04100106 CITY OF CUPERTINO + 1v ,,„
BUILDING DIVISION PERMIT CONTRACTOR INFO MATIQ
BmLDlac eoDRFss: KRISHNA KIDAMBI PEaM1TN 04100106
OWNER'S NAME: PERMIT ISSUE DATE
KRISHNA KTDAMRT
NE: SANITARY OL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
80 Z' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I m IIaMW under Provielons of Chapter 9(commencing Job Description
n� with Section 7000)of Division 3 of Ne Businesaaed Professions Code.and my license is ����.�■�T�,VT `T�raaa
I.full farce and coca I. .. R�0"D
Ucense Clan Lle.N SFDWL-2 STORY (3629
ON Dete comncur GARAGE 441 SQ. FT
ansCHITERS DECLARATION
'� lundcrmnd mY PbM mall the used upublic rccoNa )
a Licensed professional NC"/ 0 �IJ'.IU(�f7L�
OWNER-BUILDER DECLARATION
I I bemhy affirm Nat I am exempt from the Contractors License law for the
O O following moon.(Section 7031.5.Business and Pmfealons Code:My city or county gal III (31h jd=
$1 which myuiru A permit um co.1 alter,improve,demnitsh,or repair any wuctum
F- 19 prior m i%issuance, but no ares led applicant for such permit b file a signed moment
qqqq < thatWLLlicensed purwan,totiteprevision ofthe Carmen',LlconseLaw(Chapmr9 Sq.Ft.Floor Area ua[ion
O (commencing with Section 7000)of Division 7 of the Business and Professions Cnde)or
B$ that he is cumin Nerefmm and the basis for the alleged eaemptial Any violation at
Section 7031.5 by any applicant Ins a Permit subjects the applicant in A civil Penalty of APN Number Occupancy Type
out more than five hundred dolloos 000).
D I.as owner of the pmpmy,or my employees with wages As their sole compensation,
will do the work and themuadem Isnot intended or offered for sale(Sm.7014,Business1 OO Required Inspections
atmd professions Cade:The Conuanars License Law does not apply to an owner of -3b /090 q P
property who bWlds ser improves thencnn,and who dm..h wart himself or through his
own employees.provided that much improvement,me notlnuMed or offered forsale.It.
however,to building or improvement issold within one year of completion.the owner,
Wilder will have the burden of proving that he did not Wild or improve for purpose of
[�1.As owner of the proper,,am exclusively contracting with licensed contracts Is
construct not Project(Sec.7014,Business And Pmtessioru Code*The Conaactnrs V-
corm Law does not apply m an owner of property who Wilds or improver timtum.ad.
who crmmLLmsuch projects with coMactor(a)licensed pursuant N We CMUactora
Limmue
❑lam emp,antler Sec. kP for IT n
I
er ea S OWORKER'SC MPENSON ECLA0.ATIONI hereby affm under penalty of perjury one of time following declemdons:
ham end will rnmmuin•Certifiate of Consent u self-Iasum fn,Work esCompen-
n,u provided alar by Smile.3700 of IW Labor code.far dte perfmmace of the for which this permit is Issued.have end will maintain Wmkces Compenation Insurance.u required by Section
of Ne Labor Code,far Ne performance of Ne work for which Nis permit is Issued.
Workers Compensation Imurutee abler ad Policy number art:
m Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS
COMPENSATION INSURANCE
(Nis section need not W completed If the permit is f sonehundred dollm(f 100)
or Ws)
1 certify that In the perfmmace of the work for which Nis permit is issued.I shall not
employ Anypenon in any manner an As N becomesubject to the Warkeri Compensation
Laws of California.Dau
APPlkmn
NOTICE TO APPLICANT:IL after making this Continuum:of Exemption,you should
become subject to the Worker's Campaasanion provisions of Ne labor Code,you sun
.JO forthwith comply with such provisions or this Permit shall W deemed revoked, '
q 2 CONSTRUCTION LENDING AGENCY
(•n I humhy affirm that then is a construction lending agency for the performance of
C> Ne work for which this panni,is issued(Sec.3M.Civ.C.)
QLenders Name
Z)Z Lenders Addam
U Q R certify that 1 have mad this application and mu that the Above information is
IL ! correct.l arra to comply with all city and county amlnaces and seats laws mining to
0 Wilding construction,and hereby authodm mpresenmives of Nis city to enter upon the
t2l abow-mentioned property for Inspection purposes.
y (Wc)agrce in ave.indemnify and kap hamlets the City of Cupcnino against
in
liabilities,judgments,costs and expenses which may in any way acctue against aid City
APPLICANT UNDEof the Ri of I
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -ZS OS
s pennit.
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of Appliacur Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
or future building e.eaccuprant ram or handle Health ad
As defined by the CupeNno Munleipel Code.Chapter 9.13,and the Health atl Safety
Cnde.s«tianls533fa)7 ( All roofs shall be inspected prior to any roofing material being installed.
DYu Ly rvu
Will the applicant or future building ocoupam use equipment or devices,which If a roof is installed without ftrst,obtaining an inspection,I agree to remove
mit haardcus air moo minanLL as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District? �
Dy" 91N. .
w
tLhave roW the luamnuameunals myvimmcnLL under ChaPter6.95 of the Celifor-
niabb&SaAuyCodc,&ti 550535and 25534.11 maim and thr ifthe Wilding
t cunen ly haw a te a that It u y espmedhilit henotifydooccupantofdm
mens which mus, et Pnyr to sraMofa/r£5r rke.eorom' Signature of Applicant Date
Owner or soman:Ada e t Data P All roof coverings to be Class"B"or better
_ _ U
CITY OF CUPERTINO + 1v ,,„
BUILDING DIVISION PERMIT CONTRACTOR INFO MATIQ
BmLDlac eoDRFss: KRISHNA KIDAMBI PEaM1TN 04100106
OWNER'S NAME: PERMIT ISSUE DATE
KRISHNA KTDAMRT
NE: SANITARY OL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
80 Z' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I m IIaMW under Provielons of Chapter 9(commencing Job Description
n� with Section 7000)of Division 3 of Ne Businesaaed Professions Code.and my license is ����.�■�T�,VT `T�raaa
I.full farce and coca I. .. R�0"D
Ucense Clan Lle.N SFDWL-2 STORY (3629
ON Dete comncur GARAGE 441 SQ. FT
ansCHITERS DECLARATION
'� lundcrmnd mY PbM mall the used upublic rccoNa )
a Licensed professional NC"/ 0 �IJ'.IU(�f7L�
OWNER-BUILDER DECLARATION
I I bemhy affirm Nat I am exempt from the Contractors License law for the
O O following moon.(Section 7031.5.Business and Pmfealons Code:My city or county gal III (31h jd=
$1 which myuiru A permit um co.1 alter,improve,demnitsh,or repair any wuctum
F- 19 prior m i%issuance, but no ares led applicant for such permit b file a signed moment
qqqq < thatWLLlicensed purwan,totiteprevision ofthe Carmen',LlconseLaw(Chapmr9 Sq.Ft.Floor Area ua[ion
O (commencing with Section 7000)of Division 7 of the Business and Professions Cnde)or
B$ that he is cumin Nerefmm and the basis for the alleged eaemptial Any violation at
Section 7031.5 by any applicant Ins a Permit subjects the applicant in A civil Penalty of APN Number Occupancy Type
out more than five hundred dolloos 000).
D I.as owner of the pmpmy,or my employees with wages As their sole compensation,
will do the work and themuadem Isnot intended or offered for sale(Sm.7014,Business1 OO Required Inspections
atmd professions Cade:The Conuanars License Law does not apply to an owner of -3b /090 q P
property who bWlds ser improves thencnn,and who dm..h wart himself or through his
own employees.provided that much improvement,me notlnuMed or offered forsale.It.
however,to building or improvement issold within one year of completion.the owner,
Wilder will have the burden of proving that he did not Wild or improve for purpose of
[�1.As owner of the proper,,am exclusively contracting with licensed contracts Is
construct not Project(Sec.7014,Business And Pmtessioru Code*The Conaactnrs V-
corm Law does not apply m an owner of property who Wilds or improver timtum.ad.
who crmmLLmsuch projects with coMactor(a)licensed pursuant N We CMUactora
Limmue
❑lam emp,antler Sec. kP for IT n
I
er ea S OWORKER'SC MPENSON ECLA0.ATIONI hereby affm under penalty of perjury one of time following declemdons:
ham end will rnmmuin•Certifiate of Consent u self-Iasum fn,Work esCompen-
n,u provided alar by Smile.3700 of IW Labor code.far dte perfmmace of the for which this permit is Issued.have end will maintain Wmkces Compenation Insurance.u required by Section
of Ne Labor Code,far Ne performance of Ne work for which Nis permit is Issued.
Workers Compensation Imurutee abler ad Policy number art:
m Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS
COMPENSATION INSURANCE
(Nis section need not W completed If the permit is f sonehundred dollm(f 100)
or Ws)
1 certify that In the perfmmace of the work for which Nis permit is issued.I shall not
employ Anypenon in any manner an As N becomesubject to the Warkeri Compensation
Laws of California.Dau
APPlkmn
NOTICE TO APPLICANT:IL after making this Continuum:of Exemption,you should
become subject to the Worker's Campaasanion provisions of Ne labor Code,you sun
.JO forthwith comply with such provisions or this Permit shall W deemed revoked, '
q 2 CONSTRUCTION LENDING AGENCY
(•n I humhy affirm that then is a construction lending agency for the performance of
C> Ne work for which this panni,is issued(Sec.3M.Civ.C.)
QLenders Name
Z)Z Lenders Addam
U Q R certify that 1 have mad this application and mu that the Above information is
IL ! correct.l arra to comply with all city and county amlnaces and seats laws mining to
0 Wilding construction,and hereby authodm mpresenmives of Nis city to enter upon the
t2l abow-mentioned property for Inspection purposes.
y (Wc)agrce in ave.indemnify and kap hamlets the City of Cupcnino against
in
liabilities,judgments,costs and expenses which may in any way acctue against aid City
APPLICANT UNDEof the Ri of I
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -ZS OS
s pennit.
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of Appliacur Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
or future building e.eaccuprant ram or handle Health ad
As defined by the CupeNno Munleipel Code.Chapter 9.13,and the Health atl Safety
Cnde.s«tianls533fa)7 ( All roofs shall be inspected prior to any roofing material being installed.
DYu Ly rvu
Will the applicant or future building ocoupam use equipment or devices,which If a roof is installed without ftrst,obtaining an inspection,I agree to remove
mit haardcus air moo minanLL as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District? �
Dy" 91N. .
w
tLhave roW the luamnuameunals myvimmcnLL under ChaPter6.95 of the Celifor-
niabb&SaAuyCodc,&ti 550535and 25534.11 maim and thr ifthe Wilding
t cunen ly haw a te a that It u y espmedhilit henotifydooccupantofdm
mens which mus, et Pnyr to sraMofa/r£5r rke.eorom' Signature of Applicant Date
Owner or soman:Ada e t Data P All roof coverings to be Class"B"or better
_ _ U