BLD-2020-1690BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 20711 RODRIGUES AVE Cupertino
APN: 359 10 058
PERMIT NO: BLD-2020-1690
OWNER'S NAME: ARORA RAJESH TRUSTEE & ET AL
OWNER'S PHONE: 415-734-7602
JOB DESCRIPTION
(425.9 SF); ATTACHED ADU (748 SF); (2) NEW COVERED PORCHES (657 SF); (N) COVERED 2ND FLOOR DECK (178 SF)
NEW 2-STORIES SFD (3,966.5 SF); ATTACHED GARAGE
OWNER -BUILDER DECLARATION
three
wages
with
two
to self -insure
Insurance,
which this
certificate
revoked.
declarations:
as their role compensation, will do the work, and the structure
licensed contractors to construct the project (Sec. 7044,
is not intended or offered for sale (Sec. 7044, Business
I hereby
affirm under penatly of perjury one of the following
I, as owner of the property, or my employees with
Code).
& Professions
Business & Professions Code).
V
I, as owner of the property, am exclusively contracting
affirm under penatiy of perjury one of the following
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work for
laws of California. If, after making this
with such provisions or this permit shall be deemed
I hereby
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
V
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter
the Health
Code,
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12 and
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
EPA LEAD -SAFE DISCLOSURE
for this project.
Firm Certification No:
project.
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this
Certified
V
CONSTRUCTION LENDING AGENCY
a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is
No
V
Lender's
Name:
APPLICATION CERTIFICATION
the above
of this city to
costs,
-point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this application and state that
construction, and hereby authorize representatives
harmless the City of Cupertino against liabilities, judgements,
the applicant understands and will comply with all non
Signature:
C/Nlii./&/1—SQ.V7
.