Loading...
09070120foo IU N ^o ti.r X03 AyAyH Lp0 Z2 .z� ESC ,R§ CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: 7985 RAINBOW DR R'S NAME: ,"'TONE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of thc Business and Professions Code, and my license is in full fore and effect. License Class Lic• M Date q4 Contractor ARCHITECTS DECLARATION ` I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ I, as owner of the property, or my employers with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business 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.). ❑ I, 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 docs 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 Law. Q 1 am exempt under Sec B & P C for this reason r Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent 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. ❑ 1 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 Worker's Compensation Insurance carrier and Policy number am: Carrier rT�f'I% i'-00 D PolicyNo..J i!b 021 dt.06-01 COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or Icss) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correcL 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorise 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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS U Signature of Appli or arc 11490"CDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material +cfhned by the Cupertino Munici al Code. Chapter 9.12, and the Health and Safety Section 25532(x)? ❑ Yes o Will the applicant or future building occupant use equipment or devices which :mit hazardous air contaminantt as cfincd by the Bay Area Air Quality Management District? ❑ Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 255()5, 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 requirements vjkjch mttsttbe met priorto issuance of a Certificate of Oc cupancr. owner NALLUR (925) 2)0-7221 Job Description REMODEL 250 SQ FT TO INTERIOR KITCHEN NON- STR: JCTURAL 3q. Ft. Floor Area 36211043.00 Issued by: Re -roofs Type of R 30000 Occupancy Required Inspections All roofs :;hall be inspected prior to any roofing material being installed. If a roof i:; installed without first obtaining an inspection, I agree to remove all new m 3terials for inspection. Signature of Applicant Date All roof coverings to be Class'n" or better PERMIT NO. 09070120 PERMIT ISSUE DATE S A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB � 0 � Job Description REMODEL 250 SQ FT TO INTERIOR KITCHEN NON- STR: JCTURAL 3q. Ft. Floor Area 36211043.00 Issued by: Re -roofs Type of R 30000 Occupancy Required Inspections All roofs :;hall be inspected prior to any roofing material being installed. If a roof i:; installed without first obtaining an inspection, I agree to remove all new m 3terials for inspection. Signature of Applicant Date All roof coverings to be Class'n" or better CITY OF CUPERTINO PERMIT BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 7985 RAINBOW DR NALLURI ASSOCIATES INC- n9n70120 OWNER'S NAME: PERMrrL53MDATE PHONE: SAtrAxA6.2CONTROL NO. (925) 200-7221 ARCHIIECTIENGINEER: BUILDING PERMrr INFO BLDG ELECT PLUMB MECH a o a o LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section n 3 of the and my license is Professions4: REMODEL 250 n pull force andeffecDivi Jode, t. SQ FT TO INTERIOR KITCHEN Dale amass Uc.Businessand Date Conitactor NON—STRUCTURAL RCHTTECTS DECLARATION I_ 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Cale: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires tfte applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3 0 0 0 0 that he is exempt themfrom and the basis for the alleged exemption Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of riot more than five hundred dollars (SSM. 36211043 .00 . ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work. and the structure is not intended or offered for sale (Sec.7044, Business and Professions Code The Contractors License Law dots 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 sake. 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 sake.). ❑ L as owner of the property. am exclusively contracting with licensed contractors to conswct the project (Sec 7044, Business and Professions Code:) The Contractor's Li. tense Law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sit , B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen. sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued ' My Workers Compensation Insurance carrier and Policy number ate: Carrier. C T ta,-'f"1'i; %(-9 Policy No.:% - 01 IF7 TE OF EXEMPTION FROMWORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (E10(l) 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 so as te became subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Codex you must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name , Lenders Address I certify that I have read this application and state that the above information is - correct 1 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 in any way accrue against said City in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT ( Date ""C7 SOURCE Dale H DOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munici al Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes o 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 efned by the Bay Area Air Quality Management all new materials for inspection. District? [I Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505; 25533 and 25534.1 understand do if the building does not currently have a saranfl, that it is my responsibility to notify the occupant of the � �S All roof coverings to be Class'n" or better Owner D to ' authO' agent