08090163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAG4 ORINFURMATI1V
BUILDING ADDRESS: PERMRNO.
10198 TONI CT KITCHEN WORKS INC/DBA 08090163
NER'S NAME: tiumhWuhKPERMIT ISSUE DATE
ARAVIND BALAKRISHNAN 615 IRWIN ST 09/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrrECT/ENGINEEA: BUILDING PERMIT INFO
REPLACE 15 WINDOW LIKE FOR BLDG ELECr PLUMB MECH
?Cp LICENSED CONTRACTOR'S DECLARATION O O O
4�W
F I Wmby arino col 1 am licensed ander Pmviriona of chapsem
r 9(commencing Job Description
with Section 7")ofDivision 3Ofthe Business and Prof 'ons Code,andetylicenseh
�q
in
fall I.arrd t'_;:Q DOW�_CMm
ARmall x use DECLARATION
U1 uMcrstanJ my plans shell W used as Public raortls
Is G G Licensed Professional
7 OWNER-BUILDER DECLARATION
2<I 1 hemby alum Nal 1 am exempt from tW Contractor's License Law(or Ne
p o following memo.(Section 70 I.S.Business and Pmftsuo a Code:Any city or county
i m which n Ot.t.a permit be construct.alcor.improv,demolish.or repair any stroctuse
prior to its issuance,elm requies the applicant for such permit to file a signed susemcm
<
dhaL he is licensed pumansoft W the Provisions Of OC COnermon"A License Law(Chm.9 Sq.FL Floor Area Valuation
y1S0 (commencing with Section 700(f)of Division Sof the Business aM Pmfcssions Cade)or
yo that he is e..pt therefrom and the basis for Ne alleged exemption.Any violation of
Schon 7031.5 by arty applicant for a permit subjects the applicant e a civil penalty of APN Number Occu ane Type
not mare Coln fico hundred dollass ISM P Y YP
I,as owner of the property,or my employees with wages as their auto compensation,
will de the wmk and the suucsum b not mounted!or offered for sale(Sec.7044,Busircss
and Pm(essioss Cade:IT.contractors License Law dors nut apply an an Owner of Required Inspections
property who builds or improves demon.and who does such work bimselfor through his
Own employers.provided that such improvements me not intended or offered for sale If.
however,Ne Wilding or imp omment is sold within Oe year of completion.the owoer-
builder will have the When of proving Wt he did not Wild or improve for purpose of
ale.).
❑1.as owucr of the Popeny.am exclusively contracting with licensed ucmracers m
construct the project(Sec.7(144.Business and Profusions Cade:)The Contncmr's U .
cense Law does not apply an an owner of properly,who Wilds or improves themon,and
who contracts for such projects with a comm ter(s)licensed lammam to the Comracme.
License Law.
wIamuempt unclesse, ,B&PCfmthi..
wner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under peedty of perjury Me of the following declarations .
0 1 haw and will mscrusm a Cetiftcase o(Consem a self-insure fcr WOiuo`sCOmpen-
worts for which
permit
rSection 3700 Of the Mbar Code.fon tW pedormarce of the
h issad.
0 I lure and will maintain Worker's Compensation Insurance,as required by Section
3700of Ne IAWrCedc.for the dommacc Ofte work for which this permit Is issued '
My Worker's Comp mauon Inywnce tinier and Policy
�nre
lumber a :
��i� Paliry No.:
CERTIFICATE OF EXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(ITh rttY1M Red Cul bccpnpicuni tf the permit t.1(mane hundred doRN f$100)
of less,)
I Century Nat in tW per(...of the wart for which this Permit is issued.I shall not
employ any person in any manrcran as an become subject is the WOn4es'Compertsatimn
Iowa of Celtramm.Dam
Applica t
NOTICE TO APPLICANT.It.after making this Ceninae of Exemption,you should
become subjea a the Worker's Compensation provisions or Ne LaWr Code,you most
.J z forthwith comply with such provhiou or this Permit shell W decreed revekcd.
z H CONMUCfIONLENDINGAGENCY
[-+ I hrchy affirm that fm iso cmtsuuction lending agmncy,for to Pr(Oretan¢of
DL due work for which this permit Is issued(Sec.3077,Civ.C)
Gp lender's Name
7 z Lender's Address
U O 1 cv6ry,wt 1 haw mad this aPplublian and sue col Cm aWw informadun is
14 P cornett 1 epee to comply with all city and county ordinances and sate laws mlating in
OU Wilding concoction.and hereby authorier mpmunuuws ofthis city a enter upon the
W H show-menuproperty for iespecupn i G (We)agree to saw,indemnity and kap harmless the mleCity of Cupertino against
r/) IlC.Osexence dgm onts,costsand efPnsu which which may in any wrnc
way against said City
^ APPLICA NDERSfANDS ANDyy�ttf{���LL,COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE ULATIO / /
Si6atum Or Apphcam/co aur �- per` Re-roofs —_-
HAZARDOUSMATERIALS DISCLOSURE Type of Roof
Will ft applionl on future Wilding oavpmtsem or handle hancedous marcrial
definuf by tic Cupertino Municipal Cade.Chapter 9.12,and the Hcalth and Safety
nJe.nation 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �Na
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
remInt he uudons air ronwninants as defined by the Bay Ama Air Quality Management all new materials for inspection.
❑Ycs IS No
I have mal the le arducs materials mquiemems under Chapter 6.95 ofthr Califon-
me Health&Safety Code.seen.25505,25533 and 25534.1 undessmiW that if tW Wilding
doer wt currently haw v enmL civ It is my msponsibility to notify the occupant of the
mqm ntswn m metPiarmissuauceof.CeNfices,of. apney'
ZSignature of Applicant Date
s All roof coverings to be Class'%?"
Owrcr Orouthamcd spent Date' g or better
CI"1'1' OF CUI'LR'I'INO BUILDING PE12M1"I'
BUILDINO,ximm"SS: 10195TON1 Ch CONTHM.-iow KITCHEN WORKS PLRMrrNo:08090163
INC/DBA HOMEWORK
O\\':NIAuSN'Aon•:: ARAVINDBALAKRISHNAIN' 615IRWINST I)xrl: lsstil,'w09/24/2005
OWNER'S PnONli: 1054464099 SAN RAFAEL. CA 94901 PIOSE SO:(415)456�f696
❑ LICENSEE CONTRACTOR'S 1)ECLA RATION r ❑ r
BIIILDINC 11110111,INFO: III.UC F.LI(CI111.01Nlll
License Class Lie.4 r ❑ r
d I K,CII RESIDEN'1'6\L COMMERCIAL
Contractor Date
,1010 DFSCId1P ION': RITI,ACH 15 WINDOW LIAI:FOR LIKE
I Irrcby:dlirm that I :nn licensed trader tile prorisions of Chapter 9 NO INSPI:CI'1ONS,PERMIT ENPIRIM3/'_4/09
(Commencing with Section 711011)of Division 3 of the Itusiness& Professions
Curie and Ihnl nn'licence,is in full furce and efferL
I hercbv alfrin under penalty of perjury nor of the kdlo,,hu, rya declarations:
I have and will maintain a Certificate of consent to self-insure Im Worker's
Compensation,its provided for by Section 3700 of the Labor Code,lot the e
perlirtmanee of thcwork for which this permit is issued. Sq. F 'Y our,\ Vatuation:SI8000
1 have and will maintain Worker's Connpens•M1011 Insurance,as provided lir by
Section 3700 ul the Labor Code,for the perlornanee olihe work lir which this �
permit is issued.
)T'NN nr }I .00 Occupancy'fyPC:
APPLICANT CERTIFICATION
I Certify that lhave read this application and state than the above an' ons I"1� E XPIRES 11' WORK IS NOTSTAIZTED
correct. l agree locomply with all cityand counlyordin:utces an elaS \NWITHIN 18l1 DAYS OI' PGRD1IT ISSUANCE OR
to building construction,and hereby authorize representative- is city er
upon the above mentioned property for inspection purposes. ( age•c to.' ISO DAYS FROM LAST CALLED INSPECI�ION•
indenmify and keep harmless the Cilp of Cupertino nailing liabi got s,
costs,and expenses\,Inch Tony accrue against said City in c0nsequ r of the
granting ol'this permit. Additionally.the applicant understands and\I n y. Issued by: Date:
with all non-point source regulations per the Cupertino n\ttunicipal Code, ' coon
9.18.
RE ROOFS:
Signature Dale All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials lir
inspection.
❑ OWNER-BUILDER DECLA RA ION
I Invert,,-affirm Ihnl I :un corrupt ft lie Cuntraelur'.License[.:I,,v for one rf Signature of Applicant: Dale
the rollawing two revnns: AL1.I(O(IF COVERINGS TO BE CLASS"A"OR If P:I"1'E lit
1.its owner of the propene.or me employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7044.
Business C Professions Code)
h as no,net of the property,am exclusively contracting with licensed contractors to IIAZA RDOIIS?IA'I ER IA LS 1)ISCLOSUR I.-,
construct the project(Sec.70-14,Business.l'• Professions Code). I have read the hazardous materials requirement,under Chapter 6x'15 of the
California Health&Safer'Code.Sections 25505.25533,and 25534. 1 will
I hereby affirm under pcn:dl,of perjury'one ofthe loll,...in-IITr,e maintain compliance Lith the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Ileallh S Safety Colic.Section 25532(:x)should I store or handle hazardous
I have and will maintain a Certificate ofConsent to sell-insure for Worker's material. Additionally,should I use equipment err devices which rail hazardous
Compensation,as provided for by Section 3700 of the Labor Code,far the air contaminants as defined by the Hav Arra Air Quality Manaeernew Di,triet I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,its provided far by the Ileallh& Saely Code.Sections 25505,'_5533,and 25534.
Section 3700 of the Labor Code,for Elie perlitmamec of the work for which this
Ol,nrr nr authorized agent: Date:permit is issued
I cenity than in the performance of the work for which this permit is issued,I shall
not employ;my person in any manner so as to become subject to the Worker's
Compensation laws of California. IL after making this cenificale of exemption,I CON'STRUCHON LF.N'DINC A.(7FNCI'
become subject to the Worker's Compensation provisions of the Labor Code.I must I hereby alirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Cir C.)
Lender's Name
APPLICANT'CER I IF]CATI ON Lender's Address
I cenil'y Thal I have read this application and stale that the above information i5
correct. I agree to comply%1 ith all city and county ordinances:and state laws rclatin_g
to building construction,and hereby atlll(rl%C representatives of this city to enter
upon the abo,c mentioned property for inspection purposes.1\\'c)agree to save AI(CIII'I'FCI"S DECLARATION
and keep harmless The City of Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and\,ill comply
with all non-point source regulations per the Cupertino Municipal Code.Section Licensed Professional
9.18,
Signature Dale
a RNA
CITY OF CUPERTINO
OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
�Oq l LV3
APN # Date: ^
Q y if
Building Address:
Mailing Address (if different from building address):
Owner's Name: . Phone#:
Contractor: � n �a�� Phonc5l��
c 4,w,Kr Fax: / l
Contractor License#:
Cupertino Business License #: S
Contact: �oh�scn Phone:&,")
Fax: G b b 6
Residential CommercialH.Job Description: �� JAlr�C/ot"-S, Gl f!�
�IJei/leh 4L. /4 ILA
Building Permit Info:
Bldg AP Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ I1/I11N-A E] IIAII B, IV-HT, V-B -3 Z
Valuation: Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist.& attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.oriz
Revised 7/01/08
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