B-2018-1236 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1236
18625 RALYA CT CUPERTINO,CA 95014-3823(375 25 005) GOPALAN SRIRAM
ANDPANDURANGAN
KAVITHA TRU
18625 RALYA CT
CUPERTINO,CA
95014-3823
OWNER'S NAME:GOPALAN SRIRAM AND PANDURANGAN KAVITHA TRU DATE ISSUED:07/23/2018
OWNER'S PHONE: I PHONI NO:OWNER BUILDER
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor GOPALAN SRIRAM AND PANDURANGAN KAVITHA TRU Date X BLDG_ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 ofthe Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WOOD SIDING ON I-CAR DETACHED GARAGE LIKE
I hereby affirm under penalty of perjury one ofthe following two declarations: FOR LIKE-(350 SF)
m. I have and will maintain a certificate of consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued,
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued Sq.n Floor Are.: Valentino:$4925.00
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 APN Number: Occupancy'lype:
and state laws relating to building construction,and hereby authorize 37525 005
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07123!2018 Issued by:Jasmine Archbold
Data:07/23120]8
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lou,for one of the - RE-ROOFS:
ollor g I
t reasons: All roofs shall be inspected prior to any roofing material being installed.If.roof is
,as owner of the property,o 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)
z I,as owner ofthe property,anm exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Cade), Date:07/23/2018
I hereby tifli m under penalty of perjury one of the following three declm.fiomt ALLROOF COVERINGSTO BE CLASS"A"OR BETTERm. 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read Bre hazardous materials requirements under Chapter 6.95 ofthe
Section 3700 ofthe Labor Code,for the performance ofthe work for which this California Health&Safety Code,Sections 25505,25533,mrd 25534.1 will
/'� permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
0 1 certily that in the performance ofthe work for which this permit is issued,l n Health&Safety Code,Section 25532(x)should I store or handle hazardous
v shall not employ any person any m as to become subject to the material.Additionally,should f use equ p tent or devices which emit hazardous
I].contmnlnan[s xs doHneit by the Be A a Air Quality Management District I
Worker's Compensation Taws of California.It,alter making this certificate of will mainhdn comas""e with the Cn em n Municipal Cade,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Heulth&Safety Code, 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CEl2TIFICAT[ON Date:07/23/2018
1 certify that I have read this application and state that the above informatlon Is CONSTRUCTIO 11EIDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a coostru h !onding agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
Judgments,caMew hich may accrue against said City In Lender's Address
consequence this permit.Additionally,the applicant understands
and will compint source regulations per the Cupertino Municipal AIiCH'LI 'I''S DECLARATION
Code,Section I understand my plans shall be used as public records.