B-2016-1179 PERMIT_1CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1179
10200 N DEANZA BLVD CUPERTINO, CA 95014-2219 (316 26 088) (K & KAMERICA INC)
SAN JOSE, CA 95119
OWNER'S NAME: KUMAR NITIN TRUSTEE &ET AL DATE ISSUED: 01/13/2016
OWNER'S PHONE: PHONE NO:
0. _D1 olksmnl's I I I 1
License Class Lie. # {) 4 ?_ 0 q 'k b
Contractor ( K & KAMERICA INC I Date I ) .Z1 f
I hereby affirm that I am licensed under the provism s of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Cade and that my
license is in full farce and effect.
PERMIT INFO:
BLDG —ELECT -PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
Install illuminated channel letter wall sign for E-Trade.
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
r. 1 have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued. Sq. Ft Floor Area:
certify that I have read this application and state that the above
nformation is correct. I agree to comply with all city and county
Irdinances and state laws relating to building construction, and hereby
mthorize representatives of this city to enter upon the above mentioned
uoperty for inspection purposes. (We) agree to save indemnify and keep
mrmless the City of Cupertino against liabilities, judgments, costs, and
expenses which may accrue against said City in consequence of the
Iranting of this permit. Additionally, the applicant understands and will
:omply with all non -point source regulations per the Cupertino Municipal
;ode, Section 9.18. / / /
Date /// 3 // b
:by affirm that I am exempt from the Contractor's License Law for one of the
ving two reasons:
r. 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 & Professions Code)
r. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1. I have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed rvoked.
:ertify that I have read this application and state that the above information is
erect. I agree to comply with all city and county ordinances and state laws
lating to building construction, and hereby authorize representatives of this city
enter upon the above mentioned property for inspection purposes. (We) agree
save indemnify and keep harmless the City of Cupertino against liabilities,
figments, costs, and expenses which may accrue against said City in
osequence of the granting of this permit. Additionally, the applicant
iderstands and will comply with all non -point source regulations per the
ipertino Municipal Code, Section 9.18.
APN Number:
316 26 088
$800.00
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: 142T_Fw, 4 /' /3 ' i6
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fast obtaining an inspection, I agree to remove all new materials for
inspection.
of Applicant:
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Cade, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 15532(a) should I stare or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
our contaminants as defined by the Bay Are Air Quality Management District I
will maintain compliance with the Cape Municipal Code, Chapter 9.12 and
the Health & Safety Code, ecfi s 25505,-;5953, and 25534.
agent:
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date