07010001 CITY OF CUPERTINO
IrJILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
If 6
OWNER'S NAME: ATE
RAVI RAO DAVALA 1049 SI'TKA TERRACE 01/02/2007
INE: SANITARY NO. CONTROL NO.
(408) 98--9289
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION - Job Description
U r 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with Section 7000)of Division 3 of Ute Businessand Professions Code,and my license is TEMPORA::ZY POWER POLE
''o,H in full force and effect.
r ? License Class Lic.#
F DateContractor
ARCHITECTS DECLARATION
a< I understand my plans shall be used as public records
tyri
'u.y Licensed Professional
0 OWNER-BUILDER DECLARATION
} 1 hereby affirm that I am exempt from the Contractor's License Law for the
o o� following reason-(Section 7031.5,Business and Professions Calc:Any city or county
% which requires a permit to construct.alter.improve,demolish,or repair any structure
Z In prior to its issuance,also requires the applicant for such permit to file a signed statement
_a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area $200
Valuation
F C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 34214015 Number Occupancy Type
not more than five hundred dollars(5500).
❑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 sale(Sec.7044,Business
Required Inspections
and Professions Code:The Contractor's License Law docs trot apply to an owner ofP
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I.uem daFSa B&P C r this reason
O Dale
KERS C PEN ATION D CLARATI
I hemb affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the ork fo which this permit is issued,1 shall not
employ any person in an manner ct to the Workers'Compensation
Laws of Califo
Applicant
NOTICE TOA CA :If, g Ibis Cc t rears f Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[�►�-� I hereby affirm that there is a construction lending agency for the performance of
IYi> the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
■0 z Lcndees Address
U O 1 certify that 1 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
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ray t) liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date �/ �/2
APPLICANT UNDERSTAND D WILL COMPLY WITH AL NON-POINT Issued by:
SO REG ONS.
1 Re-roofs J�
Ap anUCo for Datc
HAZARDOUS MATERIALS DISCLOSURE Type of R)of
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
❑Yes VW'
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
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new m lterials for inspection.
District?
❑Yes LWO
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant that it ism ponsih.l. to noufy the cupant of the
require c el prior to
ofaCenifeatcofOccu Signature �f Applicant Date
C All roof coverings to be Class"B"or better
Owner or uthorizcd agent D e
F Community Development
S-1jL10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPERTINO
Building Department
JOB ADDRESS: r02S�� / _ _ DG �� c� PERMIT #
`790/0 d
OWNER'S NAME: �" �, PHONE # Z10 _ 16 2
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: 0 _
S.gnature (Daie
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Till e-
11.2,ZO2
er/Contractor Signature bate
CITY OF CUPERTINO
��loleeol
TQM;)' POWER
CUPEkT1NO PERMIT APP=LICATION FORM
APN# 3 Date: N 2,
2-e-V 7
Building Address: /o2�,� ,
1
Owner's Name: VS P �� ✓1 LA Phone#:
Contractor: Phone: License#:
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Contact: kl� Pho :Cu
pertiriZo B�un�esLicense #:
Building Permit Info: /_
Elect El `7/-e (��ICC%C�i �b�� ;tv � i v
Job Description:
Residential Commercial ❑
Cost of Project: 2�o J
Qty. if
Applicable Fee ID Fee Description Fee Group
1 BTEMP —Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING