15100216CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1172 SCOTLAND DR
CONTRACTOR: JAHAN CONSTRUCTION PERMIT NO: 15100216
OWNER'S NAME: PRATHURI CHANDRA AND SREEDHARA RAMA
P O BOX 2494
DATE ISSUED: 10/27/2015
MORGAN HILL;CA 95038 PHONE NO: (408) 375-9694
SIRIE]ION. RESIDENTIAL COMMERCIAL
OWNER'S PHONE: 7322666410
LICENSED CONTRACTOR'S DECLARATION
License Class Lie. 4__ _ 1
FRONT ADDITION TO ENLARGE THE LIVING ROOM AND
CREATE (N) OFFICE (135 SF); COVERED PORCH (56 SF);
REMODELED AREA TO CREATE (I) OFFICE AND POWDER
ContractorDate"
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
Sq. Ft Floor Area:
Valuation: $50000
t. 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.
e and will maintain Worker's Compensation Insurance,
APN Number: 36228004.00
Occupancy Type:
as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information is
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize
180 DAY ROM LAST CALLED INSPECTION.
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,
Issued by. Date:
costs, and expenses which may accrue against said City in consequence of the
_
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.
Signatur �' �� Date o
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
inspection.
(71 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
ALL ROOF Cq�VERINGS TO BE CLASS "A" OR BETTER
t. I, as 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
sale (Sec.7044, Business & Professions Code)
HAZARDOUS MATERIALS DISCLOSURE
2. I, as owner of the property, am exclusively contracting with licensed contractors to
I have read the hazardous materials requirements under Chapter 6.95 of the
constmct the project (Sec.7044, Business & Professions Code).
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I hereby affirm under penalty of perjury one of the following three declarations:
Safety Code, Section 25532(a) should I store or handle hazardous material.
t. I have and will maintain a Certificate of Consent to self -insure for Worker's
Additionally, should I use equipment or devices which emit hazardous air
Compensation, as provided for by Section 3700 of the Labor Code, for the
contaminants as defined by the Bay Area Air Quality Management District I will
performance of the work for which this permit is issued:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
ner or authored agent:
permit is issued.
¢ Date: ,
3" I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
I hereby affirm that there is a construction lending agency for the performance of work's
must forthwith comply with such provisions or this permit shall be deemed
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
revoked.
Lender's Address)
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information isARCHITECT'S
DECLARATION
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
I understand my plans shall be used as public records.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Licensed Professional
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date