B-2017-0572CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0572
10883 LEAVESLEY PL CUPERTINO, CA 95014 (356 15 025) TALENT DECIDE INC
LOS GATOS, CA 95030
OWNER'S NAME: BATNI RAJEEV AND DEEPA DATE ISSUED: 04/12/2017
OWNER'S PHONE: 408-2034328 PHONE NO: (408) 306-3968
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class.B Lic. #808951
Contractor TALENT DECIDE INC Date 06/30/2018
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
--performance of the work for which this permit is issued.
2. ' I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance ofthe work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I 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 accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
-�7
Date 4/12/2017
BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(N)TEMPORARY POWER POLE (100 AMPS)
Sq. Ft Floor Area: Valuation:$1000.00
APN Number: Occupancy Type:
35615 025
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A e
Date: 04/12/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-
ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole metalled without fust obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/12/2017
hereby affirm under penalty of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. . I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
s. 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
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I 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 accrue against said City in
consequence of the granting.of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 4/12/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
r'
Own®i'-or authorized agent:
Date: 4/12/2017
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
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PLUMBING 1 IMFCHAMCAT. , P(—rPI(`AT nr,TTQf' T T AXrrnT.c
(408) 777-3228 •FAX (408) 777-3333 • buildinc�Ca�cupertino.or
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CONTRACTOR NAMEC
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USE OF .SFD or DLTLEX ❑ MULTI -FAMILY
BUILDING: ❑COMMERCIAL
PROJECT IN WtAND El YES PROJECT IN El YES
URBAN INTERFACE AREA NO FLOOD ZONE NO
IS TBE BLDG AN 'El 1 -ES
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DESCRIPTION OFWORK 7
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TOTAL VALUATION:
By my signature below, I certify to each of the following: I am E the property owner or authorized agent to act on the property owner's beha I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildingconstruction. i authorize representatives of Cupertino to enter the above-iden 'fled property for inspection proposes.
SignatroeofApplicandAgent: Date:
SUPPLEME INFORMATION REQUIRED
OFITCE usE CiNL]
El --OVER TIIEmC LINTER
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❑ STANDARD °.
' ❑ 114,4JOR
MEPA7iscApp_2011.doe revised 06121/11