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04040081 (2) I CITY OF CUPERTINO _ BUILDING DIVISION PERMIT 4;CONT, OR=INFORMATION::. <. BU I LDING A DDRESS' _ BAY AREA REPIPES PERMIT NO 04040081 19984 WHEATON OR OWNER'S NAME: PERMIT ISSUE DATE SANKARAN RAMANATHAN AND 13HAGAV1861 ORANGE GROVE DR 04/14/2004 ONE: SANITARY NO. CONTROL NO. (408) 371-5763 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDC ELECT PLUMB MECH 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARATION rd U I hereby affirm that I am Iicetsed under pmv0lons of Chapter 9(commencing Job DCSCrIpt100 n ad ii with Sec"tion7�Kk))of Divi5ion3 arrive Business and Prufessinm Code.and my license is in nur6Qybneerrea. REPIPE/WATER SERVICE/WATER HEATER g? LiccnSe closs_�_'��Lick E"O Dare� Cm_ ntrecmrRwfto e q�Q ARCHIIELDECLA y B �YSBtlersmnd my plans shall he used as public records JyU T G y Licensed Pmfcasional i S OWNER-BUILDER DECLARATION ii! 1 hereby affirm that 1 am exempt from the Contractors License Law for the ZOO following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit in construct,alter,improve,demolish,or repair any structure _yam prior to its ismancc,also requves the applicant forsuch permit to file aligned statement gY< that be in licensed puumnitatothe Provisions nIthe Commerce's Li...Law(Charter 9 Sq.Ft. Floor Area Valuation y t-O (commencing wi th Sued..7")of Division Sof the Business and Professions Cnde)or y tat he is exempt therefrom and Ne basis for the alleged exemption.Any vinlatfun of Section 7031.5 by any applicant for a permit subjects the applicant to a c ■1�p A c�3kfXI1 ih6e10 0 Occupancy Type not mare man five hundred dollars($5W). ■ o !s'�LC P Y YP 01,as owner of the property,or my employees with wages as their,sole compensation, LE LJ do the work entl Ne structure is not intended or offered for sale(see luvia�B�gJttst�ir�j�r7ea�sQ Required Inspections and Professions Code:The Convenor's License Law does nut apply to 1j'rd$Ir l` 0, C 2004 q p property who builds or improves thernan,and who does such work himselforh hs o L own employees,provitled mm such improvements are not inoentled or oReretl foraala.IL however,the building or improvement is sold within one year ofcoPPletion,P LDING builder will have the burden of provingthat he did not build or improve for - Sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors w construct the project(Sec.1044,Business and Professions Cade:)The Comraao's Li- se taw does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contracmr(s)licensed pursuant o the Cmdractori License Law. I am exempt under Sec. ,B&P C for this reason Owner Data ^y`NWORKER'S COMPENSATION DECLARATION j I hereby affirm under Penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-Insure for Worker's Co Tri sation,as provided for by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued 1 have and will maintain Worker's Compensation Insurance,as mquired by Section 37M of the Labor Code,for the performance orme work for which this permit issued. My Workc' CompTd'onl umnce carrier and Policy number art: l�fA�l CERTIFICATE OF EXEMPTIONFRA WO K S' COMPENSATION INSURANCE (Thissection decd not bccomphred if the Permit is for enc hundred dollars(5100) to less.) 1 certify mat in the performance of the work far which this Permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cedilicam of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you most . .JO fvnhwi th comply with suchpmvlsions or this Permit shall he,deemed revoked. Zt ti CONSTRUCTION LENDING AGENCY [tiff I hereby affirm that mere is a eodnmNnd lending agency for the performano of Ri> the work fur which this permit is issued(See.3097.Civ.C.) UJ Q finder's Name r7 z Lender's Address U Q 1 certify that 1 have read this application and some the,the above habituation is IL F. correct.l agree to comply with all city and county ordinances and state laws relating to 0 abovedgeotioned ion,and hereby mthonprposes. tivesofthisCity to enter upon the W above-mentioned for inspection an keep ea. (WB)agree to save,indemnify and keep harmless the City of Cupertino against Uz liabil ities,eor go dcxpenspewhich may in any way accrue against said City C)z A FP his permit. APAND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SO Z Re-roofs SigDare HAZARDOUS MATERIALS DISCLOSURE Type of Roof. Will the applicant or future building uecuper store or handle hawduus material as refined by the Cupedi no Municipal Code,Chapter 9.12.and the Health and Safety ode,Section 25532(.)1 DO All roofs shall be inspected prior to any roofing material being installed. m Yes /011z 1Will the applicant or future building occupant use equipment m d.,I.ma which If a roof is installed without first obtaining an inspection,I agree to remove it hateardoes air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. t istrict7 y [3 Yea nt No I have mad the hazardous materials requirements under Chapter 6.95 of the Califon all Health A Safe,CWc, tions i5505.255JJ and 25534.1unrkmmntl that ifmc Wilding dues n e ndy have nano,thm it is my responsibility m nod l' the tscopent df the rc ra cu wh' m MmetPdurteissuanccofa rvhc¢o cu err. Signature of Applicant Date L/ -s� r�u oar n rcdpgent Date All roof coverings to be Class "B" or better Community Development aClOF 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDDRES PERMIT# of U v OWNER'S NAM 25 - /P GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile r Contractor Signature Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE CUP4ERTINO PERMIT APPLICATION FORM APN# Dat Building Address: I q' l/ Own 's Name: Q440 a, �IC� kCL�Q v� �f ?E7— )71P3 C tractor: Phone: icense#: Co to Phone: Cupertino Business License#: ah e 3-7i , Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description p / L/' I t �1�i/lL /1 % GuQ ! �(r✓ick t Residential Commercial ❑ Cost of Pr je 11�-00 0.170 Qty,if Appeioble Fee ID Fee Description Fee Group PPERMrrFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING . BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal, PLUMBING USL Business License BUILDING