05010129 CITY OF CUPERTINO .o+,a, ,xss'a" + �'
BUILDING DIVISION PERMIT C, . "'CT,OR INFO.t RMATIO, N, .
BUILDING ADDRESS: _ KRISHNA KIDAMBI pERMITN 05010129
OWNER'S NAME: PERMIT LSBUE DATE
KRISHNA KIDAIVIRT
12
NE: SANITARY OL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C7 O O O
LOZp LICENSED CONTRACTOR'S DECLARATION Job Description
F❑ 1lmmby Orrin Met I am licensed under provisions ar Chapter 9(commencing
<W win Section
'")of Division 3 of Ne Business and Profession nes
Code.and my license^ m full forts and.f7m. DEMO
jE2? Limasc Chis Lic.Or
Z p DateConsumer fn(
'3s ARCHITECTS DECLARATION
to 1 malcrsund my plans shall be umd as public records Irf
leu
.'�G G Licensed Proforckmal ->1 �I, .
i 3 OWNER-BUILDER DECLARATION
<y I hereby from Nat I am exempt rrom U.Cnmracmr's License Law(or the
.00 following armor.(Section 7031.5,Business and profession Calc:Any city or county P65 ,
x$� which".I..a permit m convect alter.impress.demolish,of repair any structure '//
u-toprior m its issuance.alsu mquires Ih.applicant Tor such permit m File a sigacd summeait 999
ti'< mat he is lianacd pvrwan.I.Me provision of th.Cnntmcmra License Law(Chapter 9 Sq. Ft. Floor Afeai l! ,' ' �' , ,( VaIUBC OD
�t-p (commencing with Section 7000)ofDivision 3 of the Busimm and Professions Cade)or L✓ I f
i $ mat he is exempt themfrom and the haze for me alleged exemption.My violation Of
Section]031.5 by any applicant for a permit subjects the applicant in a civil penalty of 3 5q jl4Mb@10 0 " �/ J Occupancy Type
not mom Man live hundred dollars(SSW).
I,az owner of the property,or my employees with wages as Meir sola compensation,
will do me work,and me auuutum is not immaded maffemd(Duel.(Sec.)0,1,1,Business
said Profession Code:the Comarcmts Liana Law does not apply m an owner or Required Inspections
properly who builds or improvuautemon.and whodoeasOch work himself or through his
Own cmplo,cm.provided Nat such improvements are not intended or Offered for sale IL
however,the building or improvement is sold within am ysOr of mmpleuon,the ow.,-
Wilder will have the burden of proving that he did not build or improve for purpose of
raale.).
[3 ,`u owner of the property.am exclusively contracting with licensed eonuacmra to
con41atK1 the project(Sec.20,1,4.Businessand Profession Code:)The Conuumrs Li
cense Law docs not apply to m owner of property who builds or improves themon,and .
whomntra for such projects satire CT f(s)licened pursuant in Ne Conuadors
License la .
0lamci runners ArP C for this reazon
wom 1
(( WORKER'S COM ENSATION ECLARATION
1 hereby afrrm under penalty of perjury ane of the following declaration:
1 haw and will maintain a Certificate of Consent to self-insure for Worker's Compere
-ration,u provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insure n¢,az tequimd by Section
3"of the labor Code,for me performance of the work(or which this permit is issued.
MY,
y Worker Compenalion In..carrier and Policy number tic:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M1ecompleted if the permit is forone hundmd dollars(Stuart
or las.)
I¢reify mat in the perfumunam of in.work Tor which this permit is issued,l shall nut
employ any person in any menncrso as m become subject to the Workers Compcumti.n
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:IL a@r making this Certificate of Esemplion,you should
become subject in Ne Worker's Compensation previsions of the labor Code,you must
O (oMwim comply with such prnvramex or this permit shall he deemed revoked.
zCONSTRUCTION LENDING AGENCY
[r I hereby affirm that then is a comuuction lending agency for me performance of
aMe wish(tar which this permit is issued(Sec.3099,Civ.C.)
14 A Lenders Name
0. z lenders Address
U 0 1 ttnify Nat I haw read this application and state met the above information is
Ly P correct.l agree m comply with all city and county on insrtcn and Mute laws relating to
0U building conuuction.and hereby Brumaire mprexnuliver Or this city to enter upon the
W shove-mentioned property for impaction purposes.
(We)agree to rove,indemnify and keep burnims the City of Cupertino against
rF.,,i liabilities,judgmcnu,costs and expenses which may in any way accrue against mid City
U 7, in consequence of the granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t
SOURCE REGULATIONS.
Re-roofs
Signuum.r ApplianUContractor Date -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant start or handle hamrdous material
as defined by Ne Cupertino Muni al Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)?
Yes All roofs shall be inspected prior to any roofing material being installed.
❑ Nu
Will the applicant or future building occupant uta equipment or dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardous air cmtaminam u defined by the Bay Area Air Quality Managcmcnt all new materials for inspection.
District?
❑Yes Nu
maJ me haaardnus mamrialsmyuimments under Chapter 6.95 of the Glifnr-
tlhavc
&Safny Cade, mra,25505.25533.,125534.Iundcrstandthatifts,Wilding
curtcntiy M1aw n Nat it' y responsihiliry m notify mea port of the
mtswhiehmuat pettnnr yy��van. COuficmcfaapan . Signature of Applicant Date
m\_ jh Tom )j�fro All roof coverings to be Class "B"or better
Owner Of milmiaud., at —, a..7� / /Da¢
LSO
<U,
n>=
Z�G
K�
zf
W�
30
?03
Kac
FZC
EFC
.NR
1
O
zC
a%
aG
U C
UC
FC
U
U`<
CITY OF CUPERTINO
BUILDING DIVISION PERMITC,ONTRACT,OR
INFO.t RMATIO,N, .
BUILDING ADDRESS: _
KRISHNA KIDAMBI
PERMITN 05010129
OWNER'S NAME:
KRISHNA KTT)AMRI
PERMIT ISSUE DATE
NE:
SANITARY OL NO.
wRCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C7 O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Met I am licensed under provisions ar Chapter 9 (commencing
with Sexton 7") of Division J of Ne Business and Procession Codc. and my license is
is full forts and ellen.
DEMO
License Chis Lica
Dam— Contractor
ARCHITECTS DECLARATION
I undcrsund my plans shall W used u public meads
,
r I'
Licensed Prof.rck al
OWNER -BUILDER DECLARATION C.M ION
I hereby License law for the
from Uc Cnnions
Nal 11.
'
affirm exempt
Code:
following mazan. (Section ](131.5, Business and Profession Code: Any city orcountyambire
7R/y5
which toconstruct.Mealter,imparsc.
/, n; r//999
uh Perlia fie a siranyta cement
Us issuance. eLawJ statement
prior m its issuance. also requires duArimusof for such permit o ice (Charter 9
Sq. Ft. Floor Area,l! -!'
Valuaton
s
met hciaBanmep.mu.n„nthepmvlainn:nrmecpn,rarroraLh<�law
Section 7") Division J Ne Businessand Professions Coac) or
,'
✓ I
,,r.�
f
(commencing with of of
Met he u exempt thertlrom and the haze for Ne alleged cxcmpuon. Any rioladon of
,-
3 5q j(4Mb@10 0
�� J Occupancy Type
Section ]031.5 by any applicant for a Permit subjects rhe applicant in a civil penalty of
not mom than five hundred dollars (SSW).
I, az owner of property, or my employees with wages az their sola compensation,
Required Inspections
will do the work, and the nvuoture is not immaded oraRemd (Duel. (Sec. )044, Business
and Profession Code: T m Conuecmrs Liecnu Law dors no, apply m an owner or
property who builds or improwstramon.and whodoeasOch work himself or through his
Own employers, provided Met such improvements am not intended oronered for sde. IL
however, the Wilding or impmwment is sold within am ysar of completion, the ..,-
Wilder will have the hurdcn of proving Nat he did not build or improve for purpose of
s
�ale.).
[3 ,cu owner of the property. am exclusively convecting with licensed conuacmra to
Cnn9r1K1 the Project (Sec. 2044. Business and Professions Code) The Coneracmri Li
cense Law docs not apply to an owner of property who Wilds or improves themon, and
.
whatnot. for such projects withac nvac r(s) licensed pursuant m Ne Convector's
License la .
0Isaaci lumbers &PCfw Nis recon
weer/
1/14
WORKER'S COM ENSATION ECLARATION
1 hereby afram under penalty of perjury ane of the following declaration:
I haw and will maintain a Certificate of Consent to self -insure for Worker's Compere
ration, az provided for by Section 32110 of the labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insursn¢, az mquimd by Section
3200 of Ne Labor Code, for the perrormanee of the work for which this Permit is issued.
My Worker Compensation In.. carrier and Policy number are:
Canis. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need not W completed if the permit is forone hundred dollars (Stuart
or lcsa)
I midfy Nat in the perfurmanee of in. work for which this permit is issued, l shall nut
employ any pnaon in my meaMfan as so mcom..Nbject to ft Worker3 CompcnVtion
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: IL a@r making this Cenificate of Esemp,ion, you should
become subject In Ne Worker's Compensation previsions of the Labor Code, you mus,
fnMwith comply with such prnvismax or this permit shall be dcmaed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that Neu is muc3lending agency for the performance of
mv
s
' work fur which this perms, is issued (Sec. Civ. C.I
Le
lenders Address
1 ttnify Met I hoe read this application and soft Net the &hove inforramun is
' correct. l agree m comply with all city and county on insrtcn and state laws ¢lacing to
building conMuction. and hereby amhorire mpreunutias car thin City to cnmr upon the
d ahove-mentioned property for impaction purposes.
(We) agree ,o save, indemnify and keep harmless the City of Cupertino against
I liabilities,judgmcn¢ costs and expenses which may in my way accrue against void City
' in consequence of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
-
Signature sApplicanuContractor Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building Occupant store or handle hvardous material
u defined by Ne Cupenino Munmi al Code. Chapter 9.12, and the Health and Safety
-
Codc,scction25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
i, havardons air contaminants u dcfmcd by the Bay Area Air Quality Managcmcnl
all new materials for inspection.
District?
❑Yes No
I have mad the Wna ousmamrialsmquimmenuunderChapmr6.95oftheUlifor-
u &Safc"Cod., dons25MS.25533and255J4.1.n&c ndthatifd Wilding
d , curtcn0y M1aw n toit' y mariner , it, o nnufy dm « punt of the
petpnpr yy��aan.
re .ntswmm�mnts
rem ccrdB.amoraapan
j6 rte) j� fro
Signature Dale
\_ a••% / /Da¢
All roof coverings to be Class "B" or better
Owner ser authod'rnd agcm—,