The URL can be used to link to this page

B-2016-1680 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1680 10529 JOHNSON AVE CUPERTINO,CA 95014-3815(375 27 004) J S C ENTERPRISES& GENERAL SERVICES UNION CITY,CA 94587 OWNER'S NAME: DUVVURU PENCHALA AND KATAMREDDY HARITHA DATE ISSUED:04/04/2016 OWNER'S PHONE:770-295-8712 PHONE NO:(510)305-1538 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#92638-5- Contractor J S C ENTERPRISES&GENERAL SERVICES Date 09/30/2016 X BLDG X ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL— —COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL TEMPORARY POWER I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-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 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500.00 APPLICANT CERTIFICATION Trtifythat 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 27 004 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant LInderstands and will comply with all non-point source regulations p r-tupertino Municipal Code,Section 9.18. 180 DAYS FROM H ECTION. Signature i` Date 04104/2016 Issued by:MELISSA V ti Date:04/04/2016 WNER-BUILD 4 ECLARATION - I hereby affirm th t am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reaso s: All roofs shall be inspected prior to any roofing material being installed.If a roof is r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/04/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. I have and will maintain a Certificate of Consent to self-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.. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read.the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material, Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupert' u jcipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S tions 25 0p,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked Owner or authorized agent:/ ._ APPLICANT CERTIFICATION Date:04/04/2016 I certify that I have read this application and state that the above information is CONSTRUCTIONi E ING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constrtio, lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is is ed Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 04/04/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a)cupertino.orq misc 13- Zo / (( fib ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 7 APN# OWNERNAME t n PHONE -7o �/ E-MAIL STREET ADDRESS p ( ll4nq \ � ` CITY STATE,ZIP jo ! / ,P FAX CONTACT NAME f � �qq CPHONEI i toe �^ lF �� Y SJ6./� �a� /�a�J (J �t� `•� �i E MAIL, :; � p � � Q�3�°0 STREET ADDRESS , r CITY, TATE,pprZ 43. �L� P,A .R FAX ❑OWNER '❑ owNER-BurLDER ❑ OWNERAGENT ❑��C,�Of CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSW$EI" LICENSE T BUS.LIC COMPANY N W°" E-MAIL(U! FAX (� A -73 STREET ADDRESS 7CITY,STATE,ZIP PHONE _�;1 c - CSS. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE of ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑.NO EICHLERHOME? ❑ NO DESCRIPTION OF WORK SemTOTAL,VALUATION: REGEtVED B �' By my signature below,I certify to each of th ow g: I am the property owner or authorized agent to act on the pro e owner's behalf. this application and the information I have pr ded is c ct. I have read the Description of Work and verify it is accurate. I gree o e I all applicable local ordinances and state laws relating to b 'dim cans fins_La thorize representatives of Cupertino to enter the above ide tifie property for inspection purposes. r Signature of Applicant/Agent: Date: SUPPL T Y INFORMATION REQUIRED OFFICE(TSE ONLY' © OYER THE COUNTER Y {i " SSTANDARD' j'1'A OR, MEPMiscApp_201 Ldoc revised 06121/11