06030072U
CITY OF CUPERTINO
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BUILDING DIVISIONPERNIIT
BUILDING ADDRESS:
GK CONSTRUCTION & DEVELOP
Nfr NO-06030072
22525 BALBOA ROAD
OWNER'S NAME:
PERMITISSUEDATE
GUNDI RESIDENCE
579 EAST CAMPBE
2006
•E:
SANITARY NO. CONTROL NO.
(408)874-0323
ARCHITECffENGINEER:
BUILDING PERMIT INFO
BLOC PLUMB MECH
O O
LICENSED CONTRACTORS DECLARATION
Job Description
P
I barony affirm Wt 1 w licensed under provides of Chapter 9 (commenting
ode,dmylicemseW
with Section 70t)(1) UacDlvialan7aftheBusinrsaMProfev/riamCan
in ulll—an
32�`ar-��
STRUCTURAL CHANGE IN MASTER BEDROOM, BEAM AND
License 1 s C•7 LW.0
INSTALLING NEW ELEVATOR IN AREA FOR DUMP WATER
Dam9 e/ /- Contraawr_,cr,.,/1'
ARCHITECTS DECI.URATI
1 understand my plans shall he used an public rmaNs
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby afOm that I em exempt from the Cotnctars Llanse Law far the
fallowing mason. (Section 703 1.5, Buslneu W Profevium Cade: Any city or county
which rtgwma a permit on eo erect. alter, harrow. dom.iieh, or repair any structure
prior n its issnsnce, also mquirm the applicant for such permit he Ere &signed sutemem
due Contractor's I1ccnsc Law
Sq. FL Floor Area
Valu 16000
mal he is leaned pursuant m the provisions of (Chapin9
(commencing with Section 7MM of Division 3 of the BudmsuM Pmfrsiaru Cade) m
that he W amount therefrom and the basis for the alleged assumption. My violation of
AL 8mber
Occupancy Type
Section 7031.5 by airy applicant far a permit subjects rite APPIWOL m a civil penalty of
not more than low hundred dollars ($500).
34 40. 0 0
1 tl
❑ 1. as owner ofd¢property, or my employees with wagon u their tele Compensation,
Required Inspections
q ns P
will do the wart and tesaumum WmUmMed or orated formula (Sm. 70/4. Budnss
and Prefesdaru Code: The Comer,. Limen law does rot apply n un Owner or
pmpony who bulla or imputes Nemo. and who does suchwart hwualf or through his
awn employe, provided that such improvements are not intended traditional fur sale If.
however. the building or improvement W mid within arc year of mmpmdon. the ownu-
Indiater will lute the burden of proving that M did ads Wild or Improve for purpose of
arc.).
Q 1, as owner of the property, am escludvely convecting with licensed anbacma in
Construct the pmjecs (Sec. 7044, Business and Professions Code:) The Communes U-
come law does not apply m an owner of propen, who builds or improwa thereon, and,
who emacs, for such projects with a comrmtor(s) licensed pumam m theCanvmnrs
License law.
❑ I am"empt undn See . B a P C far this lease.
Ower Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro or the following declallorts:
1 hum and will maintain a Cenifrau of Consent in self-invert In, workers C.pan-
ado, a provided for by Secvm 3700 al the labor Cade. far the perfomane, of the
work far which this permit u issued.
❑ 1 haw and will maintain Warkars Compensation Insurance, u required by Sectio
.
3./()O of NC Labor Cade, far me peRmra....f the work (orwhich this Permit is issued.
My Workers qompenteation Insuanee carrier use Policy number are:
Carder: lse C—Poliry No_ 177909--tCER
IFICATEO EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
'
(Drusection mcd an, N completed If tie permit is franc hundred dollars (5100)
or les&)
I cenify that In the perfomsoce of the, wart for which this permit Is issued, I shall am
employ any perm. in any miumran m m became subject W the Worker oustan ation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. Nur making this Campari of Eumption. you shoal
became subject to the Warkees Cwpcmdon provisions of the Labor Code, you mm
Comply with such provisions or this permit shall be darned rewind.
CONSTRUCTION LENDING AGENCY
I hereby Nim that there W a eoMrvminn loading agency for the performance of
one work for which rids permit W Issued (Sec. 3097, Ch. C.)
Lender's Num
Landers Addms
I curtly that I have read oris application ma am that the show wramado L
.
coma. I agree m comply with all city and county ortirsnams and soon lave misting m
building construction. and hereby authonle representatives of Nis city to enter upnn are
shove-mantiuned property for inspection purposes.
(We) agree to ave, indemnify and keep hamlets the City of Cupertino against
Iiabllimajudgmem.coats and mpenson which may in any my... against said City
in consequemm of the swung of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date CSG
SOURCERE ULAMONS.
4 oC
Re-roofs
Type of Roof
Signature of Applicam Commnr r DOW
DISCLOSURE
HAZARDOUS MATERIALS
Will the applicant orlumen Wilding aceupamstore urtandle has lous material
a ONmd by the Common Municipal Code. Chapter 9.12 and the Health and Safety
Code, Sectio 75532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yon ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (own building occupant ua equipment or devices which
it hamrdnm all ceuminenn u de0md by the Bay Arca Air QuNty Management
all new materials for inspection.
strict?
❑Yes 0N
1 have mad the haardous materials mquln m mi oder Cleaper G95 Crum Cabral.
nuHalthBSafety Code.Smiau75505,73533 uW 25534.1 contracts that if the Wilding
dao rot evenly haw a terent. dont it u my repo eshilhy m notify sire aeupmt of the
royuimmcnuw'hmuat be met priurw Ltsuameafa Certificate of Qcc mer
Signature of Applicant Date
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All roof coverings to be Class "B" or better
Owner or mthori7eda agent Gone