07090005 CITY OF CUPERTINO
BUILDhNG DIYIS?10N PERMIT G�1 TR �CTC)R I�1 CIRMATI�_kY*
PERMIT NO.
BUIL pI1�Cµ4j2DR sTAFFORD DR DIJOSEPH' S PLUMBING INC 07090005
T 117��JJ PERMIT ISSUE DATE
OWNER'S NAME:
RAJA VENKATESH 2867 KILO AVE 09/04/2007
SANITARY NO. CONTROL NO.
NE:
(408) 365-2058
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLVW MECH
0
z ZLICENSED CONTRACTOR'S DECLARATION
ulP I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
UZ with Section 7000)of Division3oftheBusinessandProfessionsCopd�e.andmylicenseis REPIPE HOUSE, INSTALL WATER HEATER.
y in full force and effect. 7
v�Z License Class Lic•
t- Dam_g�T��Contractor
ARCHITECTS DECLARAT ON
I a a 1 understand my plans shall be used as public records
yU
U.HLicensed Professional
'O< OWNER-BUILDER DECLARATION
j< I hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
:19 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
t"r^ prior to its issuance.also requires the applicant for such permit to file a signed statement rea Valuation
s�z that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 5q.Ft.Floor A
%t $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $7800
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 1 Number Occupancy Type
not more than five hundred dollars($500). 36207005 .
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code The Contractor's 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 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.).
0 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 La-
cense Law does 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 Contractors
License Law.
0 1 am exem t and Sec B&P C for this masonOwner t f Date ��
WORKER'S COMPENSATIOD DE RATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 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.
have and will maintain Workct'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.'/�/�!�p% Policy No.:
CERTIFICATE OF EXEMPTION FROM'WORKERS'
COMPENSATION INSURANCE
Clhis section need not be completed if the permit is for one 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 in any manner so as to become 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 Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z C4 CONSTRUCTION LENDING AGENCY
F~.r ►�-. I hereby affirm that there is a construction lending agency for the performance of
l✓rthe work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
a+ Lender's Address
;D 2
U 0 I certify that I have read this application and state that the above information is
t-. correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
T` Cls (We)agree to save,indemnify and keep harmless the City of Cupertino against
Nliabilities,judgments,costs and expenses which may in any way accrue against said City
(�Z in consequence of the granting of this permit. Date
►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Contractor Date T Of F.00f
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[3 Yes ;No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building t
docs not currently have a tenant,that it is my responsibility to notify the occupant of the ,
requipmcnis 4ich must be er r tuAsuance of a Certificate of Occupancy.
Signature of Applicant Date
�'//r � 9a7 All roof coverings to be Class"B"or better
Owner of authorized agent Date ---
CITY OF CUPERTINO �� � � 000.5
REPIPE/ F ES/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# . ' 62 ^0 7 - 00 f -_a Date: �_ V-411
-� ,7
Building Address:
//,6,0
Owner's Name J� / Phone#:76,� -212 y
Contractor: Phone: 7 License :
Contact: t Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb J3-
Job Description: p.r11 1'1
Residential Commercial ❑
Cost of Project: 7
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE P_umbing Permit Issuance PLUMBING
BPREPIPE Re ipe of Fixtures PLUMBING
BPFIXTURE P'Ag. Fixture PLUMBING
BPWSVCS I\/lain Water Service PLUMBING
BPSEWER S.wers PLUMBING
BPSEWAGE S,.-wage Disposal PLUMBING
BUSLIC B asiness License BUILDING