00110061 ,r
CITY OF CUPERTINO - - -
qmt M&G nrviSION, ! PERMIT CONTRACTOR INFORMATION: 1
Joao Dwc nnn0ls.• - - - PI:RMIr'h0.0lrj 1,71061
cls. B7 KRZICH PL'' A
OWNER'SNAME:
RAN RA,7AMA JN .
11ONIi: SANITARY NO. �n.CONTROL N0.
ARCHITEC(ENGINEER:, ,a BUILDING I'ERMI'I'INFO,
w❑❑ DC ELECT PLUMB '
Nil; U
I ICI NSLD CONTRAC3T)R S DEC(ARAHON - t"
z [it., , job Leser' tion'
o z I nr rr l of Gld art I Chapter 91 m,tin t g - n
r� twits ser 70tltq rD�aon Jin the business;and Professions Codn and toy be t:,, SHAKE -POMP,:, -
�, i rbr e andegeet.
a tar CI � Lew
,n a a; —of/ p Coni
130 a 6'or ARCHITECI"S DiiCLARATION
n,0 I undcrsnnnd nu,plain"hull Mused as public records V k -
s ae O O Licensed Poll'e..ional
S o LL OWNER BUILDER DECLARATION
t3 1 hereby of im,that 1 are exempt boards,Comracmr's Liavnse Law fur the s f
Z< following reason.(Section 7031.5,Business and Professions Cody.Any city .or county.
which q a perm I t c t er It p demolish. r repair any structure
cturecis
i
3=° Prat t Issuance, L l ,t ppl toutsellpermitf File i,mdst inner hal he is 1 d famuntimun thepnwrAM,,Mfdo,C t t i's License Law(Chapter 9 Sq, Fl Floor Area _ ,•Vnluatipgpf
(commercial wish Seamon BAND of Dlvlsi n 3 of the lius nes,and Eradication,Cade) _,,,hot he isa mpt mardonamul the kok fieffie,alleged elacculption Any violation
ofSeYon703L5byayt ($5 btu wh)ns the nppl'cn civilpcwhy' " _
tent mnBveWtdred hundred dollars[asno). A�pj �Nj} V (y Occupancy Type
01,d ons net orthe
and the y,or my come I, a(hedhwagenas enal for sale(pen,atian,
will ne the work,and the omemre is not intended or seLaw ha sale(Sec. o,ad A - -
Bu,mea,arta Pmrxcon,cuae:me Contractor's License Law dna tint apply to an �x' _r of propeny Who builds or improves thereon,and who does such work himself ..,17quired Inspections
15. FRAM
or through his own ennployeev pros Ned that such improvements arc not intended(itv'
uttered for sale,If.
It
uttered the huildmg or impmvemen,i,sold within one year of 307 I NSULATJ ON
uorldvai.e.the owner-nuilde,will have the burden a(proving that he did not h tild or
npmve BapatPo,eofsale.).' , - ; 601' '— ROOF -TEAR- OFF
OI,i,; rufffie pr�pettr.amexe�n,wel,contracting with bee n,ed eommemrsm 60� P.00F P�YIJOQB "NA J,I_
Wstmot me project(See.7014,Basin.,and Pmfes,wn.Code:)The Cortmctor's 603 ROOF- BATTENS
License Law doe.,not apply m an owner of propaty who builds m imprm'es thereon, .
and who contacts for eact,Pmjens with a ommemr,heensed'nom", 1.the ' 604 ROOF IN—PROGRESS
Con rneme,uem,e Low. = t
01 am exempt under Sec. li&V C rill this reason "r,
Owner Dam
WORKER'S COMPFNSATION DECLARATION - -
I hereby alRnn under penahy of perjury one of the following declamations: ,• . '
1 1 have and will maintain a Certificate of Conant to self-insure for Worker's -
-amtponsmion, a., provided for by'Section 370b of the labor Cade, for the
la rformance of the work for which this Ismaid is issued. - ..
,01have and will maintain Wmycr's Compensation Insurance,as required by Section `
3700 of the LnMr Code,for the perfonuanm of the work for which this permit is a, '
Csuuneidee.M_y.M�i)rrkerrs Coiii nsatinn LnssumncecariernId Poliynumbrar'e�:
peI/Pq .eyoF ❑ FROM WORKERS'
COAPENSATION . s
,
INSURANCE -
(This inion need not W completed if the permit is for one hundred dollars
($11101 or Ic,nJ s -
1 certify that in to perfrrmamcc of the work for which this permit is issunl,1
shall not employ any Person in any manner x)as to become iubjca In the Workers'
Compensation Laws of California.Dam n
Applicant ..
NOTICE TO APPLICANT.It,aOcrmlking this Certificate of Exemption,you should ' - -
became sobject o the Workers Compensation prnvininns of the LsMe Code,you must
0 ,forthwith comply with such provisions m this permit shall be decried revoked: '
' F CONS"I'RUCfION LENDING AGENCY -
a. ' 1 heresy aRmt that there is o construction lending agency famh,Pedonnancc
w of the work for which this Permit is rowed(Sec.3097,Civ.C.)
a•Q Isomers Name - K
= Z Lender's Address .1
1;T. 1 certifythat 1 have road this application and state that the aMve in(ontimion is -
O [r comet.I agree to comply with all city and county ordinances and state laws relating ,
V to Wilding construction,and hereby aotMrise representatives oflhis city to enter upon
•�, the Wroc-mentioned property for inspeoion purpn.,es.
► M. (We)ague m save,indemnify and keep harmless the Ciry of Cupertino against
Zn, liabilities,judgments,costs and expenses which may in any way arcme against said
V z City in emoccrenceof the gmmingof this permit, s
r
APPLICANToNDERWANDS
CREGULATIONS. Issued by: Date' .
Sigammeof ApplieanJContmcmr Dam Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding.,at storeor handle ha>ydous nmmrial. 'Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.12,mud the Health and Safety
'Code.Scetian 25532(x)'! -
OYe, re ON. All roofs shall be inspected prior to any.rooting material being installed.
-
Will coon mt ad manure definagbytheStyAe.Airctn ay Mina which If a roof is installed without first obtaining an inspection, I agree to remove
emit M1azafdaus air mnmminamx as Jefin W by the Bay Arta Air Quality Management .,
w;el^ all new materials fon inspection. Applicant understands and will comply with
ore, ❑Nu all;non=point source re ons.
I bare read the hmardoua materials tequ woman,under Chapter 6.95 of the '
California Heahb ffi Safety Code,Sections 25505,23333 and 25534.1 understand that
uthe Wilding does not cumemlyhave atenant,that it is my MiDurdbility to notif ,/ � _
mcupam of the requirements which must he met prior to mwance ora Certificm of /
Occupancy. -
Signat plicant ' Date
Owner orpathod,ed agent Dane All roof'coverings to be Class `B" or better
` OFFICE'
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY h 4
Sec: Twp: Rng: Sub: Blk: Lot:36205036.00
DATE ISSUED.... . . . : 11/13/2000
RECEIPT 0..... . . . . : 13995
REFERENCE ID 9 . . . : 00110061
SITE ADDRESS .....: 213B7 KRZICH PL
SUBDIVISION .......
CITY ..... . .. .....: CUPERTINO
IMPACT AREA . . .. ...
OWNER ....... .. . . . : RAM RAJAMANI
ADDRESS ..... . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4942
RECEIVED FROM . ...: DAVE S
CONTRACTOR . . . . ...: LIC 4
COMPANY . . . . . .. ...:
ADDRESS .. . . . . . ...:
CITY/STATE/ZIP .. .. ,
TELEPHONE . .. . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------ ---------- ---------- ---------- ----------
BPERMFEE VALUATION 0.00 77.00 0.00 77.00 0.00
BSEISMICRE VALUATION 0.00 0.50 0.00 0.50 0.00
BC FLAT RATE✓ 1.00 90.00 0.00 90.00 0.00
PERMIT 167.5D 0.00 167.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 167.50 5700
TOTAL RECEIPT ....._167.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
...e..e. ............................ ........ .......a....................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
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