06010116 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITC0NTRACT0R4.INF0RMATI0N A
BUILDING ADDRESS: OM BUILDERS, INC PERMITNO.O6O1O116
510 RAINBOW DR
'R'S NAME: PERMIT ISSUE DATE r
KROTHAPALLI ANJANEYULU AND KUM37O53 CHERRY ST. #117 02/10/2006
PHONE: SANITARY NO. CONTROL NO.
(510) 744-1085
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED mhatIAMCONTRACTORS derpDECLARATION JobDescri -
uC I hereby affirm that 1 am fthe undo provisions of Chapter 9(Commencing Description
W with Section]IXp)ofDivision]of dABusinessarb Profeixiuns Code.and mylicemeis
„ mfull to=and effect. REVISION--FOUNDATION EFFECTING LAYOUT
>'qa Date Cites Lie'" NO NEW PERMIT ISSUED/ORIG. #04050085
=t,-p Dau: 7'S DECLARATION m Er'' AR CHHECse DECLARATION
e< 1 understand my plans shall he used as public records
>du
g
Licensed Professional
< OWNER-BUILDER DECLARATION Contractor's
ON
q1 Maso .('firm on 1 1. exempt from the Gonias o License Law for the
p o following reason.(Section 703 1.5.Business and improve.
dmons Code:Any city or county
E which reyuims pcnniun cnmwcl,almG improv.h Permit t or e pair any swcmn:
Z Z� prior its issuance,sedpursuant
un so uarequirestte the proviisiorm of for such perms'm filLicense
Law
(Chapter
��$< Nmhcisliccnmd SectiotwNepmviviomafof ftBuacmranicensetaonsCodmr9 Sq. Ft. Floor Area Valuation
(commencing with SectionTafq)of Divuian3m(the Business and Professions Code)or $214
y — Out he u exempt Ihcrefrom And the basis for the alleged exemption.Any violation of 4
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy
not more than five hundred dollars,(S50o). P Y Type
I,amvner orthe property,ar my employcu with wagna their talc compenation,
will do the work end the structure is not intended croRered passage(Sec.7044,Business 36611047 . 0 E)
and Professional Cade:The Camrscmrs License law does not apply m an owner of Required Inspections
property who builds orimpro as Herron,and whodoesswit wmkhimself or through his
awn employees,provided Has such improvements arc not intended oroRered for sale.If,
however.the building or improvement is sold within one year of eempletion.the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of ` ♦ \
ale.). O
1,u owner of the properly,am mclmivdy contacting with liccrued convacrors m S
QI Ne pmjca(Sec.]014,Business and Profnsvom Code:)The Conmmors Li-
ceme Law docs not apply to an owner of property who builds or improves thueon,and
who contacts for such projects with a contractor(s)licensed pursuant to the Coneactors \
License Law.
❑
I..cameo,un ,B h P C for this mason
Dem
WORKER'S10111 COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
0 1 haw and will maintain aCertifimw of Comenuoulf-insum for Workers Compen-
sation,As provided for by Section 3700 of the labor Cade,for the performance of the
work for which this permit is issued.
0 I ban and wilt maintain Worker's Compensation Insurance,As required by Section
3700 of the labor Code,for the pertormatt of the were,for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisseedon need not be comPlemd lithe permit is panne hundred dollars(SIM)
or less.)
I cent(,Out in to performance of Ne work for which Nis permit is issued.I shell oat
employ any person in any mvmersn is On bcgome subject m the Workers Compensation
Laws of Calif ornia.Date /&;X
Applicant gr
NOTICE TO APPLICANT:If.after making Our Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of thc labor Code,you most
.J O fOMwpermit Moll comply with such provisions or this permshall he deemed revoked.
z� CONSTRUCTION LENDING AGENCY
lhereby ME.that One is.consmmtinn lcodingageney for the performance of
C! the work for which this permit is issued(Sec.3097,Civ.C.)
4 Lando,Name
= z lenders Address
U C) 1 comfy that 1 have mad this application AM sum that the.hove information is
IL f-' conte'I agree m comply with all city and county ordinances and su¢laws relating in
O V building construction,and hereby Audiencereprcsenutiws of this city to enter upon the
above-mentioned property for inspection purposes.
F y (We)agree to ave,indemnify and kccp harmless the City of Cuperorb against '
N Iiabilidu,judgmcns.costa and exposes which may in MY way acmtm against said City
f,z
in consequence of the granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2'�6"A�6
SOURCE REGULATIONS.
�
Signature of Appbca . tractor D DA Re-roofs
H
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ytapplicant or future Wilding occupant Chaptstemor handle ha lthAd SArial
efiSec hY the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
.Section 33532(.)?Yes No
All roofs shall be inspected prior to any roofing material being installed.
®
/ If a roof is installed without first obtaining an inspection,I
Will Ne applicant or four.building occupant esu cyuipmem or devices which g agree to remove p
emit hmudnus air conurnmants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
0 Yes UN.
I have mad the hanrdnmmamrials requirements under Chapurli.95 of the Califon
nia Hcalth&SMIcly Cade,Scctimt 25N)5,25533 and 8534.1 understand th addre building
does Out currently hoc a Aman' at it 0 my responsibility he notify the OCCUPMl of the
rcquimmcnu which must-weamanCe.r.ce„i reae of Occup fix Signature of Applicant Date
owner or authodeed agent A All roof coverings to be Class"B"or better