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B-2017-1067CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1067 21512 REGNART RD CUPERTINO, CA 95014-4819 (356 23 043) H R I CONSTRUCTION INC APTOS, CA 95076 OWNER'S NAME: VASA SURESH LAHERILAL TRUSTEE OWNER'S PHONE: 831-23-043 License Class a Lic. #891255 Contractor H R I CONSTRUCTION INC Date 02/28/2019 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: t. 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. 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. DATE ISSUED: 07/03/2017 PHONE NO: (831) 295-2213 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: I ST FLOOR BATHROOM REMODEL- (80 S.F.) REMODEL OTHER- ADD BEDROOM- (243 S.F.) Sq. Ft Floor Area: I Valuation: $50000.00 APN Number: Occupancy Type: 356 23 043 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 07/03/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 7/3/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 2. 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 revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 7/3/2017 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: �— Date: 7/3/2017 CONSTRUCTIQN� 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 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 •�O'��'O ` (408) 777-3228 - FAX (408) 777-3333 - building cu ertino.or j& ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT n PROTECT ADDRESS X151 '/ APN # IL OwNERNAME � � i p r�H , /�Gh I PH E-MAIL b M J� ADDRESS/�.2 RC r/, REE CITY, STATE, ZIP FAX CONTACT NAME C50,`�NS �� PHO1.ES� S' 221 'SRO KAIi'L J� STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME L/�,� _ �`)%T LICE SE DUMBER O LICENSE TYPE o BUS. LIC k O 2 2 3 7 COMPANY NAME D` KAP C r� E-MAIL FAX STREET ADDRESS sw 2 _I CITY, STATE, ZIP f1�� O 'L PHONE ARCHITECT/ENGWEER NAME /V/� � //L LICENSE NUIvMER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK RxAmmmf e e 1 f e m* t ohie(- V-kc6ao EXISTING USE PROPOSED USE CONSTR �TORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA O KITCHEN REMODEL AREA OTHER lr REMODEL AREA 2 J PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJ DETACH []ATTACH q D WELLING UNITS: IS A SECOND UNIT ❑ YES BEII.GADDED? NO SECOND STORY ❑ YES ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF - PLANNING APPL k ❑ NO PLANND3G APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO , RE IVSD BY : T`QT�ALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on1the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize epresentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE 4L TION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure To= if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLWCHECICTITE Ii