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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
4CONTRACTOR4NF, RMATIOON,'
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BUILDING ADDRESS:
CHARVEZ CONSTRUCTION
1E1MITNO.03090238
'R'SNAME:
360 W 8TH ST
PERMIT ISSUE DATE
PHONE:
(408)893 -7693
SANITARY CONTROL NO.
ARCIHJE -CT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
p
1 hereby affirm the. I Am lianscd under provisions of Chapter ( commcncing
with Section 7000) Of Division 3Or the Bisin.. end Prufcathea Cade. and my lice.. is
in Licenlse fame Class d effect, Lie.0
BATHROOM REMODEL
/SERICE UPGRADE
Data Connector
ARCHITECTS DECLARATION
F
1 undcrsunJ my plans shell M recd a public rtcnrds
'�
Liccnud Pndsxiunel
OWNEmexemDER OE CLARATION
pf
1 hereby affirm those Linen. Lew
eaempn from Ne ications
nn
C's
cor.W following mvxon. (Seto.. ]In LS, Business and Profcuium Codc: Any ally Or caumy
1.
which requires a permit to Convect, alter, improve, demolish, or repair any structure
pals to its i ....... Ise, roquive lW applicant for such Tcrmiuo file a signed oncmcnn
that he is licensed Torment n the provisions of the Contractor's License Law (Charter 9
Sq. Ft. Floor
Area J
I LVaAti on
(commencing with Section 7") of Division 3 of be Bminev end Proressiom CMC) or
that he is exempt therefrom and the basis for de alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant ror A permit subjects the appliCML to A civil Penally of
not more than five hundred dollars ($500).
❑ Las Owncrrofnhe propcny, or my employee with wgesutheir sole campenudon,
101 -
FOUNDA)$-AQisid Inspections
will do the work, and the somehow, H not intended oraffcrcd for sale (Sec. 7044. Business
and Professions Code: The Conweroe's Licem, Law does not apply In An owner of
properly who builds or improves themon,and who Eoeamch work himselfor through his
102 -
PIERS
own employ=, provided that such improvements art not intended or offered fortune. If.
lO3 —
UFER
however. the building or improvement is sold within one year of completion, life owners
builder will he. the burde n of proving that W did net build of improve far purpose of
104 -
REBAR
sale.).
105
ANCHOR BOLTS
r1, as owner of the property, am exclusively contracting with licensed contractors to
Lionel the pmjccl (Sec. 7044, Business and Professions Cede:) The Connector's Li.
_
106
SEWER & WATER
tense Law dons not apply in an owner of property who Wilda or improve Merton , and
who farmers for such projects with a contractor(s) licensed pursuant to the Contractor)
202 -
UNDERFLOOR PLUMBING
Lie.. Law.
❑lam exempla ter c. ,B &P for this aso
203 -
UNDERFLOOR MECHANICAL
Date
204 -
205 -
UNDERFLOOR FRAME
UNDERFLOOR INSULATION
WOa e's OMPENSATI +DecL�RA�ION
Ihercby eRtm under penellyo(peju ennhe nTllli wing dealaramm:
301 —
ROUGH PLUMBING
❑ I have And will maintain a Cenifcam of Consent o self.Insum for Worker's Compere
302 —
TUB & OR SHOWER
sa.ion, u provided for by Section 37W of the labor Code, for fie Performance of the
3 0 3 -
ROUGH MECHANICAL
work for which this permit is iuved.
❑ I have and will maintain Warkere COnfrom inn lmuence, As mquimd by Section
304 -
ROUGH ELECTRICAL
37M of the Labor Code, far the performance of the work for which his perm, is Issued.
305 —
FRAME
My Worker. Compensation harem envier end Policy number am:
306 -
HOLDOWNS
Cartier. CERTIFICATE OF EXEMPTION FROM WORKERS'
307 —
INSULATION
COMPENSATION INSURANCE
308 -
SHEETROCK
(Thissectinn nccd not W completed 11 the permll is for one hundred dollars IS 100)
309 -
EXTERIOR LATH
or kss.)
I certify that in the performance of the work ror which file Permit is issad.I shell net
3 10 ,—
INTERIOR LATH
employ any person in any mrtmeru As to become subject tolW WmIeri Compcnsadon
311 —
SCRATCH COAT
Laws of Celifornla. Data
Applicant
313 -
501 -
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. If. after making this Ceniftcate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions Or this Permit shall W deemed emkcd.
502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 -
FINAL MECHANICAL ENERGY
I hereby affirm end there its comWnion lending agency for Performance of
504 -
FINAL BUILDING ENERGY
the work fur which this permit is issued (Sec. 3(197, ON. C.)
Lander 's Name
505 -
506 -
FINAL ELECTRICAL
GAS TEST
Landcr's Add.
I Gentry that I have red did. application and state the. the above information is
comma. l ague to comply with all city and county ordinances and su¢laws relating to
507 -
FINAL PLUMBING
building convection, and hereby authorise rep entations or .his city to cmcr upon the
for Inattention
CAL
FI&&NWG
shove- memioned property purposes.
(We) agree to ea, indemnify and trop harmless the City or Cupenum against
liabilities, judgments, costs and expenses which may in anyway accrue against said City ire
!09
e'er
F I
Coffeepot ofun gran1mgofrompermit.
APPLICA UN ER STAND D WILL COMPLY WIT LL N POINT
Issued by:
KS Dale /
SOURCE, UL IONS.
Re -roofs
Type of Roof
L-
Yrill fAppliceHAZARDOUSMATRIALSDISCLOSURE k
Will the applicant or rut= building Occupant store or handle havardous material
u defined by the Cupertino Municipal Code. Chapter 9. 12. and the Health and Safely
-
send..25533(a)7
❑Yes �HTu
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 ruwm buWing occupant use equipment or devices which
emit hmardons air contaminants As defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes 91N0
1 have mad the hnudtmsmakriais mquimmcnu under Chapterti.95 of the Califon
nix HOAlth &S ly ,Secdom 255 05.25533md25534.lunMnwdthmifNc Wilding
does not curmo y h e enant, at it k my1npensmili y u nodfy 1W oes Pam o the
requimmcneaw ich usl Wmel or to isama Ora Ccnmcateof One um
Signature of Applicant
Date
All roof coverings to be Class "B" or better
owner
a.naaxed agent
v
I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 7743 CARRIAGE CIR I CONS TR CTOOR:iI1 A E I PERMIT NO: 03090238 I
OWNER'S NAME: SANDHYA SURAVAJJALA & V K SREE I IJP V-, I I DATE ISSUED: 09/30/2003 1
OWNER'S PHONE: 4082579045 J U /('_, I PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
License Class / LLic. # "?7`3 L
Contractor _ rJ G�T _CV03C, Date S ^ 2 m \
I hereby affirm that I am licensed underthe provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date^L��'(
❑ OWNER- BUILDER.DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a.Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
JOB DESCRIPTION: RE2SWENTIAL U COMMERCIAL
BATHROOM REMODEL /SERVICE UPGRADE
Sq. Ft Floor Area: Valuation: $7000
APN Number: 35906050.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
180 DA FROM LAST CALLED INSPECTION.
Issued by: Date:5 - 1 -?
RE- ROOFS:
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 all new materials for
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit-hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized age Date O—I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's. Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed