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02080165o,,ITY C�UPERT NO D Mo EMO C 0� PERMIT A LI ONFORM 02 OF 016Y- APN Building Address: 7 (owner's Narne: 0M GUN DAVATHAL-A Phone -400)a5;-� ontractor: UPI; RIIIIi'' IS, ,,,, License#: Ut I In licant/Contractor: rech Sq.Ft. Floor Area: 13OL gift, Architect/Engineer: it) Yec L(t) /W, OL (VER C Type of Construction: y -Group: Fee ID Fee Desg tion Fee Group Bldg Permit Fees MEMO BSEISMICOM Seisrnic Commercial BSEISMICRE BPLANCHK Business License 0 Z Z C rte.'. Z UC ;14 0 0-4 Uz CITY OF CUPERTINO 7�1 BUILDING DIVISION PERM11 - BulQ)1i646ES_TEVENS CREEK BLVD EVERGREEN DC CO PERMITN92080165 I owAUV4D GUNDAVAJHALA 6619 DANRIDGE DR. APPL`c`T(Y8sP"TJ 2 0 0 2 �HONE: (408)887-0186 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby I licensed Chapter 9 (commencingJob Description affirm that am under provisions of DEMO with Section 7000)ofDivision 3 of the B/umess and Professions Code, and my license is in full force nd effect.,P, Lice.s� Date A_1.5T��Contucto(Ct�1.7, ARCHITECL.,D '.Sro ARAT16N s as nde 1141 so as public records ,A T—Sta "t T — Licensed Professional 0 -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the $5000 following reason. (Section 7031.5, 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 for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 3,-bq7flt6M" A&G Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of _LNbPEUT_L(_)N,3 Occupancy Type not more than five hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). C] 1, as owner of the property, am "elusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. Of am exempt under See. B & P C for this reason Owner Date — WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: M I have and will maintain a Certificate of Consent to self -insure for Worker's Comp'n- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work fintich this permit is issued. My Worker's Cgppensation Insurance carrier and Policy-miXerare: Crripal 1S::rX)7 :7�lz — Policy No.: CMTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ I00) or less.) I certify that in the performance of the work for 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 Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See, 3097, Civ, C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITEI ALL NON -POINT Issued by: Date SOURCE REGULATIONS. 0 �e-roofs Type of Roof '9tAppiktittlContractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 E] Yes '�Nci All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection. 0 Yes 4--N. I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia 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 h occupant of the notifyrequErc =.pruy. ms why m I t cmf,.� of >6 Signature of Applicant Date All roof coverings to be Class "B" or better "b w Or4'rr authorized agent ate 4 ASB E57 ES79 RNC. 1550 Dell avenue, Suite G Campbell, Ca 95008-6912 (408) 374-3362 Fax (408) 374-7269 ANAND GUNDAVAJHALA 22484 RIVERSIDE DR. CUPERTINO, CA 95014 PROJECT: 21836 STEVENS CREEK Sample Identification 1 KITCHEN/ BEDROOM FLOORING, TOP LAYER 2 KITCHEN/ BEDROOM FLOORING, BOTTOM LAYER 3 PLASTER 4 STUCCO ASBESTOS IDENTIFICATION BY POLARIZED LIGHT MICROSCOPY Fibrous Asbestos Other Fibrous Minerals, % Materials, % May 21, 2002 Job No. A-25604-02 Non -Fibrous Materials or Minerals, % NONE FIBERGLAS, BINDER, 60% DETECTED ORGANIC FIBERS, 40% NONE ORGANIC BINDER, 65% DETECTED FIBERS, 3% NONE NONE SAND, BINDER, DETECTED 100% NONE NONE SAND, BINDER, DETECTED 100% This test report relates only to the items tested. The materials were examined by polarized light microscopy according to Environmental Protection Agency methods. Reported asbestos percentages were estimated based on comparison to test samples provided by the EPA. Samples will be stored for six months and then properly disposed unless prior arrangements have been made. Respectfully submitted, ASBESTEST, INCORPORATED Robert M. Kumagai Microscopist CAC 92-0841 1 U a:aQ Z ^ OW SZ I{II m 0 i 3niN3A'V 0 vavNvO N N W N N < 0 e1 ca of ;;,A � ® S. '92!A oe ' ' e ' on Bb u ware iira'} Dodi oiai: O1 0 � osaia �• � b�nai qYtl•£f6�1E1 �A��lAB �.. � ss ndNs isicsm ' o•e� )433u3 sN3A3.LS L ° c1 O �LZ:ii ZO 90 Dnd 8 VLO96 HINHOSIVO 'ONI1.ti3dno ! <^ =h 08VAinos N33HO SN3A31S 989LZ i L �; r a 4u 3a<� <assa �yoM ! o V-IVHrVnV(3rvnE) 'saw 's awI a " " �N3td 473 L6X5 ca av F. l✓C':. XXL' �" �'✓ U� ' M r �"'�y ' �K XX\ �ry! i d G lihn <� iH a�C aaa aaa �a""" v p wla- � - smm �gz am w ms " uy Nsaws Pgi!4 xVqg ix ii" �m zs n �� =�V�� o�W`" F— six Sas x � 4 §-P m9 1 a ma a< m jXO H a p s i K096 VINHOA-WO 'ONLLu3dno OUVAInOB >13380 5N3A318 9C86<'. 3ON301038 VIVHrVAVC]Nn!D 'suvq v uvq ----------------------------- -------------- - - - - - - - ----- - - I h ---------- I L --------------------- All" nVn • I `CITY OF CUPERTINo CONTRACTOR INFORMATION f BUILDING DIVISION PERMIT Btu )!W33d6rsS^TEVENS CREEK BLVD EVERGREEN DC CO PERMITN92080165 owANAND GUNDAVAJHALA 6619 DANRIDGE DR. APPLICATOASSP"T/2002 ONE: (408)887-0186 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby 1 licensed Chapter 9 lob Description p affirm that am under provisions (if (commencing DEMO with Section 700(y of Division 3 of Ne Business and Professions Code, mad my licenx is infill lore rad effect. Liccnse}css Doth_ m RCI1117iCl'SD1'SD LARATI N wta_n pl,ns sbau as pmnlm raom.x n 1,¢cnsc1nrlcsnonal O : -BUILDER DECLARATION ON Contractors I beast .(rem that 1 exempt from the CnmractCo License Low for the $5000 t. Code: Any city nr runty my (Section PULS. Business and Pe. ire derions a. which requires nmmrthe alter, improve, demolish, or repair any structure which rtyuircs a permit re prier to its issuance, also requires the applicant for such Permit flees signed statement 3ffq7 �t6IF16t$A@0 Valuation thathewitpu.tion70she provisions of theContractor'sLicense Law (C usinora Code) (commencing with Section Iladd of Division 3 of the ass and professions Coda or Nat he u exempt therefrom tend the naso for Nc alleged assumption. Any violation of eged A Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more Nan five hundred doll.. (5500). ❑ 1. se, owner of the property, or my employees with wages as their sole compensation, Required Inspections wil I do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The contracmrs Licenx Law doea not apply to an owner of property who builds or improves thereon. and who does such work himself or through his ewn employees, provided Boarish improvements arc not intended or offered for sale. If. however, the building or improvement is cold within one yvu of completion. the owner. holder will have the burden of proving Ban the did not wild or improve fur purpose of .ale.). iso ((F 1, as Owner of the property, am exclusively contracting with licensed contactors to construct the project (Sec. 7(M, Business and Professions Code:) The Contracmrs Li O cense Law does not apply to an owner of property who builds or improves Neeson, and !k who contracts for.mch pointers with 0 comraeNrad licensed pursuant m the Contractors License Law. V ICE 1 em exempt under Sec. , B & P C for this reason V�1 Owner Data WORKER'S COMPENSATION DECLARATION t 1 herehy affirm under Penalty of perjury one of the following declarations: I have Bad will maintain 0 Cenlllemle of Consent to self-Insom for Workers Gnmpen- ' ration, as provided for by Section TING of the Labor Code, for the peforinance of the work for which Nis Permit is issued, ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for w ich this permit is issued. My Worker's Compensation Insurance carrier and Policyberere: � Ctmy�� Policy O d C RTIPIC O EXEMPTION TRAM WORKER /r OMPE COMPENSATION INSURANCE pins section need not hecompleted if the permit is foronc hundred dollars (kltk0 or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any Person in any manner so as or Itccomc suhjccun the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making Nis Cenifrcate of Exemption, you should become subject to Ne Worker s Compensation provisions of the Labor Coale, you must forthwith comply witn such provisions or Ibis permit shall M deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the perfuemance of the work for which this permit i.s issued (Sec, RAD. Civ. C.) Lender's Name Lender's Address 1 cenify Nat 1 have read this application and awe that the phase information is correct. I agree to comply with all city and county ordinances and sure laws relating to Wilding construction, and hereby aOhome representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to ave, indemnify and keep harmless the City of Cupertino against liabilities, judgments. casts and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. yy Olze-roofs � "tf S' r rJfAppl s Dam,/- HAZARDOUS MATERIALS DISCLOSURE. Type of Roof Will the applirmu m future huilding acuPant stem or handle hazallous material as defined by the Cupertino Municipal Cafe. Chapter 9. 12. and the Healthand Safety Crile, Section 25532(a)? , All roofs shall be inspected prior to any roofing material being installed. ❑Yes `pl No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant useaptipmcm or devices which a hazardous air conmmi nems as defined by the Bay Arca Air Qual ity Management all new materials for inspection. osblct? ❑Yes 1Ws I have mail Ne Imardous materials requirements under Chapter 695 of the Califon at. 11.10 S, Safety Cede. Seetsons 25505.25533 and 25534.1 understand that if the huilding' does not cuucmly have remit. Our a is my rexpnnsibility nnanythe occupant of Nc reymre rats wnicllAr r t m seance ofa Ccnifc of Wcupancy, y�ry/�" A--)" Signature of Applicant Date " -� ' ij L All roof coverings to be Class "B" or better Owafr-Ifir authorited agent at� c