10090245 REV CITY OF CUPERTINO BUILDING PERMIT M"311614 D
BUILDING ADDRESS: 948 FORT BAKER DR
CONTRACTOR:A A CONSTRUCTION PERMIT NO: 10090245
OWNER'S NAME: VENKAT BOOMMAKANTI 20689 FORGE WAY UNIT 202
DATE ISSUED: 11/19/2010
OWZWS PHONE: 4084390920 CUPERTINO,CA 95 14
PHONE NO:(408)387-0999
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION; RESIDENTIAL U COMMERCIAL
License CAlass # ADD 450SQ FAMILY ROOM& DINING ROOM AND
Contractor I Date ADDING
z_r f � RECESSED LIGHTS TO KITCHEN; NO RE-ROOF& HAS
I hereby a qqtt provisions of Chapter 9 STRUCTURAL
(common ctio )tof Divisio3 of the Bus'.
&Professions
Code and that my license is in full force and effect.
12/13/10 REVISIONii#1 MODIFYING LOCATION OF DINING
1 hereby affirm under penalty of perjury one of the following two declarations: ROOM,RELOCAy'ING WINDOWS&SHEARWALLS:ISSD
I have and will maintain a certificate of consent to self-insure for Worker's 12/22/2010
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area:
1 have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$100000
Section 3700 of the Labor Code,for the performance of the work for wh' h this
permit is issued. APN Number:35611025.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating PERMIT EMPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 18,0 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by: Date:
with all non-point sou reg lations er the Cupertino Municipal Code,Section
9.18.
Signature Date � RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
El OWNER-BUILDER DECLARATION inspection.
I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant:_ Date:
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardops materials requirements under Chapter 6.95 of the
I hereby affirm under penalty of perjury one of the following three California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
declarations: maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 have and will maintain a Certificate of Consent to self-insure for Worker's Health&Safety Code,SOtion 25532(a)should 1 store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as deri0ed by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5,2 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date: —,2-71,q
,-
I certify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I 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 building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date