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CITY OF CUPERTIN O
BUILDING DIVISION PERMIT
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BUI ADDRESS:
PERMIT NO.
CANDLEWOOD DR
KANNAN DEVARAJAN
08070091
OWNER'
850 CANDLEWOOD DR
09/05/2008
PHONE:
SANrrARY NO. CONTROL NO.
ARCHITECIYENGINEFF
R:
ADD MSTRBTH&BDRM (340SQFT)
BUILDING PERMIT WFO
ELECTO PLUMBO MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70D0) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class Lie. N
Date Contractor
ARCHrrECTS 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 Contractors License Law for the
following reason. (Section 703 1.5, Business and Professions Cody. Any city or county
which requires a permit to construct. alter. improve. demolish. or ¢pair any Structure
prior to its issuance, also requires the applicant for Such permit to file a signed Statement
Sq. Ft. Floor Area
Valuation
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 exanpL therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ 1, as owner of the property. or my employees with wages as their sole compensation.
Required Ins ections
will do the wont. and the structure Is not intended or offered for sale (Sec. 7044, Business
and Profession& Code. The Contractor's License Law docs rot apply to an owner of
P
property who builds or improves thereon, and who does such work himself or thmagh 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 hm the burden of proving that he did not build or improve for purpose of
talc.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
consiruct the project (Sec. 7044. Business and Professions Code:) The Contractors La-
not appl m in owner of property who builds or improves thereon, and.
cceae lAw do"I
who con cis for suer jests with a contractor(s) licensed pursuant to the Contractors
-
License law. `
❑ 1 am es:tier , B P C for this mason
Owner Date
WOIIKERI COMPENSATION DECLARATION
1 hereby af" 1l -der penalty of perjury one of the following declarations;
❑ I have and will maintain a Cartifreate of Content to Self-iUure for Worker's Compen.
salon, as provided for by Se cdc m 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ f 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 are:
Carrier. Policy No.:
CERTIFICATE OF L7(I]]vIP TON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be ec mpleted if the permit is formic hundred dollars ($100)
or less)
1 certify that in the perform of the work for which this permit is issued 1 shall not
.
employ any person in any in rsoas io become subj t t tit Workers' Compensation
Laws of California Date _
Applicant IV
NOTICE TO APPLICANT: , making this Certificate of Exemption, you should
become subject to the Work4es ompensetion,provisions of the Libor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked
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)
L.endres Name
Lenders Address
1 I certify that I have read this application and stare 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
l above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, cons and expenses which may in anyway accrue against said City
iin consequence of c granting of this permit.
APPLIC tiRSTANDS AND WILL COMPLY WITH ALJ, NON -POINT
Issued by: Date
SOUR ONS.
Re -roofs
Type of Roof
Signature I A iant/ConZowr Date
HAZARDOUS MATERIALS DISCLOSURE
VA did applicant or future building occupant store orbandle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(+)?
All roofs shall be inspected prior to any roofing material being installed.
❑yes ONO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment. or dcvi=x which
cmlt haurdous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Districl7
❑ Yes ❑ No
I have toad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & S y Code, Secti 25505.25533 and 25534.1 undesswsd that if the building
does not dy hese a onann,ons dart it is my responsibility to nodly the occupant of the
requirem n which must be met prior to issuance of a Certirratc of! ancyy
Signature of Applicant Date
/1 V
All roof coverings to be Class'n" or better
Owner or,61horized agent Dote