D-2017-0041CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0041
7636 WEST HILL LN CUPERTINO, CA 95014-5057 (362 27 024) RELIABLE & LOYAL
CONSTRUCTION
MANAGEMENT
CAMPBELL, CA 95008
OWNER'S NAME: PAMU PRIYATHAM AND PITTA HIMABINDU I DATE ISSUED: 07/13/2017
OWNER'S PHONE: 408-338-8295 PHONE NO: (408) 509-2602
License Class @ Lic. #916332
Contractor RELIABLE & LOYAL CONSTRUCTION MANAGEMENT Date
05/31/2018
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:
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
BUILDING PERMIT INFO:
—BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
DESCRIPTION:
O (E) SFD (1126 S.F.); ATTACHED GARAGE (437 S.F.)
performance of the work for which this permit is issued.
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 Sq. Ft Floor Area: Valuation' $8000.00
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 regulatio s per the Cupertino Municipal Code, Section 9.18.
Signature Date 7/13/20017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, 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
APN Number: Occupancy Type:
362 27 024
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aygnde
Date: 07/13/2017
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 new materials for
inspection.
sale (Sec.7044, Business & Professions Code) Signature ofAppl
2. I, as owner of the property, am exclusively contracting with licensed Date: 7/13/20017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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 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
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
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, ;5533, and 25534.
Owner or authorized agent: t J ly 1\-A
Date: 7/13/20017
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
Date 7/13/20017
X
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - building(acupertino.org
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By my signature below. I certify to each of the following: I am the property owner or authorized agent to act on the pn4vr4, owner's behalf. I have read this
application and the information l bave provided is corcct. I have rad the Description of Work- and Verity it is accurate. I agree to comply with all applicable local
Ordinances and state laws relating to building construction. 1 authorize representatives of C'upertino to enter the above -identified property for inspection purposes.
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Signature of Applicant/.Agent: Date: C
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISS CE OF DEMOLITION PERMIT
OMCE USE ONLY
PLAN CHECK TYPE
Provide Job Number from Bav, Area Air Quality Management District wtiv@ 4I5-749-4762.
El FCPRF.33
rovide three copies of a site plait showing protection for any trees 10' in diameter or more at 3' above grade.
❑ STANDARD
Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
Planning Dept to verily" building is an historical landmark. Allow 10 business days.
❑ LARGE
clearance not considered
Provide letter of clearance of all vermin front a licensed pest control contractor.
MAJOR
pplicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.
��Prcivide
signed Debris lain mrd Recyclable Materials form.
Commercial Buildings Onlv: Provide Fire M -pt clearance for lire suppression ; alarm system review
DemoApp_ 2016. doc revised 03/29/16
Abby Ayende
07/17/17
07/17/17
D-2017-0041
Abby Ayende