05030111 CITY OF CUPERTINO _+*`++%ase 'S• '- - f"' n " `"" .`$�` ,r^'
BUILDING DIVISION PERMIT ,CC)N"CR.4CTURkTNFURMATION ':'
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BUILDING ADDRESS: SADANAND D. KARVE PERIAMNO'O5O30111
1031 NOVEMBER DR
OWNER'S NAME: PERMIT ISSUE DATE
SADANAND D. KARVE 08/01/2005
SANITARY NO. CONTROL NO.
ARCHI]ECDPNGINEER: BUILDING PERMIT INFO
BLDG O PLUMB
MECH
O
'atop LICENSED CONTRACTOR'S DECLARATION Jb Description
I hereby of cat that I am licensed o
ed under provisions of Chapter 9(com
encing P
a� with Section TOM)of Division of due Business and Professions Codedmal my llum,is
In 0ll free and effect. ADD 498 ' (MASTERBED/( ATH) .&
Z License clam Loc,a
RELOCATE KITCHEN I�► 1Ll�®
S Date ARCHRECI'S DECLARATION
0 I understand my plans shall be used u public retards
" LicensedProfetiooll APR t/- 2006
OWNER-BUILDER DECLARATION
19 I hercso .(Bete on I am exempt from the Contractor's License Law for the
19 following mason.(Section 7071.5,Bassinet and Profession Code:My city Or roomy
$fl! which requites a permit in construct.slur.Improve,demalim.or minor my structure OWN &AA aq� Ma Oft
-
y prior ro it issuance,also requiem the applicant forsuch permit in Ole&signed suument
< Net he is licensed pursuant the pmm
viaioafdm Contributor's License Law 9 Sq. Ft. Floor Area alU 1mH 648
ti
B (cmnmeming with Sudon70Wlof Divlsihn7nf the Businetand Profrssiaol Cade)m
WPM
Nat he is exempt therefrom and Use baso far the alleged exemptim.My fired, Of
Secdon 7071.5 by any applicant Our a permit subjects the applicant In a civil penalty of ppj j j jp�tber Occupancy Type
trot mere than five hundred dollars(5500). 3 6 216 0 0 4 . 0 0
❑I,u owner of the property,in my employees with wage u their role eompenaWon,
willdothework.and Ne awctum4notimmndedmoReredforsak(Sec.7044,BLWMass Required Inspections
and Prefix ns Cada:The e Conductors License Law does oat apply to an owner of q P
pmpny who builds or improves Kumon,and who does such work himself Or through his
awn employees,provided that such Improvements ase act Intended inoffered for sale If.
however,the building or Improvement Is mid within Om year of completion.Ne Owner.
builder will have de burden of proving that he did not Mid or Improve for purpose of
cal..).
w1ras Owner of Me property,am exclusively contracting with licensed conductan to
construct Ne pmject(Sec.7044,Business and Profeaesoas Code:)The Contacted Li-
cense taw docs not apply in an awner of property who Wilde or improves thereon,and,
who canuacu for such pmjcm with a conuamor(q licensed purssant On the Characters
Lkense law.
❑lam exempt under See. ,B&PCfmthismamn
Owner . �.- Date
WORKER7i COMPENSATIONDFOLARAT70N
I hereby afrmm under penalty of perjury am of the following decimations:
1 Nes and will maintain•CaAfixauhf Coolant in seIf4m um for WorkeraCompen-
"her,as provided for by Sudan 5700 of the Labor Cade,fm the performance of due
work for which this permit Is issued.
❑1 ban and will maintain Workers Compensation W urantt,u required by Section
7700 of the Labor Code,for the performance of the work for which this permit is Issued.
My Worker's Computation Iolunntt carrier and Policy number am:
anima Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(TTu ecedm need rot N completed Ifthe permit is forme hundred dollars(5100)
or leu.)
I unify that In the perfammanco of the work for which this permit is Issued,l Med net
employ any person In any mmne��(aq,m u brsomc wbLect m the Workca'CompemaYon
Laws of Calif, u
Applicant
NOTICE T'0 APPLICANT:If.after making this Certificate of Exemption,you should
became subject in Ne Worker's Compensation provisions of the labra Code,you most
.,O fOMwith comply with such Provisions or this Permit mail W dttmed raveled.
y CONSTRUCTION LENDING AGENCY
E" Ihemby dTmn dust thea Is a construction lendingagemy for rime Performance of
C see work for which this Permit u stud(Sec.7097.Civ.C.)
Pi erQ Landers Name
z Lender's Addmas
U O I ttNfy that I have read this applkadon and seem thst the above infomndm is
0,F tract.I agree to comply with all city and county ordinances and site laws slating to
DUWilding construction,and hereby audmodsempresentatives of Nis city inenter upon the
[27 above-mendoned property for imputed purposes.
G (We)ague to save,indemnify and keep handles;the city of Cupertino against
ram fA liab0idea.Judgments,emu and expenses which may In any my areae against said City
in
his
U APPLICANT UNDERSTANDSuence of the rounfing OfIAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. //
petition or AppHcxwu onummr Data
F`� �� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant in fumm building ouupmt sae or Wndu hazardous material
as dented by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
Code,Sudan 255724)? All roofs shall be inspected prior to any roofing material being installed.
Oyu OW
I Will the applicant or future building ucuPam use equipment m dcvlcis which If a roof IS Installed without firs[obtaining an inspection,I agree to remove
mit hax daus air camuninsnu u de0mit by 0e Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea Q4.
1 have mad the htndms materials acquirements under Chapter 6,95 ofmhe Califon
nia HnW
d &SafctyCode,Sutlem 25505,23577 end 25534.1 understand the if the building
oesnot currently hew a tenant.dust of is my respomlMllty te redly No occupant of the
dui. cru�w,h_kh run be metpnartu add mu ora Cerdlkale of Occupancy. SlgnatUre Of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Dote
�i