05080079 CITY OF CUPEWFINO
BUILDING DIVISION PERMIT I CONTRACTOR INFORMATION '":
rr a•�.6_. fix_ :d'_.,wf{®�%+S��i'tma'.w .x "�8�«,.�
BUILDINGADDRESS: KRIS KIDAMBI PERMIT NO.O5080079
10060 CARMEN RD
NER'S NAME: PERMIT ISSUE DATE
KRIS KIDAMBI 08/31/2005
PHONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
SLOG ELECT PLUMB MECII
t� 0
_oo LICENSED CONTRACTOR'S DECLARATION
E C 1 hereby affirm Wal 1 am licensed under provisions of Chapter 9(commencing Job Description
b wiNSecuon]IXMBof Dividon Sofdw Business aml Profession Code.and my licensee
�H infull force and mfem REVISION-STRUCT. REVISION TO 2ND FL
j ra 2 License Class Lk.M
goo Dam Comoscan FRAM. PLAN OVER KITCH. /DIN.
^�5 ARCH ECTSDECLARATION NO NEW PERMIT ISSUED/ORIG. ;#04100106
m I undcrwnJ my plans shall W mod as public mcnrds
JS.
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
cr O following mason.(Section 703.5,Business and Pmfenion Code:Any city or county
K w which requires a permit m conswct,are,improve,dcmmksh,or repair any swcture
priar to its issuance,also mquiros the applicant for such permi..o file a signed statement
that he is licensed pursuant to the provision or We Connector's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
&FC (commencing with Section 7")of Division 7 of Oc Business and Professions Code)or $18000
i Nhe bat he Is exempt therefrom and tase for the alleged exemption.Any violation of Y
Section 7011.5 by any applicant for.permit subjcm the applicant to a civil penalty of APN Number Occupancy Type
not marc Wan fisc hundred dollars($500).
I,u owner ofJe pmpmy,mmy employee with wage&vs their sole mmpcwJon,
will W the work and Weswcture is not intended mattered tarsale(Sec.7034,Business
and Professions Code:The Cantracmrs License law don not apply to an owner of Required Inspections
property who build&or improves Wercon,and whodoea suchwark himself or through his
ten employees,provided Nat such improvements are not intended at offered for sale.If.
b.weven We building or improvement is to within mm year of completion.Ne owner
builder will have Ne burden of proving that he did not Wild or improve for purpose of
sale.).
/ \
❑Las owner of ct property,am exclusively contramimg with licensed contractors to `fes
..La c p felt(Sec.7033,B A, and Profcvsions o,0,u pr Contractors Lad
erne La d far
uch apply p an i m property haild&or improvesthereon.and. a�
who con for such prep wi antracmr( d pars......the Contraaah �•`�
Y W.
•I a ramp,under Sec. B P fm this
ter, p j
WORK ER'SC MPFNSATIO ECLARATION
1 M1emby affimr under pwlty of perjury ane of the following declarasian:
❑1 have and will maintain aCenifinm of Consent to self-insum for Worker's Compen-
Milan,AS provided for by section 37th of the labor Code.for the performance of Ne
.,it for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,m reyui cd by Section
3700 of the Labor Code,far the,performmee of the.,it for which Wis permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scetim need no,becompleted if,he permit is rarone hundred dollars(SIM)
nr leu.)
1 cenifv Nos int ykrfarmencc of the work//1[�� r 't ay�acd.l Shall A.
employ any pc any man�r';sdubc[r�Suro,M Wa 'Cmnlrcnaamn
taws of Calif. a.Dam / // //
APPlican. —,I_ , r
NOTICE TO APPOCANT:If.after making this terfificate 6rEx ption,you should
become subject 10 the Worker's Compensation provisions or are Labor Code.you must
.J Z forthwith comply with such provisions or this permit shall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
L. .�. I hemby affirm Nat there is a construction lending agency lot Je performance of
fY the ,it fu,which Nis permit is issued(Sec.7097,Civ.C.)
It1 Isnder's Namc
D• Undcr's Address
�z
U C) I eedfy Nat I ban rad this application and state that the aW ve irr omadiun is
B,P correct.1 agree in comply with all city and county ordinances and state laws mining to
0U building m.tum.and he¢by auJmriae aprexma,iw of Nis city as enterupnn Bac
N Uj ahove-mentiond pmpeny for inspection purposes.
(WcI rte to eve,mdcmmfy and keep harmless the City of Cupertino again!
o-F•t T%j liabili m, gmcnrs.caad and�pe M1ich meyi wayaccrwagains,said Cay
U z in co nee of the turn of th' Pe
APP ANT UNDERSTANDS WILL C P WI ALL NON-P01 Issued by: Date
5D CE REGULATIONS. c A
%be-roofs
Signawrc of ApplicanVCom Dan:
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore Wilding occupant,tote or handle health A material
AS dcfSoc i. the Cupertino Municipal Code.CTapmr 9.13,and IM Health anJ Safety
xmeazssaz(a)7-
OYq ONO All roofs shall be inspected prior to any roofing material being installed.
Will Ne airIx n,or future building occupant use cyuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harammrs air contaminanm u dcfncd by the Bay Area Air Quality Management all new materials for inspection.
Disuict'i
❑Yes ON. .
K
real the hmaNnus ma 'al yuimmc nJerChapmr6.95ofthcCalifor-
nSafety CaM.Sccdon2 tlt y3u3 an 5 .IunMrstand Walirthc ilJing
Jcndy hese a tenant.N s//may rcs n ity m nn ' the scup t of c
dw ymuSslMmctp mrsx.ahe st e 'raa Ocayp ar.A/ p Signature of Applicant Date
b
Owae,m amMri'red&gem - ,m4 All roof coverings to be Class"B"or better
CITY OF CUPEWFINO
BUILDING DIVISION PERMIT I CONTRACTOR INFORMATION '":
rr a•�.6_. fix_ :d'_.,wf{®�%+S��i'tma'.w .x "�8�«,.�
BUILDINGADDRESS: KRIS KIDAMBI PERMIT NO.O5080079
10060 CARMEN RD
NER'S NAME: PERMIT ISSUE DATE
KRIS KIDAMBI 08/31/2005
PHONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
SLOG ELECT PLUMB MECII
t� 0
_oo LICENSED CONTRACTOR'S DECLARATION
E C 1 hereby affirm Wal 1 am licensed under provisions of Chapter 9(commencing Job Description
b wiNSecuon]IXMBof Dividon Sofdw Business aml Profession Code.and my licensee
�H infull force and mfem REVISION-STRUCT. REVISION TO 2ND FL
j ra 2 License Class Lk.M
goo Dam Comoscan FRAM. PLAN OVER KITCH. /DIN.
^�5 ARCH ECTSDECLARATION NO NEW PERMIT ISSUED/ORIG. ;#04100106
m I undcrwnJ my plans shall W mod as public mcnrds
JS.
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
cr O following mason.(Section 703.5,Business and Pmfenion Code:Any city or county
K w which requires a permit m conswct,are,improve,dcmmksh,or repair any swcture
priar to its issuance,also mquiros the applicant for such permi..o file a signed statement
that he is licensed pursuant to the provision or We Connector's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
&FC (commencing with Section 7")of Division 7 of Oc Business and Professions Code)or $18000
i Nhe bat he Is exempt therefrom and tase for the alleged exemption.Any violation of Y
Section 7011.5 by any applicant for.permit subjcm the applicant to a civil penalty of APN Number Occupancy Type
not marc Wan fisc hundred dollars($500).
I,u owner ofJe pmpmy,mmy employee with wage&vs their sole mmpcwJon,
will W the work and Weswcture is not intended mattered tarsale(Sec.7034,Business
and Professions Code:The Cantracmrs License law don not apply to an owner of Required Inspections
property who build&or improves Wercon,and whodoea suchwark himself or through his
ten employees,provided Nat such improvements are not intended at offered for sale.If.
b.weven We building or improvement is to within mm year of completion.Ne owner
builder will have Ne burden of proving that he did not Wild or improve for purpose of
sale.).
/ \
❑Las owner of ct property,am exclusively contramimg with licensed contractors to `fes
..La c p felt(Sec.7033,B A, and Profcvsions o,0,u pr Contractors Lad
erne La d far
uch apply p an i m property haild&or improvesthereon.and. a�
who con for such prep wi antracmr( d pars......the Contraaah �•`�
Y W.
•I a ramp,under Sec. B P fm this
ter, p j
WORK ER'SC MPFNSATIO ECLARATION
1 M1emby affimr under pwlty of perjury ane of the following declarasian:
❑1 have and will maintain aCenifinm of Consent to self-insum for Worker's Compen-
Milan,AS provided for by section 37th of the labor Code.for the performance of Ne
.,it for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,m reyui cd by Section
3700 of the Labor Code,far the,performmee of the.,it for which Wis permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scetim need no,becompleted if,he permit is rarone hundred dollars(SIM)
nr leu.)
1 cenifv Nos int ykrfarmencc of the work//1[�� r 't ay�acd.l Shall A.
employ any pc any man�r';sdubc[r�Suro,M Wa 'Cmnlrcnaamn
taws of Calif. a.Dam / // //
APPlican. —,I_ , r
NOTICE TO APPOCANT:If.after making this terfificate 6rEx ption,you should
become subject 10 the Worker's Compensation provisions or are Labor Code.you must
.J Z forthwith comply with such provisions or this permit shall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
L. .�. I hemby affirm Nat there is a construction lending agency lot Je performance of
fY the ,it fu,which Nis permit is issued(Sec.7097,Civ.C.)
It1 Isnder's Namc
D• Undcr's Address
�z
U C) I eedfy Nat I ban rad this application and state that the aW ve irr omadiun is
B,P correct.1 agree in comply with all city and county ordinances and state laws mining to
0U building m.tum.and he¢by auJmriae aprexma,iw of Nis city as enterupnn Bac
N Uj ahove-mentiond pmpeny for inspection purposes.
(WcI rte to eve,mdcmmfy and keep harmless the City of Cupertino again!
o-F•t T%j liabili m, gmcnrs.caad and�pe M1ich meyi wayaccrwagains,said Cay
U z in co nee of the turn of th' Pe
APP ANT UNDERSTANDS WILL C P WI ALL NON-P01 Issued by: Date
5D CE REGULATIONS. c A
%be-roofs
Signawrc of ApplicanVCom Dan:
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore Wilding occupant,tote or handle health A material
AS dcfSoc i. the Cupertino Municipal Code.CTapmr 9.13,and IM Health anJ Safety
xmeazssaz(a)7-
OYq ONO All roofs shall be inspected prior to any roofing material being installed.
Will Ne airIx n,or future building occupant use cyuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harammrs air contaminanm u dcfncd by the Bay Area Air Quality Management all new materials for inspection.
Disuict'i
❑Yes ON. .
K
real the hmaNnus ma 'al yuimmc nJerChapmr6.95ofthcCalifor-
nSafety CaM.Sccdon2 tlt y3u3 an 5 .IunMrstand Walirthc ilJing
Jcndy hese a tenant.N s//may rcs n ity m nn ' the scup t of c
dw ymuSslMmctp mrsx.ahe st e 'raa Ocayp ar.A/ p Signature of Applicant Date
b
Owae,m amMri'red&gem - ,m4 All roof coverings to be Class"B"or better