions Cade,and my license
axs.''i i,mfallBreean!aHxel. RE—PIPE
R c d u ikon Class. Lie,d
nate Contractor
w 3 a y ARCHITECT'S DECLARATION
t iff O 1 undenanA my plan.shall be uuJ as puFlic records
wa.p O LianscA Pndessianal
u. OWNER BUILasnaD1?R m the Contr ON
coo
vl S 1 herby.Minn alma am escmpt rrom the Cotton,C s Limns,Law for Inc -
F 2 i following remv,n.IScclian'eoiv 5,Buviter. aud improve,
delions Ctalc:Any tiny o,manly
I c whd y ' l rot I t Irl, p 1 diti p- ysauasre
�3m prime I me L,n y mapplicantr rape iO tile sighaddalansiat
that lie is licensed, oI Scene. p p si nn t I iness L Cor9 S Ft. Floor Area Valuation
uoanmeecmg tem tharevin—r lI ui.d.mn 5r he IHmmeas and Protestant,An, code) y' $0
of that ha Is 31.5 by
Ihereham and me basis h,r the amesed uampnttto nary l penalty
or of Inm e tit. by any Itppfimnl for a pemtit subjects me arpfieam to a ni.al penalty
of of marc doll fine laamlreada,llan($Sli). APN Number Occupancy Type
01.a,oxoer„the properly,or ray employee will,wages:t,mar,ole.... ptimalian. 36939006. 00
will do Iho work,and the structure is not intended lir ellirtd for,ale(Sec.T(Pd,
Hminays and Proleoions Cade:The Contract *,License Law dons at,,apply to set Rey aired InsppeCllonS
o,i Who bnudsu,in,rpmoa,beren,and who does work himself 202 — UNDERFLON PLUMBING
or through his own employee..provmm mm.such immovemem,am non intended or
ottered for rade IL howeve,me hudding ar ann,ovemam i„old within one yen,or 301. — ROUGH PLUMBING
completion,the nwnerlwilder will have the burden of proving that Ise did not build or
`u..... 111Lporr•„cof,ale.t. 502 _ FINAL PLUMBING ENERGY
X77(/ r.1 the proper,am exclusively comranhts with ceased tan rano,In 507 FINAL PLUMBING '
tract the project(Sea 9MJ,Business and Pmfosioos Cade:)The Contractor',
License Uaw doi nal op ly to un owner of properly who builds or ianpwves thereon,
and who candool, lin t projt,a doh a connmaods)licensed pa antra ,,the
Con11mt o/s License la �1111
sen
sliboal �mpinnde: a sre '
Du-
RL 'SG :AI
t ere”time,unJer penalty of pe jury one of the following Jmlumlinm:
❑ 1 have and will nainain a Cerificaa of Consent a,self-imure for worker's
Compensation, a. provided lin by Section 3700 ar the Labo, Codetin the
perfannance of me wad fin which this permit is issued.
❑I nava and ,It n,n.lain Wudm's Compensation Ineumnec,as required by Sermon
1700 or the Labor Code,for the lwfunnxnce of the work for which this perrnll is -
sued.My Wudua^,Canpcnrnrioo laonrw ec eorne,and Policy nunnbe,are:
Carrier: Policy Na.:
CERopTcAT1os,of:F.KEh1rnON FROM WORKERS'
COMPHNSAf10N INSURANCE
(I his section need not be completed If the per is for one hundred dollars
($100)oe let,,)
I candy that in the pmhrmnncc of the work for which this pcmtit is issued.1
,hall not employ any Knoll in any manner so as ur become subject to the Worker'
Con ape n Low,of Calif I,.,Dae
Applicant
NOTICE TO AI'PLICAN'L If,nue,making this Certificate of Exemption,you should
section, object 1.the Workefs Compmsaion provisions of the W mu Code,you mull
C)
borrow ith ttanply xim such provision,or In,pcnnil.ball be leaned revoked.
z U1 CONSI'Ruc r1ON 1.EN DI NO AGENCY '
a 7 Ihenhy;dfinn that is.cunamnion lending agency for the performance
W
if do x.,k for which do,permit is issued(Sec.3097.Civ.Cd
1 Q Lama,'.Nand
= z Lender's Address
V Q 1 amity ma 1 have read this application and state that he above information is
P., Eva 'areal.1 agree u,ev.ne,wise all any and manly nidi re,and.rte lawn cloning
O r, t,bammg cenxlmction,not hereby nuthave representatives of mix city to enter upon
ry ole ahma.memioued property for lmpeadmt poga)se%,
[ro V
(We).greasev,indcmnify and leap harmless the City of Cupertino against
ties,juin m. eel,an exp, wI all may m any war.,orae again,:dd `
U al mosclaeoast rl s,,a on �pennh. •—/ )
ICAM'U ')E $ ND ANI LCOMPLYWI"HALLN N-IrowrIssued by: DaleZCl?RE LAT L '.sere Appf ant C ,ease, Data Re-roofs
' a DOUS MAA1IR1A1S DISCLOSURE
Blmeappdcam or bane buading«rapaa,Iarear handle mvadoa,rtalerim Type of Roo
as defined by the Cupedin,Mtomaipal Cudb.Ch.Nsr 9.l2.and thcHealth and Safely
Coda Seelion^_55]2(.)'?
0 Ye. :O No All roofs shall be inspected prior to any rooting material being installed.
Will me.pphcartlinfantile mdldinga,capamn ccgaipmemor-devict,which If a roof is installed without first obtaining an inspection, 1 agree to remove
mnit Imiardem air cunlaminants m Jdined by the Hay Area Air Quality Management
Dolrie,r all new materials for inspection. Applicant understands and will comply with
O Ye. 0N all non-point source regulations.
1 have mai the haemJous macrials requirements under Chapter 6.95 of the
C.1dontia health&Stuoy Calc,Smtions 25505.25513 lid 255)1.l unde stand that
irthebnilaing dt .dcurently have a tenant.that it is my msponsibilay a,notify the
ueeupam of the r ams w ant he amt Prier to isxuuncu ora Cclara e of
oe`uwnt`v' Signature of Applicant Date
Gwoerm -- — Date All roof coverings to be Class "B"or better
OFFICE