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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUI TNG A D ESS:
0058 NORTHWIND SQ
SANJAY MALUNJKAR
PERMIT NO.
08090228
OWNER'S NAME:
PERMIT L55LiE DATE
20085 NORTHWIND SQ
09/30/2008
PHONE:
SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_
LICENSED CONTFACT'OR'S DECLARATION
9
Job Description
I hereby atn that I am licorucd under provisions of Chapter (commencing
fn
with Section 70D(F) ofDivision 3 ofthe Business and Profession; Code, and my license is
KITCHEN, ADD RECEPTCLS , ACCESSIGHTNG , EXTND GAS LINE
in full force and effect.
License Class Lic. x
DateContractor
RC
AHITECTS DECLARATION
I understand my plans shall be used as public renxtrds
Licensed Professional
.OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to consWet. alter, improve, demolish, or repair any sructurc
prior to its issuance, also requites the applicant for such permit to file a signed statement
Lha he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor AreaValuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$4000
that he is exempt therefrom and the basis for the alleged exemption Any violation of
316 3 8 0 0 9 tff Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
not more than five hundred dollars (5500).
.
❑ I. as owner of the property, or my employers with wages as their sole compensation,
Required Inspections
will do the work and the swcture is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law dors 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 improve mems are not intended or offered for sale. II,
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
sal.).
as owner of the property, am exclusively contracting with licensed contractors to
construct the pmjw.(Sec 7044. Business and Professions Code:) the Contncmr's Lr -
cease Law does not apply to as owner of property who builds or improves Thereon, and .
who contracts for such projects with a conuactor(s) licensed pursuant to the Contactors
License Law.
C]I am ext and r Sec . B & P C for this reasoq
Owner Date _V9 Iq
RKEWS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of the following declarations:
❑ 1 have and will maintain a Canificate of Consent to tielf-Insurefor Worl¢s's Compcn-
Won, 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 Workers Compensation Insurance, as required by Section
3700 of the Libor Code, for the performance of the work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person inxy manner>;q,a� W � BibjecI to the Workers' Compensation
Laws of Callforrrla. 1T 4/! tC
Applicant
NOTICE TO AP-PLISRKTfir. after making this Cardficate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Codc, you most
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)
Lenders Name
,
renders Address
1 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 repmscntativrs of this city to enter upon the
above-mentioned property for inspection purposes.
(Wer) 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 permiL
Type of Roof
SIgnauurA#AV9Fmru1Conuractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle ha'rardous material
as dented by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(47
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
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 contaminans as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
1 have mad the hazardous material mquiremens under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534,1 understand that if the building
docs not ndy hoc a icnatt. that it is my responsibility to notify the occupant of the
require ns 'ch must be met prior to issuance of a Certificate of 0pancy.
Signature of Applicant Date
All -roof coverings to be Class'%" or better
Daic
Owner orauth rizl;dAgent