03060199 (3) CITY OF CUPERTINO " .�..
BUILDING DIVISION PERMIT FaCONTRACTORINFORMA",+. ri.�aaed2 ,.b'
BUILDING ADDRESS: PRASAD KANNEGANTI PERMIT NO03060199
2171996 PEPPER TRIET? IN
OWNER'S NAME: PERMIT ISSUE DATE
dE: SANITARY NO. CONTROL NO.
ARCHITECf/ENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30$ LICENSED CONTRAC OR'S DECLARATION
4 I hereby afthm that 1 am licensed under provisions of Chapter 9(commencing - Job DesCTiptlO❑
with Section IMM of Division 3 o(tha Bueinuund Pmlcssiom Code,and my Been.is
+ „ infull force and effect. KITCHEN REMODEL
�
a Dam License Class Conw■tr D
F,
n t p TS DECLARATION AL
ARCHITECTSDECLARATION
IundcratanJ my plans shall the,used upublic records
'oto Licensed Professional SEP 2 g 2003
3 OWNER-BUILDER DECLARATION
�<X 1 hereby o1Erm that 1 am exempt from Ne Contractor's License Law far be
i
00 following reason.(Section 71313,Business and Professions Code:Any city or county
5_ which reactions a permit to consumer,alter,improve,demolish or repairanystructure W
_Icer poor to its issuance,also roquims the applicant for such permit o file a signed statement
¢¢xx< Omhcislicensed pursuant nthe Provisions Ofthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
d I-� (cam meneing with Section 70(10)at Division 7 of the B usiness and Professions Code)or
that he is eaempt themrrom and the basis rot IM alleged exemption.Any vialat)on of 35913043 . 00
Section 70316 by any applicant(in a Permit subjects the applicant to a civil penalty of ane APN Number Occupancy Type
not mom man five hundred doll..(Mr. P Y YP
❑1,ss owner of the prop.ny,or my employca with wages as their.nle compensation,
will do the work,and ma."acute is net intended or off Bad fora.(.(Sm.7W.Business
and Professions Code:The Carmine,Liana Law does not apply man owner or 10 2 - PIERS d Inspections
properly who builds or impravesIliamon,snd whodoessuch workhimselfortlrough his
Own employees.provided that such impmveranu are not intended oroRered forole.If. 103 - UFER
however.the building or improvement Is mid within mm year of completion,the owner.
builder will ban the burden of proving mat M did not build or improv for purpose or 104 - REBAR
role')' 105 - ANCHOR BOLTS
(]1.as owner of the propcny,am exclusively contracting with licensed contractors to 10 6 - SEWER & WATER
connmcl the project(Sec.7010.Business and Proportions Code:)The Contractors Li-
amelawdomnotapplyloanownerofpropenywhobuildsorimprovmthemon,and, 202 - UNDERFLOOR PLUMBING
who contracts for such projects with o cantractor(s)lianud pursuant o the Comractora
Licen¢Law. 203 - UNDERFLOOR MECHANICAL
P1iam eaemptu Sec. ,B k P C1 far this noon 204 - UNDERFLOOR FRAME
Owaer_. / ' Data 0(.2002 205 - UNDERFLOOR INSULATION
KE MPENSATIONDECLAQATION
I hereby afsim,under penury of perjury Oeeaf allowing declarations: 301 — ROUGH PLUMBING "
R ave and will maintain s Cenficate of Conscnt to mlf-Insure mrworkers Compcn" 302 — TUB & OR SHOWER
sation,as provided far by Section 3700 of ftlabor Code,for the pctf....of the 303 - ROUGH MECHANICAL
work far which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
7700 of the labor Code,for the pedomanee of the work for which this permit is issued. 305 - FRAME
My Workers Compensation Insurance auicrand Policy number art: 3 06 - HOLDOWNS
carr+`° Policy No, 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 = SHEETROCK ,
(this section need nal be completed inhe Morris is for one tondmddollan($100) 309 - EXTERIOR LATH
or less.) -
1 cenify matin the performance of me work for which this permit is issued,1 shall not 310 INTERIOR LATH
anyperaon many mannermum Mmmc mbjen to the warkcn'Compcw0on 311 — SCRATCH COAT
Lawso
Laws of California,Data
Applicant313 - ROOF NAIL
NOTICE TO APPLICANT:IL ebur making this Cenhicate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation provisions of the labor Code,you must
�z mrlhwithcomply with such pm.isiammtits permit hall he,counted mwkd. 502 - FINAL PLUMBING ENERGY
' O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(-r .y., Iherehy affirm that mart is a comtmge
ccion tendingancy(crlMlcrfarmamaeuf 504 - FINAL BUILDING- ENERGY
C > thnder's urwhich this pecmitisissad(SttJ(197,Ci¢C.) 505. - FINAL ELECTRICAL
W A Lender's Nam.
M.
z Under, 506 - GAS TEST
U O I cenify mat 1 Mw mad this application and Stam that 1M above information is 507 - FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and sum laws relating to
0 V building convection,and hereby aulhoriae representatives of this city to cmer upon 0th FIN MECH CAL
a. ahovc(We)
aned gree to artyaw fininspection nifakeep In.
g1s (Wc)agree w ssw,indemnify and kap harmless Be,City of Cup,
against 0 9 F I /) 127 F" 0, Iiabilitie6judgments,casts and expenses which may in any way accrue.92OSloid City 5 NGone /o
U -'7(77 APPLto
IC nccUNDERSTAIII, InNDSIAtND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Dale
SOURC GU ATIONS.
A (o
3 Re-roofs
Sig tore o Appl ren onhmtor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom or handle hoardous matadal
as carload by On
Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Coal salon 25572(al? All roofs shall be inspected prior to an roofing material bei. Installed.
❑Ym RN. P P Y g g
'Will the applicant or future building occupant use equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
hamolnm air contaminants as deMcd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya til No
I hove mad the haaNnusmemriats myvimmsnts under Chapter 695 of me Calirory
nice Halm h Saf.tyCodc,Secdwu255O5,25573 and 25534.1 unJcrnarW thuif the building
mea not c by haw a canard,mat it a my msponsihility an andly be occupant of the
ro'.4cou, hien uatht mpnunuirsuarmoracen;acateal ey. SignalureofApplieant Date
Ow amt rohle sl m3 All roof coverings to be Class "B" or better