04060046 (2) CITY OF CUPERTINO _
BUILDING DIVISION PERMIT CONTRACTOWINFORMAJON
RUILDINGADDRESS: ROCKWOOD CONSTRUCTION CORP PERMITN004060046
10311 BODR NNY .
OWNER'S NAME: PERMIT ISSUE DATE
;�. RAJ VENKATESAN 14583 BIG BASIN WAY
E; $ANITARYNO. CONTROL NO.
(408) 868-9026
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
0 0 0 0
200 LICENSED CONTRACTOR'S DECLARATION --
: I hucby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
whist,(iun'Ipil(gof Division3of Nc Busirr3"u fcssinnx Codc, dmylicenscis
S'q? Li�co'w Class d°ff /- �G�4 ADD 480 SQ. FT. (FAMILY RM/MS . BATH)
Dr Dau Cuntmctor �,
A CHITECI-S OEC a r�
�y c< I undersun�pleru shall he useJ u public technical -
Ddu
o Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby reason.(0rm Nn I am cxcmpt from Ne cssion C's :Any L Lew fur the
Q o followwhichinquresaPermit
]B31$Busher.simprove,
ve,demolish.
e Profession Code:Any city or county
um
x$ which requires a permis to conscunt a pplic int corm hear iitu ea repair ed awmure
m_ea priormis issuence.alw requintsthe applicant forsuch permiuo Nc resigned suntmcm
2,< [bathe is licensed pursuanto the pmvisioswfshc Comiscum',Limn.Lev,chapo,9 Sq.Ft. Floor Area Vination
9 C (commencing with Section]IXp)of Division 3 O(LW Businessand Professions GWe)tar
i
in.,he is cxcmpt therefrom and Ce basis for the alleged eaemption.Any violaian of
Section 7031.5 by my applicant for a permit subject the applicant to a civil penalty of 3 W41NIO&Clo 0 Occupancy Type
not more than Live hundred dollars($50().
0 L as owner offt propun.many employees with wagesu their sole compenuuon,
ill do the work.and the structure is not intended or offered for sale(Sec.7044,Business
and arty wh bis Code:Then,n ws thereon.License law doe+not apply C an owner of Required Inspection
property who s provided
ro i id that suthereon,andwho an,norchwork oroffe edseffor tluough his
f,
owneer.the building
uip ing or Improvement such improKmenttarenol earocdmputied far mancL
however Ne buil ding or inissoldwithinone year of comm tion,thepose of
builder will have the burden of proving Ne[he did not Wild or improve for purpose of
sale.).
❑I,asu owner of el progeny,,B sines and contracting with licensed convenors m
construct the project(Sec.][)redo Business and r,wh ions Cotler)The Conhentams I.L. J
w roe law docs not apply je an wither of pmpony who builds or improves Contra.and J
who contracts for ouch projects with aconsracsorts)licersed pursuant Lot Ce Convacsols
iorson caw.
am exempt under Sec. ,B&P C for this reason \
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby a it m under penalty of peejury one of tie following drelantions:
have and will maintain a Cerufeateof Cnmenl to of-insure far Workcr's Compen-
sation,az provided for by Section 37Mof the Labor Code,for On performance attic
work for which this permit is issued.
0 1 have and will maimain Worker's Compensation Insurance..required by Section
3]00 of the Labor Code,for the performance of the weak for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier; Policy No.: ,
CERTIFICATE OF EXEMPTION FRPM WORKERS'
COMPENSATION INSWRANCE
mlisseclion Load not he completed if the permit is for one hundmddollars(SIM)
rr less.)
I certify Cat in the performance of Ce work for wh'ch Cia permis is issued,1 shall Or
employ any any an whew b' the Workers'Com sation
I aws of Cali.DateP Heart
— O
N CE TO APPLICANT:I.a cr u
,objet[se the Work&a Cr rimLion previsions of the Labor Code,you mus[
0Z fo with comply with such ploy ons or thia permit shall he deemed revoked.
Z''-' CONSTRUCTION LENDING AGENCY
(-+'�-• Ihumby affirm that there is a comwctinm lending agency for the performance of
a 7 ft work fur which this permit u issued(Sec.3099,Ci,C.)
V.1 Q lender's Name
D. Leaders Address
� z
U Q 1 certify Ca[1 have read this ap,liLoti.a and state that Ce be.information is
D. F cmmct.I agree to comply with all city and county ordinances and more laws Gating w
0U building constmction,and hereby authatim rupresentalivea of this city to enter upon the
r[Il aMvcmcntioned pmpcny for inspection purposes.
4. (We)agree to save,indemnify and keep harmless the City of Cupertino against
.F'.,fA liabilities judgments,costs and expenses which may in any way acemc against said City
U in consequence of the granting of this perm it.
^ APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da[
i/wal_�
SOURCE REG TIONS.
6 3 am Re-roofs
Si awrc of ApplicaHAZARDO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant tar future Muni building Occupant acre or huddle Health
Safer l
az defined by Cc Cupcnino Municipal Coda Chapter 9.12.and the HcaIN and Safety
Code,Sccuon 25532(.)? All roofs shall be inspected prior to an roofingmaterial being installed.
[D 9Nw
Will the applicant or future building Occupant uta equipment or dcvico which If a roof is installed without first obtaining an inspection,I agree to remove
E hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
nuictT
G Ycs �u
1 have mad the Introduce materials requirements under Chapter 6.95 of Cc Califor"
ria Hcal"SafetyC ,Scctiona 25W5.25533.025534.1undmunduaif Ce Minding
docs nm curcnuy w a¢man[,Cas it is on,rcepomalodity m nattily the uxupant of Cc
mquimmc Isit h hcmnprobluissuan rfacerdreaefaapancy. Signature of Applicant Date
owner .ancon maagem Dant All roof coverings to be Class"B"or better
RORW
CITY OF CUPERTINO TZ `* "`
BUILDING DIVISION PERMIT Ci)NTRACTQI2 INFORMATION __-
DINGADDRESS: ROCKWOOD CONSTRUCTION CORP.PERMIT NO 04060046
OWNER'S NAME: PERMIT ISSUE DATE
RAJ VENKA
E:
SANITARY NO. CONTROL NO.
408 868-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
EnELECT PLUMB MECH
upQ LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm that I am licensed under provisig Dr Chapter v(commencing Job Description
�za with5cnion]0(181 vtsion3of the Busireas vd Pro an COM.ardmylittmcis
;qi '"foot""`'" «er ADD 480 SQ. FT. (FAMILY RM/MS . BATH)
License s _
0=W Dal
_IR ' DEC ..�,..n
rc I undersand my plans shall W used is public reenNs •`r r-
to
;d. Licensed Psofcssurml
vim OWNER-BUILDER DECLARATION
'a 1 hereby al'otm Nal 1 em cxemPL from the Contractor's License Law for the
no following msmn.(Section 7031.5,Business and Profasivas Code:Any city or county
x m which Omahas a Permit In ennwuet,alter,improve,demolish.or repair any structure
a '^ prior to its issuance,also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
0,1-o Commencing with SeCdon 7")of Division 3 of lbs Business and Professions Code)or
i 9$ Nat he is exempt therefrom and Or basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects lho applicant to a civil penally of 3 9&61IDH @*cr0 0 Occupancy Type
Dat mart Nn five hundred dollars($5(0).
❑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 of offered for sale(Sec.7044,Business
rad Protestors Cine:The Coatiaaor's Lied.law docs at apply wan owner of - Required Inspections
propeny who builds.,impro.thercon.and who d...h work himself or domigh his
own employ=,provided Nat such improvxments are not intended orofferW for axle.If.
locroweved,the building or improvement is old within one year of completion.and owner,
holder will have the burden of proving Nat he did not build or improve for purpose of
saia)
❑I,as owner of Ne propcny.am exclusively contracting with licensed contractors to
comuuet the project(Sec.7044.Busineu and Rofusioru Codc:)The ConuacorS Li _
cense Law docs Dol apply to an owner of property who Wilds or improves thereon.and
contracts for Such projects with a eonVYIOKSI licensed pursuant w the Contractor's
so law.
am exempt under St . .S k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
affirm 1 hereby aunder pcdaily of perjury one of the following declaratimoo
nave and will maintain a Ccnificae of Consent to calf-insum for WorkersCompen-
on,as provided for by Section 37W of had Labor Code,far the performance of the
work for which this permit is issued.
rad will maintain Worker's Compensation Insu ce. ire y Section
❑ W . p
4 Labor COM,for thepd"mmane.ofthewor r apcnnl is asued.
y leer's Cnmpensmon Insurance armor rad Poli um6crme:
Camey: Policy No.: +
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nis section need not W complced ifthc Permit is future hundred onllars(SIM)
of less.) \
I certify Nm in the pe7!}snnaned of the work for whicM1 is rmit B issued.10 ell of
employ any personmaanl1ee)��mnner so a wbecomem 'n tW Warkers'Com an
lawsaf Cal' mice.
A pliant -
N µC T A PLICA :1,aft a n c Ecatc of Eacmption,you should
o subject o the Worker's Cc n on provisions of the Labor Cotle,you must
.J z. fo Ih comply with such provisions or this permit shall W dcemcd ranked.
zCONSTRUCTION LENDING AGENCY
'e. I hereby affirm Out there is a emouvminn lending agency for the Performance Of
[� the work for which this permit is issued(Set.7097,Civ.C.)
!y Q LenMri Nam.
2
2 lender's Address
J
U O I certify Nat I have read
thisapplication an
d sue dead
at the move information is
Ecorrect. agrceocomply with city and teand r in to
U building construction,and hcmbyauthoriurrepresentatives Or this city LOColor Upon did
move-mentioned fortian poses.
(We)agree
creephvycdmyCCliabilitiejudgments,costs and carcasses which ianyway against said
y and
Of
I
U Z or
APPLICANTeUNDERSTANDSthis
ANYWILL COMPLY WITH ALL NON-POINT Issued by: Date
CE REGULATIONS.
- �" 7� Re-roofs
el vof Applicad coy Doc
H ARDOUS MATERIALS DISCLOSURE Type of Roof Will the appiicam m fuwm W ilJing occupant store or Mndle haallous mamnal
Mfined by Ne Cupenino Municipal Code,Chaper 9.11,and the Health and Safety
ildi*ct?
leSection zss3z(a)? ���ff(������ All roofs shall be inspected prior to any roofing material being installed.
❑Yea I�(faO
Will the applicant of future building occupant ase equipment ant devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants as tel by the Bay Arca Air Qudlily Management all new materials for inspection.
❑Yes
I have real the havandi ``rials odpiremcnu under Charter 6.95 of the Califon
alth tit SafetyCode,Seconds 15505,25533 rad 25534.1 undedea d that if the Wilding
docs not contently have a en c Nat it u my responsibility o nasty the dedupnl of rbc
rcyuiemenlx which
must m psorwi..me.of.Coors", - cy Signature Of Applicant Dale
Owner or actdrn dagent Dal All roof coverings to be Class"B"or better