MX-M1100_20160803_094618I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS:
10510 PINEVILLE AVE CUPERTINO, CA 95014-4529 (369 13 031)
NAME: KRISHNAKUMAR KALMANJE AND SUJATHA
CONTRACTOR: I PERMIT NO: B-2016-2445
JG INC
CA 91406
DATE ISSUED: 08/02/2016
OWNER'S PHONE: _I I PHONE NO: (80D) 485-4919
LICENSED CONTRACTOR'S DECLARATION
License Class GENERAL BUILDING CONTRACTOR Lic. #991840
Contractor FUTURE VISION REMODELING INC Date 04/3n/2018
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
vith Section 7000) of Division of the Business & Professions Code and that my
icerse is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 -t r. I have and will maintain a certificate of consent to self -insure for Worker's
✓ i Compensation, as provided for by Section 3700 of the Labor Code, for tire
performance of the work for which this permit is issued.
z. 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.
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.
Sign atur * Date
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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 (Sce.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contacting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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. 1 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.
3. 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
certify that I have read this application and state that the above information is
:orrect. I agree to comply with all city and county ordinances and state laws
elating to building construction, and hereby authorize representatives of this city
o enter upon the above mentioned property for inspection purposes. (We) agree
o save indemnify and keep harmless the City of Cupertino against liabilities,
udgments, costs, and expenses which may accrue against said City in
=sequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
3ode. Section 9.18.
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
MASTER BEDROOM BATHROOM REMODEL - E,P, (50 S.F.)
Ft Floor Area: Valuation: $$8000.00
i Number:
13 031
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
RE -ROOFS:
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 all now materials for
inspection.
Signature of
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(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminauts 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 Codections 25505, 25533, and 25534.
I'
Owner or authorized agent:
Date:
CONSTRUCTIONL NDING AGENCY
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
Address
understand my plans shall be used as public records.
Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildingacuoerdno.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
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RECEIVEDBY
T'O LVALUATION:
PLANNINGAPPL# ❑NO PLANNMGAPPROVALLETTER
EICHLERHOMR? ENO
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By my signature below, I certify to each of the following: Into the properly owner or authorized agent to act on the property owner's behalf I have read this
application and the information I have prod ed 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 relath o bl i in uc ion. I authorize representatives of Cupertino to enter the a ve denti property for inspection purposes.
Signature of Applicard Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN cxEcx TYPE-:
RouTING SLIP
❑ OVER THE -COUNTER.
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition peralit for
existing building(s). Demolition permit is required prior to issuance of building
pemlit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC wORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE=
❑ .FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH ,^
B1dgApp_2011.doc revised 06121111