06070196 CITY OF CUPERTINO � ' '1
BUILDING DIVISION PERMIT CONT.I CTOK TNFORMAT ON'.
��`@ .f•1r,a.
BUILDING ADDRESS: KRISHNAN PERMIT NO.06070196
10570 STOKES AV
OWNER'S NAME: 12RMR 6EUfl DATfi
a RENUKO KRISHNAN 09/18/2006
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG EO PLUMB MEOCH
) O LICENSED CONTRACTOR'S DECLARATION - lob Description
! I hereby'frim that 1 am I'taaed under provision of Cloaca 9(aneramm ng
n.
? y null(orceandffec
OeDivhionSofShcBusinevandProfcssiomCadc.andmylicenseis ADDITION FAMILY ROOM, LIVING ROOM, MASTER
jqz Damnscclae CLin.IS
oma BEDROOM, ENTRY. 1ST FLOOR 768 ' '2ND FLOOR 211 '
p Dao: TSDECr
IW7 ARshaf W use DECLARATION
U I undersand my plans shall W anter u public marl
d
�0�
Licensed Profussianal
-y2 OWNER-BUILDER
exempt
DECLARATION
COO 1 Maso.(S= that 1 1. exempt from Vic Convns Co License Law for the
O 4 which
mason.(Section 7(DLS,Business and Improve,
in demolish,Code:Any city ver county .
3 which requimS n permit m enrec the pier.Improve,ach mnr repair any dmarmu
-zy
prior to its issuance,Manthe Um applicant for Con=wit Uccaum igned Law(chapter
E o Nal ancati gwit pursuant to the of Division
of Use BusinesOLice�law(Clopmr9 Sq.Ft. Floor Area Val'J
e� (cam he
comwithsectian7Undthe, iasisf JnfUm Business and Prafessinns Ceda)or
on
/
$
that he V exempt Omre(rom and Um baa far the alleged exemption.Any violation of AApp N �y of
Section 7031.5 by any applicant for a permit Subjects the applicant e a civil Family of 3 2 6 4 8 BB Ser 0 0 Occupancy Type
not mare Nen five hundred dollars(SSW).
❑I,aow=rof and
property,rnmyntimumded ces wdhwagearUmi(Sm.c .Buxwxx,
will do thewon andthe he Corma mtnMicarma conflicted do fs set apply 70 N.Bwima Required Inspections
and Professions Code The Convacmrs License taw don act apply m rt awmr of q P
pnopertywhobuilds i Lhat pimp and whedveasuchwdedimelrf fragh his
howemplvyva,provided that weh improvemau are m year dW oralered Tarsale r.
however.the building orimprovement4Said within
et Wildofamolefarpupwar-
buildea will have IW WNen of proving that W did not Wild or improve fa purpose of
sa
1 .awmcr of the property am exclusively contracting with Ikenud anuscmn to
anstroct the project(Sec.7044.Business and Profession Code:)The Covuacmrs Lt.
most law data..,apply he an owner of propeny who Wires or Impmw the.on,ad
who contracts(orsueh pneecs with a amracuu(s)licensed paramnt to the consomme,
Leena law.
❑lamaem,maleSm, ,86,PC rthunusm
rJµ
Data 0 6
WORRER'SCO P SSAnONDECLARATION
I hereby a1Rm under pedally of perjury pa of the following dalarWan:
❑I haw and will maintain aCerURcate of Covent to self-insure forWorkdaCompen-
what.as provided far by section 3700 of the tabor Cade,fa She Pon(.. ee of the
work for which Nis permit u issued.
❑I have and will maintain Workers Compensation Insurance.as required by Section
3700 of She labor Code.for the performatt of She wort for which this Permit is issad.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tibia section and not uncompleted If Ve permit is fare=hundred da0am($1130)
or lc.)
1 cannily Shot in Vm pufoma=e of the work far which Shia Summit is burned.l Shell am
employ anyperson In any mortal SqulotWOca�e m�jaI m me Wortcn'Compensation
LAWS of Califaroia Dam 111
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcate of Exemption,you should
became subject m the WMWs Compensation provisions of the labor Code,you most
.J O forthwith comply with Such provirus a this permit Shall W thermal revoked.
Z� CONSTRUCTION LENDING AGENCY
[r I Wreby arnme Shat She.u a construction lending agency for Me Nnfomena of
IY> Um wars for which this permit b iaad(Ses.3M.Cir.C.)
Ig1 Q Lenders Name
.0.7 Lenders Address
U i certify Sha I have read this Wixom and scam Sher Ne above information u
I, f-' comct-I agree to comply with all city and county ominaca end SUM laws rabid,to
pU building conswmian and hereby mmmize repre.mUtiwemf this city m emmupnn lW
W aWve-menu ned pmperty(Or irancMmm PurFo¢s.
(We)agree to save,indemnify and kap hamless f City of Cupertino against
IHy(0./1 liabilitiea.judgmcnts.cats adexperues which may in aY way aa.c againstaid City
U Z in APPLICANT UNDEumacca Of the RSTANDS ANOf this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REgPLATIONS.
IlL�w ka Aum IR�O6 Re-roofs
Signame of ApplicanUConwcmr . - D— a� Type of Roof
HAZARDOUS MATERIALS DISCLOSURE -
Will the appliant or future Wilding occupant nom Or handle harudo smaterial
as dented by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
pM.Sectio No
2ss32(r)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yoe
Will the applicant or fuorm Wilding ecenpaa use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haaardon air anmmimnu as defined by the Bay Area Air Quality Management all new materials for inspection.
Dimin7 /
❑Ya �INu
I have mad She hvardous materials requirements underCTapdr 6.95 of the CSlifer-
nUHahhhSafmyCade,Seem=25505.25533 du125534.l undersand than ifthm Wilding
does Out currently hart a moat.Shan It is my responsibility to=ufy the arupant of the
requirements which muss be met prior to ismrnce ofa Cenifeete o(Oca�'"q- Signature of Applicant Date
oV I I S 0 6 All roof coverings to be Class"B"or better
Ow.,or mthorimd.scru Da —
CITY OF CUPERTINO � ' '1
BUILDING DIVISION PERMIT CONT.I CTOK TNFORMAT ON'.
��`@ .f•1r,a.
BUILDING ADDRESS: KRISHNAN PERMIT NO.06070196
10570 STOKES AV
OWNER'S NAME: 12RMR 6EUfl DATfi
a RENUKO KRISHNAN 09/18/2006
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG EO PLUMB MEOCH
) O LICENSED CONTRACTOR'S DECLARATION - lob Description
! I hereby'frim that 1 am I'taaed under provision of Cloaca 9(aneramm ng
n.
? y null(orceandffec
OeDivhionSofShcBusinevandProfcssiomCadc.andmylicenseis ADDITION FAMILY ROOM, LIVING ROOM, MASTER
jqz Damnscclae CLin.IS
oma BEDROOM, ENTRY. 1ST FLOOR 768 ' '2ND FLOOR 211 '
p Dao: TSDECr
IW7 ARshaf W use DECLARATION
U I undersand my plans shall W anter u public marl
d
�0�
Licensed Profussianal
-y2 OWNER-BUILDER
exempt
DECLARATION
COO 1 Maso.(S= that 1 1. exempt from Vic Convns Co License Law for the
O 4 which
mason.(Section 7(DLS,Business and Improve,
in demolish,Code:Any city ver county .
3 which requimS n permit m enrec the pier.Improve,ach mnr repair any dmarmu
-zy
prior to its issuance,Manthe Um applicant for Con=wit Uccaum igned Law(chapter
E o Nal ancati gwit pursuant to the of Division
of Use BusinesOLice�law(Clopmr9 Sq.Ft. Floor Area Val'J
e� (cam he
comwithsectian7Undthe, iasisf JnfUm Business and Prafessinns Ceda)or
on
/
$
that he V exempt Omre(rom and Um baa far the alleged exemption.Any violation of AApp N �y of
Section 7031.5 by any applicant for a permit Subjects the applicant e a civil Family of 3 2 6 4 8 BB Ser 0 0 Occupancy Type
not mare Nen five hundred dollars(SSW).
❑I,aow=rof and
property,rnmyntimumded ces wdhwagearUmi(Sm.c .Buxwxx,
will do thewon andthe he Corma mtnMicarma conflicted do fs set apply 70 N.Bwima Required Inspections
and Professions Code The Convacmrs License taw don act apply m rt awmr of q P
pnopertywhobuilds i Lhat pimp and whedveasuchwdedimelrf fragh his
howemplvyva,provided that weh improvemau are m year dW oralered Tarsale r.
however.the building orimprovement4Said within
et Wildofamolefarpupwar-
buildea will have IW WNen of proving that W did not Wild or improve fa purpose of
sa
1 .awmcr of the property am exclusively contracting with Ikenud anuscmn to
anstroct the project(Sec.7044.Business and Profession Code:)The Covuacmrs Lt.
most law data..,apply he an owner of propeny who Wires or Impmw the.on,ad
who contracts(orsueh pneecs with a amracuu(s)licensed paramnt to the consomme,
Leena law.
❑lamaem,maleSm, ,86,PC rthunusm
rJµ
Data 0 6
WORRER'SCO P SSAnONDECLARATION
I hereby a1Rm under pedally of perjury pa of the following dalarWan:
❑I haw and will maintain aCerURcate of Covent to self-insure forWorkdaCompen-
what.as provided far by section 3700 of the tabor Cade,fa She Pon(.. ee of the
work for which Nis permit u issued.
❑I have and will maintain Workers Compensation Insurance.as required by Section
3700 of She labor Code.for the performatt of She wort for which this Permit is issad.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tibia section and not uncompleted If Ve permit is fare=hundred da0am($1130)
or lc.)
1 cannily Shot in Vm pufoma=e of the work far which Shia Summit is burned.l Shell am
employ anyperson In any mortal SqulotWOca�e m�jaI m me Wortcn'Compensation
LAWS of Califaroia Dam 111
Applicant
NOTICE TO APPLICANT:If,after making this CeniOcate of Exemption,you should
became subject m the WMWs Compensation provisions of the labor Code,you most
.J O forthwith comply with Such provirus a this permit Shall W thermal revoked.
Z� CONSTRUCTION LENDING AGENCY
[r I Wreby arnme Shat She.u a construction lending agency for Me Nnfomena of
IY> Um wars for which this permit b iaad(Ses.3M.Cir.C.)
Ig1 Q Lenders Name
.0.7 Lenders Address
U i certify Sha I have read this Wixom and scam Sher Ne above information u
I, f-' comct-I agree to comply with all city and county ominaca end SUM laws rabid,to
pU building conswmian and hereby mmmize repre.mUtiwemf this city m emmupnn lW
W aWve-menu ned pmperty(Or irancMmm PurFo¢s.
(We)agree to save,indemnify and kap hamless f City of Cupertino against
IHy(0./1 liabilitiea.judgmcnts.cats adexperues which may in aY way aa.c againstaid City
U Z in APPLICANT UNDEumacca Of the RSTANDS ANOf this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REgPLATIONS.
IlL�w ka Aum IR�O6 Re-roofs
Signame of ApplicanUConwcmr . - D— a� Type of Roof
HAZARDOUS MATERIALS DISCLOSURE -
Will the appliant or future Wilding occupant nom Or handle harudo smaterial
as dented by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
pM.Sectio No
2ss32(r)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yoe
Will the applicant or fuorm Wilding ecenpaa use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haaardon air anmmimnu as defined by the Bay Area Air Quality Management all new materials for inspection.
Dimin7 /
❑Ya �INu
I have mad She hvardous materials requirements underCTapdr 6.95 of the CSlifer-
nUHahhhSafmyCade,Seem=25505.25533 du125534.l undersand than ifthm Wilding
does Out currently hart a moat.Shan It is my responsibility to=ufy the arupant of the
requirements which muss be met prior to ismrnce ofa Cenifeete o(Oca�'"q- Signature of Applicant Date
oV I I S 0 6 All roof coverings to be Class"B"or better
Ow.,or mthorimd.scru Da —