B-2017-0688CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0688
10337 MARYAVE CUPERTINO, CA 95014-1339 (326 52 012) AIRPRO MASTER INC
LAS VEGAS, NV 89102
OWNER'S NAME: PILLAI DULEEP AND DULEEP RESHMI DATE ISSUED: 05/01/2017
OWNER'S PHONE: 408-368-6289 PHONE NO: (702) 598-4174
License Class C-20: C-36 Lic. #1012763
Contractor AIRPRO MASTER INC Date 04/30/2018
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.
BUILDING PERMIT INFO:
BLDG —ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE 40 GAL WATER HEATER - GARAGE
m. 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.
7 �j�2� I -have and will maintain Worker's Compensation Insurance, as provided for by
�Secfion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Sq. Ft Floor Area: Valuation: $1300.00
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
7sourcaJregulations per the Cupertino Municipal Code, Section 9.18.
rd� �l�
Signaturee''''�'''-z �� Date 5/1/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
APN Number: Occupancy Type:
326 52 012
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
m, I, as owner of the property, or my employees with wages as their sole installed without first 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 (Scc.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:/15 /2017
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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 ofthe
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 5/1/2017
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(a) 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, 2553anpd 25534.
Owe or authorized agent:
Date: 5/1/2017
CONSTRUCTION LENDING 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
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 E F %J
COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION
10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255
+CUPERTINO p
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PLUMBING i I MFCHANTCAT, nFT.RCTRIrAT nrarcr FT T A-KTTznTic
(408) 777-3228 •FAX (408) 777-3333 • buildina(�cuoertino.or
PROJECT ADDRESS 10 3� f pj� J L Ave,
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CONTACT NAME n - _/"!
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❑ OWNER ❑ OWA'ER-BUIIAER ❑ OWATERAGFNT ❑ CONTRACTOR ❑CO2`ITRACTORAGENT ❑. ARCHITECT ❑ ENGA'EER ❑ DEVELOPER ❑ TEITnNT'
CONTRACTOR NAME �qp (��Fq""" •yam' $\ J{(�
LIC ENSE NUMBER
LICINSE TYPE /7
BUS. LIC (J�j% r%��
COMPANY NAM I � �
EMAIL
FAX
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CITY, STATE, ZIP s� ` ��
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ARCHITECT(ENGI ITER NAME
LIC ENSE NUMBER
Bus. LIC r
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE _
USE OF FD vrDLTLEX ❑ MULTI-FAMMY
BUIIAING: ❑ COMMERCIAL
PROJECT IN W;tLAND ❑' YES
URBAN INTERFACE AREA ❑ NO
PROTECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ -I-ES
EICHLER HOME? ❑ NO
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DESCRIPTION OF WORK
TOTAL\ALUATIOi\. RECEI�7EDBY:-`si;
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information Lhave provided is correct. I have reg the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b - ing construction. T re -es ntatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ` Date:
SUPPLEMENTAL INFORMATION REQUIRED
oFcE USE anLY
❑ OVER THE COULTER
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❑ EZ RESS
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.❑ STA�bARD:
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❑ , LARGE
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A1EPA7iscAppj011.doc revised 06121111