07020016 CITY OF CUPERTINO � TOR IQRM�'TI�N'
BUILDING DIVISION PERMIT
PERMIT NO.
G2�`� N
BUIL IN A RESS:
OSTEELING RD. MAMENDR7. KUMAR 07020016
PERMIT ISSUE DATE
OWNER'S NAME:
MAMENDRA KUMAR
SANITARY NO. CONTROL NO.
jNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p a LICENSED CONTRACTOR'S DECLARATION Job Description
VF I hereby affirm that I am licensed under provisions of Chapter 9(commencing KITCHEN REMODEL 200 '
Z with Section 7000)of Division 3 of the Business and Professions;Code,and my license's
i,<m in full force and effect.
t ? License Class Lic.#
p Date Contractor
F m ARCHITECTS DECLARATION
j�a I understand my plans shall he used as public records
)yV
Lin Licensed Professional
< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p oa following reason.(Section 7031.5,Business and Professions Code:Any city mr county
{i which requires a permit to construct,alter.improve,demolish,or repair any structure Valuation
rn prior w its issuance,also requires the applicant for such permit to file s signed statement S Ft.Floor Area
-?< that he is licensed pursuant to the provisions oC the Contractor's License Law(Chapter 9 Cl $8000
a=-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500). 3263001 .
I•as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Lary' B&P C for this mason
❑I am exempt u'nd'er S
Owner •tM/)r / �t Date
W CER'S COMPENSATION DECLARATION _
I hereby affirm under penalty of perjury one of the following declarations:
Q 1 have and will maintain a Certificate of Conscnt to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Q I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Workees Compensation insurance carrier and Policy number arc:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner stVgorne subject to the Wotircrs'Compensation
Laws of California to •• ��—r�l
Applicant
NOTICE TOA PLICANT:I(after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z►- CONSTRUCTION LENDING AGENCY
E-,t— I hereby a(rnn that there is a construction lending agency for the performance of
p�> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
0. Lender's Address
U 0 I certify that i have read this application and state that the above information is
comecL 1 agree to comply with all city and county ordinances and state laws relating to
O Ubuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
*•+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGU ATTpNS. n
Re-roof:;
SignaturcofAppliea UContraetor Datk I T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roof 3 shall be inspected prior to any roofing material being installed.
C]Yes .�No If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes '12 Nm
1 have read the hazardous materials require mcm s under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the Date
requirements wpprc must be met prior to issuance of a Certificate of Occupancy. Signatu'e of Applicant
�-►A„ i„ 1� �/f o All roof coverings to be Class "B"or better
r9r , t Date
Owner or authonzcd agent