07090008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
G� Q II3R1ViTJN.
PERMIT NO.
BUIL[2jNO,QDD$F�$:T BAKER DR TBD - TO BE DETERMINED 07090008
y!��j r U j� PERMIT ISSUE DATE
?R'S NAME:
30MMAKANTI VENKAJESHWAR 09/20/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 a 0
!o o LICENSED CONTRACTOR'S DECLARATION Job Description
UJ P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z UW with Section 7000)of Division 3 of tete Business and Professions Code,and my license is RE PL 10 WINDOWS,CONVERT WINDOW TO PATIO DOOR,
tea in full force and effect.
z License Class Lic.a UPGRADE MAIN PANEL,ADD SUB PANEL IN GARAGE, ADD
;F c
Date Contractor LIGHTS CN ALL ROOMS.
� ARCHITECTS DECLARATION
a< I understand my plans shall be used as public records
)WU
W.y Licensed Professional
N
OWNER-BUILDER DECLARATION
'> 1 hereby affirm that 1 am exempt from the Contractors License Law for the
jc O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
v prior to its issuance,also requires the applicant for such permit to file a signed statement �' ,Ft.Floor Area Valuation
z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 rq $40000
e.F (commencing with Section 7000)of Division 3 of Ute Business and Professions Codc)or
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 2 5 6110 2 3:'l7bj Number
not more than five hundred dollars(5500).
Q I,az 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 We(Sec.70".Business Required Inspections
and Professions Code:The Contractors License Law does 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,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.).
Q 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Convactoes La-
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 Contractors
License Law.
Q I am a erupt Oder`Seco B&P C for this reason
Dow at
// WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Q 1 have and will maintain a Certificate of Consent to self-insure for Workers 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 Worker's Compensation Insurance carrier and Policy number are:
Cartier: 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 work for which this permit is issued,I shall not
em to an person in anmanner�p az�p�o cs�b'ect to Ute Workers'Compensation
Lawsof any
Califlq�ia.Date n" 1%_ ? l 3
Applicant M — YJr�iW4
ates
NOTICE TO APPL] ANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
E~.r V) 1 hereby affirm that there is a construction lending agency for the performance of -
(Y> the work for which this permit is issued(Sec.3097,Civ.C.)
ILa Q Lender's Name
az Lender's Address
U C I certify that I have read this application and state that the above information is
LL+ correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned properly for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
IiabiliUes,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
t--t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SO�C�R�ULA IONS
4 Y/ (an:_ --- �l fi Re-roofs �--v
Signature of Applicant ontractor �_Dit T of Roof /
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
-s defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ic,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Cl Yes RNo
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 which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new IT aterials for inspection.
District?
Q Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
reqs; mems which mustmet rior w issuance of a Certificate of Occupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorircd gent are –