07020149 7.
CITY OF CUPERTI1�10 PERMIT
BUILDING DIVISION PP�1�MI
PERMIT NO.
BUILDING ADDRESS: TBD — TC BE DETERMINED 07020149
948 FT BAKER DR
PERMIT ISSUE DATE
OWNER'S NAME: 02/28/2007
VIENKAT BONNAKANTI SANITARY NO. CONTROL NO.
_)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
19z
LICENSED CONTRACTOR'S DECLARATION Job Description
iv p thereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Scction 7000)of Division 3 of tha Business and Professions Code,and my license is REMODEL: HALL BATHROOM, MASTER BATH/CLOSET AND
t=y? in full force and effect. Lie a KITCHEN. NON STRUCTURAL
j License Class
Contractor
?t"'W Date ARCHITECTS DECLARATION
I understand my plans shall be used as public records
)qUJ
•a,F„ Licensed Pntfcssional
•O<
OWNER-BUILDER DECLARATION
]` 1 hereby affirm that 1 am exempt from the Contractors License Law for the
a p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<_9 which requires a permit to construct alter,improve,demolish,or repair any structure
4"- prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contmctur's License Law(Chapter 9 q' $20000
Fz C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number
not more than five hundred dollars($500). 35611025
❑1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of
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,Ute building or improvement is sold within one year of completion,the owner-
builder will have We burden of proving that he did not build or improve for purpose of
sale.).
,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-
ho
n,and
who contractLaw sfor such pnot rojects is with a c ntractan owner of or(s)rty licensedbuilds
pursuanP the roves Contractor's
License Law. B&P C for this reason
❑I amexempt under Sec
Owner_ :_. 0't /tL—�-- -Dam
WORI ER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑l 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 Ibis permit is issued.
❑1 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 Worker's Compensation insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not be completed if the permit is for one hundred dollars($100)
or less.)
i certify that in the performance of the work for which this permit is issued,l shall not
employ an*OAPPTIC n in anyAf.
so come subject to the Workers'Compensation
Laws of Ci� �—
Applicant �NOTICE T ANer making thisCertificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,z forthwith comply with such provisions or this permit shall be deemed revoked.
z� CONSTRUCTION LENDING AGENCY
F,CA
41 hereby affirm that there is a construction lending agency for the performance of
fy.> the work for which this permit is issued(See.3097,Civ.C.)
Irl A Lender's Name f�
z `` /
Lender's Address
�VU O 1 certify that 1 have read this application and state that the above information is
(I.— correct.I agree to comply with all city and county ordinances and state laws relating to
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building conswction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless-the City of Cupertino against -
rA liabilities,judgments,costs and expenses which may in anyway accrue against said City
U z in consequence of the granting of this permit. Date
�-+
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'r:
SSO C iR�UL �1j� _
J Q ? Re-roofs
Signature off Applica(NContractor Type of"',oof
HAZARDOUS MATERIALS DISCLOSURE yP
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 roof:;shall be inspected prior to any roofing material being installed.
>f�N�
❑Yes If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices whicn all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Arca Air QualityManagement
District? yy,�
❑Yes []No
1 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 Ute building
docs not currently have a tenant,that it is my responsibility to noddy the occupant of the Date
rc ircments which must be met prior to issuance of a Certificate of O�ccu "cy SignatuI e of Applicant
" All roof coverings to be Class"B" or better
ilbatc
Owner or authori.cd agent