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12070104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10475 BYRNE AVE CONTRACTOR:ALTAP ELECTRICAL PERMITNO: 12070104 OWNER'S NAME: POTLURI SRINIVAS AND BULLIAMMAYI PO BOX 41009 DATE ISSUED:07/16/2012 OWNER'S PHONE: 6509967118 SAN.IOSE.CA 95160 PHONE NO:(408)561-2806 ❑ LICENSED CO TRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB C License Class C l-O Lic:p Ce C- / 2 2 r //If T r—CeC C C---e � �YIECH r RESIDENTIAL r COMMERCIAL r Contractor --ft-�-/ IJat� r�_`1_z/'....L hereby affirm that Into licensed wider the provisions a Chaptc /9 •JOB DESCRIPTION:SINGLE fAMII,Y DWELLING EI-ECfRICAL SERVICE (commencing with Section 7000)of Ui%kion 3 of the Business& Professions UPGRADE Code and that nn•license is in full force and effect. I hereby affirm under penalty of perjury one of the following toxo declarations: I have and will maintain a certificate of consent to set F-insure for Worker's Compensation,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 provided for by Sq.Ft Floor Area: Valuation:$1750 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. MIN Number:35712039.00 Ocnnpancy'I'ypc ,\I'I'LICAN f CIiR'1'IPIC,\'Il(IN 1 certify Thal I have read this application and state that the above infomnation is coffee[. I agree to comply with all city and county ordinances and slate Tars relating to building construction,and herebymmhorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep/harmless the Cit•of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence ofthe 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued Signature ❑ OWNER-RUILDIIR DECLARATION RE:ROOFS: All roofs shall be inspected prior to any roofing material beiig installed If a roof is 1 hereby affirm that I am exempt tram the Contractor's License Law for ane of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,mid the stncmre is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sce.7044,Business& Professions Code). AI-I-ROOF CO\'ERINGS'I'O RIC CI„\SS \"OR 13E'I-I'FR hereby affirm under penalty of perjury one of the fulloning three declarations: IIA%AItUOl1S MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to sell'-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code.Sections 25505,25533.and 25534. I will maintain performance of the work for which this permit is issued compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(h)should I store or handle hazardous material. Section 3700 ofthe Labor Code,far the performance of the work for which this Additionally.should 1 use equipment or devices which emit hazardous air whit is issued. contaminants as defined by the Bay Area Air Qualiry Jlanagement Distw District I ill Ire maintain compliance with the Cupertino Dlunicipal Code.Chapter 9.12 and the I certify that in the performance of the workfor which this permit is issued I shall Health&Safety Code.Sections 25505,25533•and 25534. not employ any person in any manner so as to become subject to the Worker's Compensationlacsof California. If,atiermakingthis certificate ofexemption,I r]}ryher orputlhorizedu hRe�(t: '� �.j // / become subject to the Worker's Connpensaion provisions of thco Elie Labor Code,I nst forthwith comply with such provisions or this permit shall be deemed revoked. CONST RUC`flON LENDING AGENCY APPLICANTCI,RTI FICAT'ION I hereby amrm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that[he above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances mid state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to Saye Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply .UtClll'I'ECI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255 CUPERTINO M ' /� (408)777-3228 • FAX(408)777-3333 • building0cuoertino.ora v\ [-]PLUMBING EINECHANICAL ❑ELECTRICAL ❑hIISCELLA.�7E0US PROJECTADDRESS I Lp (— e V I APN :551 , — OWNER NAME 6 5 v _ 9 9 C _7 1 1 G I E-MAIL STREET ADDRESS I D / 7 Sr� r vi c— A-t-t— l CITY, STATE Z@ C'C/f)G ✓ \ l�o FAX CONTACT NAME U few` PHo o S6 ► - Z�o6 a� e�QGYr I _a(,0a a. ' h-` sTBEE-TADDREss cTTY,rATE z@ 673J F-lw'�6d. �C 2 S� -5 a� CA 9 S f 2-oFAX ❑OWNER ❑ DWNEi-Bvn.DEx ❑ OWNER AGENT XCONTRACroR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME �� E-(e G�r`-� LICENSENUMBER L.ICENSETYPE BUS.LC4 COMPANY NAYff / / 1 l V^ / ZT(,p `11Cr•, �pl` E MAIL,('\ U G' 1 e FAX .�.. STREET ADDRESS 0.S' a ro�>fL I CT!,STATE,ffi ARCHTTECIYENGDJEIIiNAM=_ LICENSE NUFIDEA I BUSS.LICK COWANY NAME' I =MAC I FAX STREET ADDRESS I CITY.STATE ZLP I PHONE USE OF SFV ar DUPLFJ( ❑ MULIT-FAMILY PROIECr DJ WEDLAMI ❑ YES PROJECT IN ❑YE5 IST1iEBIOGAN ❑ YES BUILDING. El MM mCIAL I URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO I SCHI...R HOME! ❑NO DESCR.TTION OF WORK PuyKA IJ + Q_�^ /�6 dU - V D v CA. TOTAL VALUATION: / 7!:,; 6 I RECEIVED BY: By my signamro below,I certi:y to each of the following: I Ron the property owner or authorized agent to act on the prop owner's behalf. I have read this application and the information I have provided is comeL I have read the Description of Worst and verify it is accurate. I ag=,p comply with all applicable local ordinances and smm Laws mlatin building construed I autborize m msenMdves ooa��f'C ertino to inter the above-identifieedpropesy for inspection pul�oses. Signature of ApplicantlAgeaeuf1�r--- Dam: SUPPLEbM-VTAL INFORMLATION REQUIRED ,, OFFICE USE ONLY 41-1 ER-THE-COUNTER ❑ ev'REss u ❑ STANDARD u Z ❑ LARGE ❑ MAJOR h1EP,Lfisc4pp_2011.doc revised 06/-71/11