08030017 CITY OF CUPERTINO
BUILDING DIVISION PERMIT "'CC11Rly.CTQRI1�iI`f}RMt�x7¢�1`I ".
BUILDING ADDRESS: PERMIT NO.
22320 KENDLE ST TBD - TO BEDE1'ERMINED 08030017
NEWS NAME: PERMIILYUEDATE
VINOD PERIS 04/08/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTTEC rENGINEER: BUILDING PERMIT INFO
' ADDTN OF 43SQFT(LAUNDRY)RMD BLDG EO PLUMB
MECH
O
O O LICENSED CONTRACTOR'S DECLARATION
�uI hereby SEEMS Net l un licensed under provisions of Chapter 9(commencing --^^-^_ -. Job Description
wit Secdon 7001B of Division 3 ofte Business and Professions Code,and my license is
^< in full face and effeeL
License Class Ue.g
n F Dato Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
:tyU
god Licensed Professional
5 5 to[I am exempt R DECLARATION
Contractors
Z 2 0 1 Malo alarm Not 11. .Bumps from he Canlramoo e:Any
Law,for the
1 e O! following mason.(Section BOOMO!,Business and w,de un Cale:Any city or county
which requites Issuance.pmmh re cmmwc4 ells.improve,demolish, Il repair any swcer,
goMat heor Miuumodmuantso to Movisithe applicant for aschpermittofensek a,Law
-�G Nat me cingwiit Sccd n la Oe pro vision of tiro Contractors ld elaw(Chepur9 Sq.Ft.Floor Area Valuation
�s (Commencing IS axe pt hcrefrom and
Weof basis
f r of We aRnpud en and n.AnyProfession,Cndon or
Net he ts exempt Nerefmm and Ne baso(or We alleged exemption.Any violation of
Secdon 7031.5 by arty APPI]nl for a permit subjects to applicant to a civil penalty of - APN Number Occupancy Type
not mme than five hundred dollar($500). P Y YP
❑I,uownerof Omproperty,ormywployenwitwagenneirmmcompe don,
will do Newark,and We structure is norinteMed or offered forule(Sec.7 'Businus Required Inspections
and Profession Codec The Commutes Licences Law docs not apply m an owner of q p
property who builds or improves thereon,and who does such work himself or Nmugh his
awn employee,provided that such improvements am notimmnded aroffered forsam.if.
however.the building or Improvement I.mid wants ane year of completion.We owner-
builder will have to harden of Moving Nat he did not bkld or improve for purpose of
sale.).
.
as ownm of the property,am exclusively contracting wish licensed conaadom to
ontmct to project(Sec.7044,Business and Profession Code:)Ile Contractor,U.
cense law does not apply to am owner of property who builds or improves thereon,and,
who contmcis for such projects wit a commands)licensed pursuant to We Contractor's
Lice.law.
❑I mss exempt under Se //�/y�q—, ,f—,B&P C for N s Mason
i
r z � Dam o
PEN CLARATION
1 mmby affirm under penalty of perjury one of tiro following declarations:
❑jhawandwillmainWna Ce r3mmof Consenuowlf-insumforWarketsCanpen-
astm.ex pmvided for by Section 3700 of to labor Cods,for We performance of We
work for which Nis permit is indent.
❑I have and will mainland Workers Compensation Insurance,as required by Section
3700 of We Labor Cade.for to performance of to work for which Nis permit is issued. '
My Workers Compemasuan Insurance carrier and Policy number am:
Carl Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Il Swedish need not he completed if the permit is for me hundred dollars($100)
or leas)
1 ecnify tot in We performance of to work for which this Permit is issued.I shall not
employ any perms in my meRpermas�heremambjen to to Worked Compensation
Lewsaf Califomie.oaFJ/L `1 Ys/�/3
Applies.' 3�llr'e/i.A
NOTICE PL fSmk+ty this Cenificam of Exemption,you should
become subject to Ne W r a Compen21 n provisions of She Labor Coda you most
0 forthwith comply with such provision or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
(~► I hereby affirm Nat Nem is a conuucunn lending agency for to performance of
�i
We work for which Nis permit ts issued(Sac.3097,Civ.C.)
Qlender's Name
z lender's Addmu
U p 1 certify Nat 1 have mad Nis application ark WHO that to above 1111mmalm.Is
I, (~ correct I agree in comply with all city and county oNtnenees and sum laws mladng to
0 U building convection,and hereby sex arim mpresenmuves of this city to enter upon We
Is7 above-mundoned property for impecom purposes.
a (We)agree to...indemnify and keep harmless to City of Cupertino against
h liabilities,judgments,costs and expense which may in my way mane almost mid City
U,'Z in consequence of the granting of tis MMdL ti
r-' APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG S,
Re-roofs C7 /
Sign�au of run aayO� �— ✓ .
HAZAWOUS MATERIALS DISCLOSURE Type of Roof /
Will to applicant or fume building Ocmspwasrom or handle hrrudous motorial
u defined by the Cupertino Municipal Cade,Chapter 9.12.and Ne Healt and Safety
Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
0Ye e
Will We applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..it hazardous air conuminanu as defined by the Bay Area Air Quality Mmagcment all new materials for inspection.
District,
❑Ye Nu
I have oaf the hux ohme,materials requirements under Chaper6.95 of Ne Califor.
nm Healed&SafciyCod,Sccdon 25505,25533 amf 25534.1 understand tmifte,Wilding
does rat corm h e emanL Nat It is my responsibility He noury to occupant Of We
mgmmme t be met prior m iamancc of.CLrtJfS'M"Oecu ancy. Signature of Applicant Date
O mer of Norizcd engem
� tib 'DOW All roof coverings to be Class';q"or better