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02020090HOC U z O H I OZ�C aPml;u °_Cali F F�o< C Z � � S C OC zP* U C W. CITY OF CUPERTINO t , a - ° - a , , , • �riF• CONTRACTOR INFORMA� ~N: BUILDING DIVISION PERM BUILDING ADDRESS: PERMIT NO. 10225 ORANGE AVE. CHARVEZ CONSTRUCTION 02070084 OWNER'S NAME: APPLICATION SUB DATE SEETARAM VEMULAPALLI 360 W 8TH ST 07/15/2002 PHONE: SANITARY NO, CONTROL NO, (408) 893 -7693 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I • _t LICENSED CONTRACTOR'S DECLARATION Job Description I herby 0) of that i n 3 of B under provisions si Chapter 9 and with Section T000) of Division 3 of the Business and Professions Cade. and m license REVISION, NO NEW PERMIT ISSUED is in andef[ect Lfc.a (ORIGINAL 402020090) Date Contractor ARCHITECT'S DECLARATION ' I understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Conl=or's License Law for the following reason. (Section 70315, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure. _prior to its issuance, also requires the applicant forsuch permit to file a signed statement SA} _rt. �tj0 r, to �,, . ; ' i ��' s) s = ... ,, j,"� ,}j�' °' Y � J. aluation thatlid ls,,lictgrtl pursuant E ;thr previsions of the Connactor's License Law (chapter 9 (commencing with Secton 000)0 Division 3 of the Business and Piofgssiens Cade) or that he A exempt therefrom'and the basis for the alleged ekemptioh. Any violation - of-Section 70315 byanyapplicantfor a permit subjects the applicant to a-civil penalty ;nf not mom than five hundred dollars (S500). IIIRbe - `" y Occupancy 'Ij+pe ❑ I, as owner of the property, or my employees with wages as their sole compensation, ' �•, 1 0 2 — PIERS Required inspections I• • •' • ` °' - -will do'the-work: 'and d:e'suvctum is-not intended or offercd'for'sale (Sec. 7041,_ tBusiness and Professions Code: The Contractors License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself O 3 - UFER or through his own employees. provided that such Tprovcmemss are not intended or ffdred'for sale: If, however, the buildin ar ini' rowment is sold wiifiin'one � ear of •R e P r 'completion, _ 104 - REBAR - °t ' the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 105 - ANCHOR BOLTS M I. as ownernftIreproperty, amexelnsivlycnntmetingwith l,eerrsedcontractorsto 10.6' - SEWER- & ^WP;TER construct rbr prtsjrct Is= 7014, Bus;rrrss and Professions Code:) The Contmcior's License Law does not apply to an owner of property who builds or improves thereon, 2 2 — UNDERFLOOR PLUMBING ' - • - -- ' . and- who.,cOmcrets.for such projects .with. a.contractor(s).licensed pursuant w the. _ 203- _ ' "UNDERFLOOR -- ME}CHANICAL -- - CanUaCLQes License Law. ❑ I am exempt under Sec.' " " ' ` , B & P C for this reason 204 - UNDERFLOOR ' FRAME i ' owner '' -Date - ' — 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING - I hereby affirm under penalty. or Pcfjuq,unc of the followiag declarations: - 302 — TUB & OR SHOWER Cl I hive and will maintain a Certificate of Consent to self-insure for Worker's 303 - ROUGH MECHANICAL Compensation, as- provided for-by Sec2ion -3700 of the Labor Code, for the peiformanccof the work for which this permit isissue& 304 — ROUGH ELECTRICAL C1 I have mid will maintain Workers Compensation Insurance, as required by Section 3 0 5 - FRAME 3700 of the labor Code, for the performance- of the work'for which this permit is 306 - HOEDOWNS isiucd. My Worker's Compensation Insurance carver and Policy number ate: Policy'No• CERTIFICATION OF EXEMPTION FROM WORKERS': - •° 3 0'8 -- L ' SHEETROCK' COMPENSATION INSURANCE' .. _ s.3 09 ,EXTERIOR- LATH ` . , .-- -. �_, Crhiiscciion need'not be completed if the permit is for one hundred dollars , . • 310 - INTERIOR LATH ' (S l00) qr less -) ,. ,, ]certify that in the performance of the work for which thu permit is issued, ..:.- -3.11 _ SCRATCH COAT, shall not em ]o an erso a in an manner'so as to become svb'ec[ to die Workers' P r yP y I.,, ' 313 ROOF NAIL" ""' A nlican[audn Laws of Califomia. Dale " PP p 50 -1. FINAL ELECTRICAL .ENERGY. 502 — FINAL PLUMBING ENERGY NOTICE TO APPLICANT: If, after making this Certifica[e'of Exemption, you should Become subject w the Workers Compensation provisions of the Labor Gods_ you must fdiihwiih comply with sudt provisions or this permitshallbedeemedrevoked, SS03 — •-FINAL MECHANICAL. ENERGY-.__-.__.. 'CONSTRUCTIONLENDING'AGENCY 504 - FINAL BUILDING ENERGY ��' ' ° e �Y . . Performance " '• I herb affrnn lending o,enc for the this permit is issued (Sec 3097, f the work. for whir ci.C505 TR_ ICAL FINAL ELECTRICAL •... _ . Narne' r... - 506'--GAS TEST ;.. _ .,. _ .....- -' . ...... ....... . ..__... _ 507 - FINAL PLUMBING' , Lender's •,'h , I certify that I have read this application and state-that the above infamtation fs •eohi!c[ I agree to comply with all city and county ordinances and state laws relating 508 - FINAL MECHANICAL to building construction, and hereby iuthorize-representatives of this city to enter upon the above- mentioned property for inspection purposes._ 509 — FINAL GRADE (We) $ere to' save, indemnify and keep harml:ss the'City or Cupertido against 51.0 - FINAL ` liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. " • WILL /�-� P F SOURCE REGULDAT O SNDS =AND CO',IPLYLI'1TH ALL'NON- POINT Issued y: Date Signature ppliczm/ ontraetor , ; , ' - ;Date Re -roofs '•,1. , I-IAZARDOUS MATERIALS DISCLOSURE Will! e applicant or future building occupant store or handle lazardous material . . 'Type of. Roof, .. ..... ..... ..... ... .. . ... .... as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code, Sectiori 25532(a)? - '_ ❑Yrs• -, ❑Nn; .. '". ' All roofs sha11 be inspecEed.pr,oz to any roofing material being.znsraIled. . Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit, hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection. Applicant understands and will comply, with °Yes ❑No- all non - point - source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533 and 25534, 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the -- - -- ' occupant of the requiremerus which must be met Prior to issuance of a Certificate of °" °paRey' Signature of Applicant Date All roof coverings to be Class `B" or better , Owner or authorized agent Date . - C' CE OK2 C �u mac ,Sy? s�F-u of :z ;OOat C �LLO� j ce 6OC y AFC a3° O Z C a -> yc 7 Z UC k'' F O:U Fa Uz CI G UOPERTON eat OF PERMIT CONTRACTOR INFORMATION: BIyL,gIp,Gff'E5§ NGE AVE. PERMIT NO. 02020090 AM VEMULAPALLI A45I2:)ffnsffd4 ff2 PHONE: SANITARY NO. CONTROL NO, ARCHITECT'ENGINEER: BUILDING PERMIT INFO . BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm tom 1 inn licemed under provisions m Chapmr 9lcmarmncing ADD 750 J b Descri [IB SQ . FT . e p ,""' �� with Section ]BOBIof°i,tsPon3oRnaBUSmess anaProfesslmisCode,atdmynernse is in full force and effect. REMODEL 1300 SQ. FT. License Cle" Date Contractor 'S APR 0 2 2003 ARCH ITECT DECLARATION 1 understand my plans shall he tied as public mcordn BUILDING Limnmd Professional OWNER-BUILDER to ION rapt fir nt Conte 1 hmas e(S cn that 1 am exempt from the Contractor i License Law for the following reamer (Seaton 7031.5, B, and io Code: Any tiny or county which q alma improve. demolish, innImo.'rap oreasiganystructure $101000 e. o phone t I Try to applicant f such Permit License signed Statement -... Y .__ .. ... .. ___. _...._.. -_ _ $ Ft, Floor Area _ -I, \l �s; 1357 11..1[ 5 OY : bb' Valuation that he is licensed p a s00) s fob Contractors License TUwanx Cad) cone) (commending wmsnt Iman J fah B_sn sandibri The obemfmm and the basis for the An vi or thin he rt an bas alleged gammon Any violation 3 715 3 31.5 b c,,,h - of Section ]031.3 iv any applicant for a permit suhjens the applicanuo a civil penalty or not mnmtnan fi.e hundred dollars asool. APN Number .•.r :Occupancy Type 101 - FOUNDATION 01, as mwner, onne pmpeny,mmy employee, won wages a1 their sale Ima,mr,mion. will do he work. ana the sweid. is not intended 0, offered for ale (Be,. 704,1. Business aria Professions Coale: The Contractor. License Use does not apply to an iU2 — e b Required Inspections y . owner of property Who builds or improves thereon. and who does such work himself 103 - UFER r through of Ihrougn ms own employers. provided that such improvements sold are not to caur or g or improvement sBaaa for sale. v, nowe.er, me building is solo winnin one .�ea< or .. ., - -104 - - REBAR - ofpr rive, fcuc.)r will have the Harden of Proving that he did hat build or i�completion, for 105 - ANCHOR BOLTS pai pry purpnmo -- .106 - - -. SEWER. &.WATER.. -. �Las owner none p(Seeny, era^ eaemsi.ely d P lsoo wiinads:) The Comm es m astmct me proie<t fee<. ]oar. BuaIn «s ana Prot<saaons canna The caataaora 2 02 - UNDERFLOOR PLUMBING t uanseLawdoesnotapplytoanownerofpropenywhobuildsorimproves thareon, 203._. - MECHANICAL, . and who a,mmcis for. such. pomcets..sith.a.contmctmis) licensed.pamuint.to the ....... __ ... _UNDERFLOOR Commodore, License Low. I I 204 - UNDERFLOOR -. FRAME ❑ 1 am exempt under Sec. B &PCforthis.,an .5 2 11IO2 205 - UNDERFLOOR INSULATION 'WORKER'S COMPS AION DECLARATION 301 - ROUGH PLUMBING I hereby af fimt under Penalty of Perjury one of the following declarations : 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL ❑ I have and wiOlmalmwn a Cenifieatc of C.Iarea, to offierme for Worker. Comp<nmomin, as Provided for by Section 3700 of In, Labor Coen far the 304 - ROUGH ELECTRICAL performance of the work for which this permit is issued. 3 O 5 — FRAME FRAME ❑ 1ha. isae will maintain workers Compensation Insurance. asmquireebySection 3700 of the Labor Cede, for the performance of the soWfor which this permit is 305 - NS issued. My Worker's Compensation I,...mea artier and Policy number arc: 307 -- . INSULATION Cams: `. i ;. .., 3 :.Policy Na: .. .. - 3 O 8", � ; F •'• . ' CERTDACA'l OF EXEMPT ION FROM WORKERS' ', .,- COMPENSATION INSURANCE,. ,.-, -_: _ -- —, ,309._.,0 ; . - , . I 'ROCK; EXTERIOR._LATH.. '• ITn seamac< doolxcompleteefthepermit i sforonehundreddollars 310 -- INTERIOR LATH, 5'°°lorless.l 311 - SCRATCH COAT h';. .i r n ry m t the ,pe r one word, for wid<I m' Permit . tsum'I 313 - ROOF NAIL ' •' �''' once m as oe1 4r p� o t the Worked ail n ply �off'liifimr SI L sa LO i compensanonLa r�q �� -- 501 - ELECTRICAL ENERGY � 502 - _FINAL FINAL PLUMBING ENERGY-- '- NOTICE APPLICANt::`1i,��ccn�Ext'p�on, you should liscone, sulrootheWoder 'sCompcnsniion pro visions of the Labor Code, you most at 503 - FINAL MECHANICAL ENERGY forthwith comply wink such provisions or this permit shall b< deemed revoked. _ FINAL BUILDING ENERG t: Ih J •CONSem is a ION'LENDTNG AGENCY' " e tllhohonhcrcii ed( 505 - FINAL ELECTRICAL' 't , Sce .lendinge.Cj,fonfieperformance workfbya sc.. of the work for which this pandit is sestina (Sec. J09], Cie. Ca, 506 -- GAS TEST <na .N L a Ada 507 - FINAL PLUMBING'' thin en dm bs is and 508 - FINAL MECHANICAL yori anmm awsm ti correct. I g e t per he beery and county ordinances oat laws meeting agree city t to conswedpropertyfobyaection 509 - FINAL GRADE uposemauvosofthiscitytoenderupon the enoWo) agree to property for ify an keep purposes, above- fs,judgmets.costsandepensesk hamay 510 - FINAL PLANNING in any way aroma ngainm Baia costs expenses which inthewayacrue against liabilities,nse 514 NA P WORKS &� amen. ran mit. City in consequence of the granting D this perms. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL Ni P TNT ' ^ Issued by: Date SOUR ;REGUI4TIONS. �`! p' - �. 24 n., aLp' Date / Re -roofs HA ZADOUS MATERIA LS DISCLOSURE R r W' ihcap o building ,v t' store ha�rsonsnamt;a I Type of Roof .. ... .. ...::. .. .. ._... .. a; defined by the Cupertino Municipal Cade, Chapter 9.12. and the Health and Safety Code Section 255.12m)? .. f loY ° ' " - t. ' ' All, roofs, shall be inspected prior to -any roofing.. material being installed. Will the applicant or future building occupant use equipment or devless which If a roof is installed without first obtaining an inspection;•I agree to remove dLit horrendous air mnmininants as defined by the Bay Area Air Quality Management District? a/ - • ' l7 Yes ,.. - all new materials for inspection. Applicant understands and will comply with. ,.; . ,• ,. .. � ,. all non -point source regulations: .I _•. , .I ' I have sad the harerdoue materials requirements under Chirpier fi 95 of the ., California Hnhh &Safety Code, Sections 25505.25533 and 25534:1 understandion iflhe building does not currently have a motor, that it is my responsibility to notify be - .. cempe , of me m'tiountems which most be tact prior to issuance of a Cenifdme of -..� ... ... .. ", ..� Q � _ •• Signature of Applicant Date_ � l L � All roof coverings to be Class "B" or better w audind2m ages, ate _' ' _a.. - .. OFFICE 4 CITY OF CUPERI "INO TY OF CUPERTINO � PERMIT APPLICATION FORA, � ),,o Z l 6z 07 00�y APN #' � s Date: � -ice az. Building Address: ! 0 2-7$' 012A 061C A J,E Owner's Name: ✓� UL^P4&Lc Phone #: �O ib,5 0 73317 Contractor: 4:!�a License #:v Contact: Ae4Z.,, N (fN144t--Ac -z- Phone 44 O K3 -7 73 l Applicant/Contractor: , C 1a 1}- ,�Z�C�s -S� Fax M uilding,Penru Info: Bldg Elect Plumb Mech Lion: Residential: 404co Commercial: Sq.Ft_ Floor Area: Sf,- $ /Sq.Ft.: Architect/Engineer: 1 • !Lf Ds�j u.4 �G Valuation: Type of Construction: Occupancy G oup: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUEMING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec. 600V < =1000A ELECTRICAL BELEC1001 Bloc 600V > 1000A ELECTRICAL BELEC200 Bloc Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Add Multi BUn-T)ING BINVESTIGA -Energy Investigation fee BUILDING BMITIGATC Comm. Housing Mt. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWM JLTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING i of alfl� CITY of CUPERTINO 2, 0- ` o �.�TY OF CUPERTINO � PERMIT APPLICATION FO � � Z z� APN 4' � � � � Date: Building Address: /0 Owner's Name: Phone #: 6b!! r733 Contractor: License #: Contact: Phone #: A tlContrlct ash Fax #: Building Pe it Info: Bldg -- Elect Plumb Mech Job De ption/:� esi ential: Commercial: Sq.Ft. Floor Area: $ /Sq.F Architect/Engineer: ation: Type of Cons ction: 4dt- pancy Grou . Quantity Fee 11D Fee Descri tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING . BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V < =1000A ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200. Elec Svcs 600V <= 200A ELECTRICAL BENERG'Y Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMTTIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL DNEWMULTI New Multi - family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Conun Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING I Y� a�.700 hL m U az Vt"1 Q y �N2 ;Zyp n t 3uf¢¢ O a t1 I `•vt� 0y X „4, 2 w — h F" Zx 6 Fee 0.3 ox z° GG W Q V=O W ►.1 G: a [� z (:- CITY OF CUPERTINO -- CONTRACTOR, INFORMAT 1: BUII DING DIVISION g>,E - . BLN'2 °TR RANGE AVE. PERMIT No. 02020090 °� kAM VEMULAPALLI PHONE SANITARY NO. CONTROL NO. ARCHITECTIFNOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L� Q 17 j L—LI LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing l b Description ADD 750 SQ . FT . with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect REMODEL 1300 SQ . FT . License Class Lic. a Date Comractor ARCHITRCrS DECLARATION 1 urderstard my plans shalt be used as public records Licensed Professional OWNER - BUILDER DECLARATION 1 hereby &Turn that I am exempt from the Contractors license Law for the following reason. (Section 70315• Business and Professions Code: Any city or county which requires a permit to ronstmer, alter, improve, demolish, or repair any atrucrore $101000 prior m ifsissuancr, also requires the applicant for such permit to file a signed statement - S q, Ft., Floor Area Valuation to he is)icensed pursudnt to the provisions ofthe Contractors License Law (Chapter 9 ( commepcing with Section 7000) of Division 3 of the Business 4nd Professions Code) or that he ii 6empi thererrorm and the basis for the allegedX;xempdoa. Any violation r 3 5 715'013 . •0 0' ofsectioo 70315 by any applicunt fora permitsubjecu the appficamto a civil penalty of not mare than five hundred dollars (s500). APN Number Occupancy T`fpe 101 — FOUNDATION ❑ 1, as owner ofthe property, or my employees with wages as their sole compensation, — PIER b- Required Inspections will do the work, and the structure is not intended Or offered for We (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself 103 -- UFER Or through his own employees. provided that such improvements are not intended err oHemd Ior said If, however, the building or improvement rs sold within One year of 104 — REBAR completion, the owner- builder will have the burden of proving that he did not build or 105 — ANCHOR BOLTS improve for purpose of sale.). -10 6 — SEWER - WATER - - 1, as owner d'the property, am exclusively conncdng with licensed contractors to ct the project (Sec. 7044, Business and Professions Code:) The Contractors 202 — UNDERFLOOR PLUMBING License Law does not apply to an owner of property who builds or improves thereon, And_whacontracts for. such projects -with a contractor(s) licensed pursuant to the 2 0 3 — UNDERFLOOR M� CHANT CAL _ con=Oes License Law. 204 — UNDERFLOOR FRAME ❑ 1 am exempt under See, B & P C for this reason rher�6 i ' ,g[ �0 205 — UNDERFLOOR INSULATION WORKER s co1dP A ON DECLARATION 301 - ROUGH PLUMBING I hereby afrrmunderpenalt yarperjury one of the following declaradons: 302 — TUB & OR SHOWER ❑ 1 have and will' maintain a CertScate of Consent to serf -insure for worker's 303 — ROUGH MECHANICAL Compensation, as provided for by section 3700 of the Labor Code, for the 304 -- ROUGH ELECTRICAL pmformi mec of the work for which this permit is issued. 305 — FRAME FRAME ❑ I have and will maintain Workers Compensation Insuh`auce, as rrquircd by Section 3700 of the Labor Code, for the performance of [he work for which this permit is 306 — issued. My Worker's Compemsadoo Insur-Ince carrier and Policy nomber are, 307 — INSULATION can;e� R ) . Pn1leyNa. 308,-; •8HHETROCK , CM' MCATION OF EX17.tMON FROM WORKERS' ...• cOMPFgSATO INSURANCE ..3.09. -_ ...EXTER I OR _J ATH ' Crhis section need'not be completed if the perut is for one hundred dollars 310 - INTERIOR LATH (S'0°)°`'") 311 — SCRATCH COAT I'c.66 ihat in the performanceJ�r the work for which this permtt is I ssued. ] 313 - ROOF NAIL •. ' Cam not employ t Laws o�rsl form $�gdaner in aS b orne jrct %the Workers' pens¢ 'tit 501 — FINAL ELECTRICAL ENERGY 502 — FINAL PLUMBING ENERGY - NPOTIC�E'1�APPL1 T: Ir. ter trmakirmg th3is Certificate of Exempuon, you shout become 5u Ire to the Walkers Compensation provisions of the Labor Code, you must 503 — FINAL MECHANICAL ENER PY forthwith comply with such provisions or this permit shat) be deemed revoked. 504 — Y FINAL BUILDING ENERG`1- . coxsmucnoN LENDING AGENCY I hereby afiirT that there is a cousuucdon lending agency for the performance 505 FINAL ELECTRICAL of the work for which this permit is issucil (sae. 3097, Civ. C.) LWders Name •- - • - .. �.. _ .506 - GAS TEST Lende'r's Address - 507 — FINAL PLUMBING ) certify that I have read this application and state that the above Wormaton is 508 — FINAL MECHANICAL ebrrccc I agree to comply with all city and county Dr&ances and state laws relating to building constmctioa;and hereby authorize representatives of this city to enterupon 509 — FINAL GRADE the above - mentioned property for inspection purposes. (We) egrce'to save, indemnify and keep harmless the City of Cupertino against 510 — FINAL PLANNING liabilities, judgments, costs and expenses which may in any way accrue against said 514 NA WORKS City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON•P i �P�� SO REG Issued b y Date 4TIONS, i __ [l � �. 6tJ� a eofApp StaatlCommclor ' • ,Date Re -roofs HAZARDOUS MATERIAIS DISCLOSURE WM the applitant or from boding txeopant store orVw die bar"m mw=W Type of Roof a, dcedby the Cupertino Municipal Code, Chapter 9.1 2, and the Hea1[h an d Safety 1. Cofinde, St0ion 25532(a)? Oyes ' Rio , All- roofs_ shall be,inspected prioz to- any.rodng material being installed. Will the applicant or fume building occupant use equipmert ar devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous ahr wntentrtanss as defined by the Bay Area Air Quality Management Dlsuic:0 all new materials for inspection. Applicant understands and will comply with ' 13 YES ° - all non -point source regulations. 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Wily Cade, Sections 25505, 25533 and 25534:1 understand that if the building does not currently bavea tenant, that it is my responsibility to notify the occupant of the requirements which musr,be met prior to issuance of a Certificate of °CC1 cy. ' a Signature of Applicant ' Date t Ail roof coverings to be Class 'B" or better ,e<authorized agent Date O Wu t�5 ¢ y SNz Oy!2� N: s�i r n`u.�p0 E;za AFC] e a Be • i oz fs7 a �? -UZ U� CITY OF CUPERTINO - CONTRACTOR INFORMA7 14: BUILDING DIVISION PERM . BUILDING ADDRESS: PERIMIT NO. 10225 ORANGE AVE. CHARVEZ CONSTRUCTION 02090039 0�� YMM VEMULAPALLI 360 W 8TH ST A�Lf� 09 06/2002 PHONE: '(4p8) 893 -7693 SANITARY NO. CONTROL NO. ARC ITEC IENG[NEERt BUILDING PERm rwF0 BLDG FlFC1' PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description Lhereby offhrm that I am licensed under provisions of Chapter 9 (commencing With Sccxioo 700b) of Division 3 of the Business and Professions Code, and my license ' REVISION--IN HOUSE USE ONLY Is in fart force and effect. ORIGINAL #02020090 License Class Lic. t Date Contactor REVISION SUBMITTED ON 07/15/02 ( 402070084 ARCHTTECI••s DECLARATION I understand my plans shall be used as public records , Licensed Professional OWNER - BURGER DECLARATION r hereby affirm that I am exempt from the Contractor's License Law for the following reason. {Section 70315, Business and Professions Code Any city or county which requires a permit to consuvct, alter, improve, demolish, or repair any structure • prior to its (ssurmce, also requires the applicant for such permit to file a signed statement - - - - •- -• - -- -- - ,S Ft 1~100; Area. t Jv • • . f 'm 'i $1010 Yiouation that he is licensed pursuant to the provision of the Contractor's license Law (Chapter 9 (Commencing with Seaton 7000) of Division 3 Of the BvsWcss and Professions Code) or that he ii exemp{ therefrom aOd the basis for the alleged eirmptioa, Any violation 5 r i , , � _� { !• : 3 ; t _' ! r 1y., y !; l 3 S.a' -', ; -of-Section 7031.5 by any applicant for a permit subjects the applicant to aeivil penalty of not mDm than Eve hundred doftars (5500). 3 5 7AR1 Nil Occupancy Type Q L as owner of the property, or rry employees with wages as their sale compensation, aired Ins ectlon5 101 - FOUNDATI p ' — wfll"do-the work, and the -structure 1s•not intended crr offered for'sale (sec. 7U44, Busmess•aad Professions Code: ne Contractor's L i== Law does not apply to an owner of property Who builds or improves thereon, and who does such work- himself 102 - PIERS or through his own employees. provided that such improvements are not intended Or - 'oifete3foe sale. If, however, the building or improvement is sold within one year of 103" - OF ER _ ' completion, the owner - builder will have the burden Df proving Cwt he did not build or 104 REBAR improve for purpose of sale.)- — - ❑ I; as owner of [he property, am exclusively contracting with licens canaactars to - _ 1 U5 - -ANCHOR- - - - -- -- construct the project (Sec. 7044, Business and Professions Cafe:) The Contractors 106 — SEWER & WATER License law does not apply to an owner of property who builds Or improves thereon, ' _=d_wbo contracts for such projects with "a contrxuat(s) BcteaW pursuant to the -. - .20.2- -- - UNDER - FLOOR- PLUMBING -- - --- ---- -• - --- - - - - -- - - -- Cona License Law, s E3 1 am exe exempt under Sec. B & P C for this reason 2 0 3 - UNDERFLOOR'- -MECHA:N•I CAL Owner Date 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations. 301 - ROUGH PLUMBING ❑ 1 have and will maintain a Certificate of Content to self -insux for workers 302 — TUB & OR SHOWER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work . for which this pefrgit is issued ". 303 - ROUGH MECHANICAL ❑ I nave and will maintain Worker's Compensation rntarance, as required by section 304 - ROUGH ELECTRICAL 3700 df the Labor Code, for the performance of the work for which this perrtt is 305 - FRAME Issued My Workers Compensation Insurance carrier and Policy Cumber are:, • 306 HOLDOWNS -._.�. Carrier. .• t ' . Policy NO.: ', 3.07 - !INSLTLAT•ION cERnFicAnoNOFExFmrnwFRQMWORKERS coMP>aVSanGrrrtlstrnANLa 3.08 ; — SHEET-ROCK' -- - -- - ' (This section need not be completed if the permit is for one hundred dollars 309 - EXTERIOR LATH ` ($100) or less.) -[ 310 - INTERIOR LATH ' I certify that in the performance of the work for which this permit is issued, shall riot employ any person in any manner so as to become subject td the Workers' 311 - SCRATCH 'COAT ' Compersation taws of California. Date 313 - ROOF NAIL Applicant 501 -' FINAL ELECTRI CAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Fatemption, you shoold became subject to the Workers Compensation provisions of the Labor Codc, you must forthwith comply with such provisions or this permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY _ CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANI CAL ENERGY 1 hereby affirm that there is a construction lending agency for the performance 504 - FINAL BUILDING El�RGY of the work for which this permit is issued (Sec.'3097, Civ. C.) Lenders Name Lender's Address ' 505 - FINAL' ELECTRICAL , 50 GAS TEST I certify that I have read this application and state that the above information is ,loutish. I agree to comply with all city and county ordinances and state laws relating � 5 7 _ I NAL PLUMBING to building construct ion, and hereby authorize representatives of this city to enter upon 5 8 _ I NAL C I CAL the above - mentioned property for inspection purposes. (We) agree to [cost indemnify and keep harmless the City of Cupertino against judgments, costs and expenses which may in any way accrue against said in 5 - I NAL j Citb. co City. in consequence of the grunting Of this permit 510 APPLICANT UNDERSTANDS AND WILL CONLPLY WITH ALL NON -POINT SOURCE REGULATIONS. Issued g - Date SignatumofApplicanUConuktor Date Re- rook'$ HAzAmbus MATERIALS DLSCLOsm Will the applicant or future building oeapanl. store orhandle hazardous material Type of Roof - as defined by the Cupertiho Municipal Code, Cbopter 9.12, and the Health and Safety Code: 2333:(0}} ,• l s • , . .,. ` , , 7 h�; F_% ,- ❑Na • .. sP, s,' :I'? 13 Yes h AlLroofs shall be- inspected prior. to any.roofing.material-being installed.. _ - -. _ Will the applicant or future building occupant use equipment or devices which. If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection_ Applicant understands and will comply with Dyes ❑NC1 all non -point source regulation. I have, read the hazardous materials requirements under Chapter A,95 of the Califomia Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that iCthe building does not currently huve a tenant. that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance Of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorizedagertt Date OFFICE