08020152 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' O1�ITRACTt1R INk'UtMA' IfI11V�`x
ESU N
BUILOIIAcyffS:AVI SON AVE RICHARD KIM CONSTRUCTION P080Z 0152
HER'S NAME: PERMIT ISSUE DATE
. ANUJ KHANDELWUL 2340 MONACO DR 04/07/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 206-8369
ARCHITECDENGINEE'R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
goo LICENSED CONTRACTOR'S DECLARATION 7 Job Description
V I lertby,affl.tell are licensed under provisions of cWpmr 9(commencing P
with Section7IXMB ofDivision 3 aNm Budneu and Professions Code,and my license is REMODEL KITCHEN,REPLACE WINDOWS,UPGRADE MAIN
N in fail fame and effect.
D VIZ License Class Lm. ELECTRIC PANEL 200 AMP.
3 JF Dau Contractor
g ARCHrrEcrS DECLARATION
St I understand my plans NN be used as public records
3EO
5 t; Licensed Professional
OWNER-BUILDER DECLARATION
$ 1 hcrchy alarm Not 1 em exempt from me Com etoe.License Law for the
E p O following maw..(section Tin 1.5,Business and Professions Code:Any city or county -
which deed.a Permit to consumer.alar.impmn,demolish,or repair any structure
xi prior a its issuance Shut mquima Me applicant for such permit to file a signed summon,
s< that he is licensed purwanttoMeprovisions ofthe Contractor's License Law(Chapter 9 Sq.Ft. Floor Area C Valuation
F-O (eommcnclngwith section
TODD)of Division 3ofthe Business and PmfusinmCode)or $30000
y
that he is exempt therefrom and de basis for the alleged exemption.Any violation Of
Section 7031.5 by any applicator for a permit subjectsthe applicant m a civil penalty ofNUmber O
not more Nan five hundred dollars(55(10). 3 6 913 05 8 !�'1 Occupancy P y TYPe
❑1,as owner of the property.or my employees with wages as theirmiccompemadon,
will do the work,and theswdare is notimmuded or Offend pertain(Sec. Required Inspections
and Pmov fessiCode:The Committees Liam Law does not apply m an owner Of q P
property who buieaorimprovasth arum,andwho doessuch work himselforthrough his
awn employcus,provided thauuch improvements art notinera ed OrOBed d Inasme If.
however,the building Or improvement is Sold within are year of er mpletion.the mvner-
builder will have the burden of proving Nat lis did no,Wild or improve for purpose of
am.).
Ur 1,u owner of the property.am exclusively contracting with li m sed c°mnclma m
comment the project(Sec.7044.Business and Protectionist Code:)The Contractor's Li. _
came Law does out apply to an owner of property who Wilds or improm Iherton.and
who contracts for Such projects wiN a conwctods)licensed pursuant to Ne Conmacmfs
Lice.law.
❑I are exempt under Sae ,B&P C for this mason
ter Dam 4/7/dR
HRI 0 PE14SATION DECLARATION
1 her efRrtn under pe. y of perjury oro of the following dochoutha s:
❑I haw and will maintain•Certificau of Comenl t°self-insum for Worker's Compen.
man,as provided for by Sacuon 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑I hove and will maimaln Worker's Compensation Insurance,as required by Section
3700 of the LaborCam.for the performance ofthe work for which this permit Is issued,
My Workers Compensation Insurance under and Policy number am: -
Caerier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Obissecdm need an W completed Krim pered,is forane hundred dollars($100)
or lase.)
I certify,Nat in the performance of tie work for which this permit u issued.I shall nm
employ any permen in any mennerm a to become subject o the Worknes Compensadon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Ce tiftmm of Exemption,you should
become Subject to the WOrkcr's Compensation previsions of the V bor Code,you most
.,z forthwith comply with Such provisions Or this permit shall W deemed revoked.
,z.,0 CONSTRUCTION LENDING AGENCY
[r vim. I hemby alrmn that dare la a construction lending agency for Ne performance of
!Yi> the wadi for which this permit It issued(Sec.3097.Civ.Q .
Wemme's Name
� Cl
a z Lenders Add.
U O 1 certify that T have Seed this application and sum that the above Information hi
{c.t cortecL I agree in comply with all city and county ordinances and Stile hws muting a
.0 building convection,and hereby amhorice mpresemadm of this city to enter upon the
{rl above-mentioned Property for inspection purposes.
LS, (We)agree Or an,indemnify and keep haemieas tie City of Cupertino agaimt
to liabilium,judgmeul.costs adupensa which may in any way acme against Said City
(,)7 in consequence of the granting of this permh.
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATI 3.
f 4[�7,nQ Re-roofs
Sgnmure of Ap can I am —/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum wilding Occupmmmm orhandle haramoes makerim
as dented by Ne Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety
o .9eeti°"n5324)7
❑ / All roofs shall be inspected prior to any roofing material being installed.
Yas $Na
Will the applicant or future Wilding occupant use equipment or dcvlm which If a roof is installed without first obtaining an inspection,I agree to remove
emit hoasmnm it contaminants as dcrined by the Bay Area Air Orality Management all new materials for inspection.
District?
❑Ym pir
I have mad the havudous materials¢quimments under Chapter6.95 of the Calif°r.
MANCLIth&SurCLYCOde,Scemom 25505,25533 am1115M.1 underaand thatifde Wilding
does not currently haw a unant,that it u my responsibility a notify the occupant of me
requlrementa wh' must W met pair m issuance Of a Certificate of Occupancy. Signature Of Applicant Date
Owner°, ,ho' y DZ- All roof coverings to be Class'jgsr or better