06020138 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��Ly'ly�^ 'y Oy ��� �
BUILDING ADDRESS: PER-11"006020138
20063 MERRITT D
OWNER'S NAME: PERMIT Mn DATE
POKALA & SUCHARITA RAO 07/12/2006
91ME: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 PLO MEOCH
jpp LICENSED CONTRACTOR'S DECLARATION Job Description
I u� 1 kmby affirm that I am licensed under provisions of Chaplet 9(commencing
with Section 7gM1)ofDividon 3 of the Business and pickmdn.Coda.and my license is
I.fall faces ad effect ADD 1149 ' & REMODEL 781 '
z nam Class Lie,g
M� Dau Contractor
understand
DECLARATION
1 I undernd my plans mail all he used m Public records
)tyle
e 0 Licensed Professional
OWNER BUILDER DECLARATION
I homhY alarm that 11. esempl from the Contractors Lkeme Law Tar the
5 O O which re rtmon.(Sccuan 7/D 11,Business and ere,de ore Calc:Any cAy of county
S� which requires a permit to cormraL aloe Wprow,demaltah.or repair any structure $324996
_Zi~a
prior as its issuance.also requires the applicant forsuchpermit toriileasigned suumentValuation
that he is licensed Innocent to this provisiomof the C-----License law(Chapter 9 Sq.Ft.Floor Area
B (commencing with Section 7000)af Division 3 afthc Businemmd Professions Code)or
that he is mempt therefrom and Use basis fm the alleged assumption.Any violation of
Section 703 L5 by any applicant for a permit subjects the apphcmt m a civil penalty of ere Occupancy Type
not mart than five hundred dollar($500).
1,as owner of the prepeny,or my employees with wage as dock sale computation,
will do the work and thertmmaae la not Intended or offered far We(Sm.7044,Business Required Inspections
and Professions Cads:The Contractor's Liemue Law does set apply to m owner of q P
property who builds or improve drtmon,std who dam wch mrk himsel f or through his
awn employees,provided that such Improvements am an,intended oralfend forsme.IL
however,the Wilding or Improvement is said within ane year of completion.the owner.
builder will haw the Wsden of proving that he did ant bud are improw for purpose of
sad.).
1,u owe of the property a
me eimiWly conuMing with licensed convuwn m
arta the projm(Sec.7054.Butinem sod Rafessans Code)The Common's Li-
come law does net appy to an Owner of property who Wilds or Lmpmws thereon.and.
who umm is far such projects with a commea er(s)licensed purwant to the Contractor.
Litems Law.
❑1 ren caunpp,under Sec. ^ B At P C far this reason
net 1l .r�.!the �d.Dau
WORK S COMPENSATION DECLARATION
I hereby affirm Order pmosty of pmJury none of
the following dulasadans:
❑1 haw and will maintain sCmtiOtate afCOnaent an mlbinsuha row conces Camp...
Minn.m provided far by Section 3700 of the labor Code,far the pesforra en of the
work for which this permit is issued.
❑I Mw and will maintain Workers Compensation Innes,as acquired by Sccum
3700 o(ta labor Cada,for the periamance of the work for which this such 4 Wised.
My Worker's Compensation Im stece wrier and Policy number art:
Carter. Policy No.:
CERTIFICATEP
OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section nod ct ho eompkted lithe permit is Imam hundsrd dollano(5100)
or less.)
I cenify Out in the performance of the wart for which this permit is Loved,l shall no
cmptoy any pecan in any mum f}aNm.m baolny�mbjceIle WarkeWCompensadon
Lm of GB(oasis.pmte M 9 0 ks
NOTICE TO A�PP^I'J ANLIC aMr matlngthus Certificate or EscmpOan,you Moult
became subject to the Workers Compensation provisions of the tabu Code,you mum
O forthwith comply with such provisions o this permit mall ho deemed hawked.
r CONSTRUCTION LENDING AGENCY -
F I hereby affirm Nm them its coe rectim lending agency rat the performance of
C/. i> the work ec
rut which this Permit is issued(S .3097,Civ.C.)
„t
W Q Lenders Name '
� z IatderaAadtess
U Q I ceNfy that I sew read this application moll rete Nm the show InfocNan 4
W F comm.l agree to comply with all city and county ordinances and state laws relating he
Q U Wilding construction,and hcrebymilmn.rpMacomi.a this citym enler upon the
W ahove-mentioned property for impecuon purposes.
(We)agree m an.indemnify and kap harmless the City of Cupertino against
,I liabilities,judgments,costs and cap.which may in anyway amus gtinst aid City
U z APPLLICANTeof the UNDERSTANDS AND this
WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUTIO
S'tAr pd L :[JA I7,7anfm Re-roofs
Stgnstortof Appicawcomractor M Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applinm or fuwha building oecupanutoro"handle hmmdo s material
as dented by the Cupertino Municipal Cade,Chapter 9.11,and the Health and Safety
node.Section 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yat `®No
Will the applicant or ruturt Wilding acaepant use cquipment or devices which If a roof IS installed without firs[obtaining an inspection,I agree to remove
emit haeatdnua air contaminants m dc0ad by the Bay Arta Air Quality Management all.new materials for inspection.
D'ummt
Uyu 'Q Nu
al the
I how mhamada7uomaurWocul immenu under Chmec,6.95 oftW Calif.,.
nu Hula At Saety Code.Sauam25505.25533 md25534,l undcramd thuifthe biding
doa an,cawn,ly haw a Invent that It a my mverchblli,y to entry the occupant of the
ro uSlmmendu hhhuh mast bre )u Occupancy.12 7_o Signature of Applicant ate� an¢ofaCer06
_
All roof coverings to be Class"B"or better G
Owner or wthariced agent wD
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��Ly'ly�^ 'y Oy ��� �
BUILDING ADDRESS: PER-11"006020138
20063 MERRITT D
OWNER'S NAME: PERMIT Mn DATE
POKALA & SUCHARITA RAO 07/12/2006
91ME: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 PLO MEOCH
jpp LICENSED CONTRACTOR'S DECLARATION Job Description
I u� 1 kmby affirm that I am licensed under provisions of Chaplet 9(commencing
with Section 7gM1)ofDividon 3 of the Business and pickmdn.Coda.and my license is
I.fall faces ad effect ADD 1149 ' & REMODEL 781 '
z nam Class Lie,g
M� Dau Contractor
understand
DECLARATION
1 I undernd my plans mail all he used m Public records
)tyle
e 0 Licensed Professional
OWNER BUILDER DECLARATION
I homhY alarm that 11. esempl from the Contractors Lkeme Law Tar the
5 O O which re rtmon.(Sccuan 7/D 11,Business and ere,de ore Calc:Any cAy of county
S� which requires a permit to cormraL aloe Wprow,demaltah.or repair any structure $324996
_Zi~a
prior as its issuance.also requires the applicant forsuchpermit toriileasigned suumentValuation
that he is licensed Innocent to this provisiomof the C-----License law(Chapter 9 Sq.Ft.Floor Area
B (commencing with Section 7000)af Division 3 afthc Businemmd Professions Code)or
that he is mempt therefrom and Use basis fm the alleged assumption.Any violation of
Section 703 L5 by any applicant for a permit subjects the apphcmt m a civil penalty of ere Occupancy Type
not mart than five hundred dollar($500).
1,as owner of the prepeny,or my employees with wage as dock sale computation,
will do the work and thertmmaae la not Intended or offered far We(Sm.7044,Business Required Inspections
and Professions Cads:The Contractor's Liemue Law does set apply to m owner of q P
property who builds or improve drtmon,std who dam wch mrk himsel f or through his
awn employees,provided that such Improvements am an,intended oralfend forsme.IL
however,the Wilding or Improvement is said within ane year of completion.the owner.
builder will haw the Wsden of proving that he did ant bud are improw for purpose of
sad.).
1,u owe of the property a
me eimiWly conuMing with licensed convuwn m
arta the projm(Sec.7054.Butinem sod Rafessans Code)The Common's Li-
come law does net appy to an Owner of property who Wilds or Lmpmws thereon.and.
who umm is far such projects with a commea er(s)licensed purwant to the Contractor.
Litems Law.
❑1 ren caunpp,under Sec. ^ B At P C far this reason
net 1l .r�.!the �d.Dau
WORK S COMPENSATION DECLARATION
I hereby affirm Order pmosty of pmJury none of
the following dulasadans:
❑1 haw and will maintain sCmtiOtate afCOnaent an mlbinsuha row conces Camp...
Minn.m provided far by Section 3700 of the labor Code,far the pesforra en of the
work for which this permit is issued.
❑I Mw and will maintain Workers Compensation Innes,as acquired by Sccum
3700 o(ta labor Cada,for the periamance of the work for which this such 4 Wised.
My Worker's Compensation Im stece wrier and Policy number art:
Carter. Policy No.:
CERTIFICATEP
OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section nod ct ho eompkted lithe permit is Imam hundsrd dollano(5100)
or less.)
I cenify Out in the performance of the wart for which this permit is Loved,l shall no
cmptoy any pecan in any mum f}aNm.m baolny�mbjceIle WarkeWCompensadon
Lm of GB(oasis.pmte M 9 0 ks
NOTICE TO A�PP^I'J ANLIC aMr matlngthus Certificate or EscmpOan,you Moult
became subject to the Workers Compensation provisions of the tabu Code,you mum
O forthwith comply with such provisions o this permit mall ho deemed hawked.
r CONSTRUCTION LENDING AGENCY -
F I hereby affirm Nm them its coe rectim lending agency rat the performance of
C/. i> the work ec
rut which this Permit is issued(S .3097,Civ.C.)
„t
W Q Lenders Name '
� z IatderaAadtess
U Q I ceNfy that I sew read this application moll rete Nm the show InfocNan 4
W F comm.l agree to comply with all city and county ordinances and state laws relating he
Q U Wilding construction,and hcrebymilmn.rpMacomi.a this citym enler upon the
W ahove-mentioned property for impecuon purposes.
(We)agree m an.indemnify and kap harmless the City of Cupertino against
,I liabilities,judgments,costs and cap.which may in anyway amus gtinst aid City
U z APPLLICANTeof the UNDERSTANDS AND this
WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUTIO
S'tAr pd L :[JA I7,7anfm Re-roofs
Stgnstortof Appicawcomractor M Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applinm or fuwha building oecupanutoro"handle hmmdo s material
as dented by the Cupertino Municipal Cade,Chapter 9.11,and the Health and Safety
node.Section 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yat `®No
Will the applicant or ruturt Wilding acaepant use cquipment or devices which If a roof IS installed without firs[obtaining an inspection,I agree to remove
emit haeatdnua air contaminants m dc0ad by the Bay Arta Air Quality Management all.new materials for inspection.
D'ummt
Uyu 'Q Nu
al the
I how mhamada7uomaurWocul immenu under Chmec,6.95 oftW Calif.,.
nu Hula At Saety Code.Sauam25505.25533 md25534,l undcramd thuifthe biding
doa an,cawn,ly haw a Invent that It a my mverchblli,y to entry the occupant of the
ro uSlmmendu hhhuh mast bre )u Occupancy.12 7_o Signature of Applicant ate� an¢ofaCer06
_
All roof coverings to be Class"B"or better G
Owner or wthariced agent wD