05080275 CITY OF CUPERTINO ° " w�;�3yre ,".d15 t ' 9
BUILDING DIVISION PERNQT CONTRA,GTOR,TNF.0!b_4A'CI0 v"
BUILDING ADDRESS: RENUKA & ROHIT KAPUR PERMIT NO.05080275
OWNER'S NAME: PERMIT ISSUB DATE
RENUKA & ROHIT KAPUR 20931 GREENL 2005
E; SANITARY NO. CONTROL NO.
ARCHITECryENGINEER: BUILDING PERMIT INFO
r 1 ELECTO PLUMB MECHO
O o LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby nation that I un licensed under Provisions of Chapter 9(commencing
with Section 70100)of Division Sof the Businesand Profenslona Cairmid my livens is
In full farce tied effect SFDWL-2 STORY (3619 '. -LIVING SPACE)
'z Llate Clm Com GARAGE-772 '
Das G'S DECLARATION ARCHITECT'S DECLARATION
I unMrsund my plow shall W used a public records
h� Licensed Professional
OWNER-BUILDER DECLARATION
<I I hereby affirm(fnm Nal 1 1. exempt Imre the Cnnlncmr's License Lew for the
too following moon. emit u710L;BWner. and Pm,demolish.
Calc:Any city or county
which its Issa•mlmit recurs ft alter.Wpmw,h permit us
me a sig mystructure
print teiuiansedim also requires Novisio antsof for me onnatonttmfilncto La (Chaptem
< (announccevedpumunt to the prorieionao ofineButruess icvlcumns Code)
Sq.Ft. Floor Area Val$Qlb®330
FFG
(announcing it ioneSectfon ous and of hands for
theaeged moaandm,Any
ladon of
3�
that he b exempt Nesfmm and Ne buts(ar Ne elf{N emmpdarl.Any Notation of
Section 7031.5 by my applicant for a perm ll subjects the applicant m a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollen 43001. 32609013 . O O
❑L u owner of Ne property,a my ernpiryn"with W.Va.Neo cele eaonpewation,
will do the work and the awclue 0 not intended in offend for ale(Sec.7M,flusiwu Required Inspections
and Pmfeuiaw Code:The CwuanoYes License Law does not apply m in owner of q P
property who bu ilds a Improves hessian.and who does such work himself ar through his
hown owever.IM
thatavehlmprowmenummol year
of
lased fm Well �'�����
bawd.,Nebuildingor ImProwmentisanldwithinorcyeti of mmoveI.le ownaP
builder MB Nw the burden of proving Wm he did na build or improve for purpose a(
sale,).
" u
u owner of the property,em exclusively contracting with licensed contractors lo
mutt the project(Sec.7044,Business and Profusions Cade:)The Dominate.U. AUG f
"me law docs not apply m an owner of propeny.wha Wilds or bmprows thereon,a d 2(Ig1C
who contracts for such projects with a contractorW licensed punwnm m the Conuaaror's V t!'J
License law.
❑lam uemp oder See As. tsar Nisrwon BUILDING
Owns te
WORKER'SCO 'ENS ON RATION
1 hereby of ton under a./,y of perjury aro of Ne following declarations: .
1 haw and will maintain a Cerifiara ofConsm to aelfdnmre for Wenices Coni
cation,as provided for by Section 3700 of the labor Cade,for Ne performance of Ne
work for which this permit is Issued. `
❑1 have and will maintain Worker'{Compensation btsurance,as required by Section
3700 of the labor Code.for Ne performance of the work for which this permit is Usued.
My Worker's Campensulan Inaunnce canter and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
frits section need not be completed if the permit Is parent,hundred dollars Dili)
or ins.)
I unify that in the performance of the work for which this Permit is issued,l all not
employ anyperson in any mmnar an u in becwnesubjmt to dte Works tion
L{wsof CatifomiA in
Applicmm
NOTICE TO A CANE:If.efmsir m g Nis si Eaabor Co,you should
.J Obmomeh comp te the Worker's Co done virions of the tabu Code,you mwt
forthwith comply with such provisions or this pennluhatl be deemed invoked,
'Z ^ CONSrRUCrION LENDING AGENCY
[•w Ihereby a aim Nal Nem is a construction lending agency rot Ne performance of
C the work fee which NU permit Is issued(Sae.3197,Civ.C.)
CLender's Name ,
,7 Z lender's Address
V Q I certify that I have teal Nis application and mm that the above information is
comem I agine to comply with all city and county molumbma and sum tsw miming he
Q rU^ building construction.and hereby Wolverine representatives of this city to enter upon Nc
Sia eh w-mation id property for Wpection purposes.
gh (We)agree to saw,indemnify and keep harmless the City of Cupertino against
fA Ilabilidea,judgmt,nu,cosu and expt,naes which may in my nay sense against mid City
I.
of
C) APPLIC Nr UNDEence of the RSfANU AIs Permit.
ND WILL COMPLY WITH ALL/NON- INT Issued by: Date 40- 1
3 D�
SO EREGU 710L' //D/
Slgnuum o(ApplimntlC USlor I Ql •If/o�3 Re-roofs
0.DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupnni t om arhandle hnyallous maeriai
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �Nu
Will the applicant or fusion Wilding omupant use equipment sir derive which If a roof is installed without first obtaining an inspection,I agree to remove
mit Wartlnw aircalWninanu as defined by Ile Bay Ams Air Quality Management all new materials for inspection.
District?
❑Yes *No ,
Ihow mal
Nsihuardnuerequirements rChapterdo(Ne Cal
cele :SafnySectius25305.2553and 25534,1 undernmdmeicbuilding
does notcurrently haw aanent that It is my resmnalhilhy,te ratify the,occupant of dhe
reyul cnuwhichmust metpdorloisavanccafaCeninceso (ce panty Signature of Applicant Date
Owner or authorived ae t I I Dim All roof coverings to be Class"B"or better
y