B-2016-2587CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2587
6683 JOHN DR CUPERTINO, CA 95014-4564 (369 27 055) CANAAN BUILDERS
INC
SAN JOSE, CA 95124
OWNER'S NAME: SUDIREDDI SREENIVASU AND KORLAKUNTAKOTESWA
OWNER'S PHONE: 408-391-1553
LICENSED ENSED CONTRACTOR'S DECLARATION
License Class B Lic. #994043
Contractor CANAAN BUILDERS INC Date 06/30/2018
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:
1. 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.
z✓ ' 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.
APPLICANT CERTIFICATION
certify that I 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, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the apL
erstands an will comply with all non -point
source reguI
pertino Mun c al Code, Section 9.18.
Signature" Date 09/14/2016s
V
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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.
s. 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 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 must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I 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, 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 09/14/2016
DATE ISSUED: 09/14/2016
NO: (408) 375-4288
PERNUT IWO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REMODEL (351 S.F.) - BEDROOM; WATER DAMAGE REPAIR -
HALL BATHROOM, MASTER BATHROOM, KITCHEN, FAMILY
ROOM, MASTER BEDROOM
Sq. Ft Floor Area: l Valuation: $100000.00
APN Number: Occupancy Type:
369 27 055
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST C'ALI D INSPECTION.
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.
Signature of Applicant:
Date: 09/14/2016
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety o ,Sections 25505, 25533, an 25534.
Owner or authorized agent:
Date: 09/14/2016 __ J
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
t UPERTINO (408) 777-3228 • FAX (408) 777-3333 buildinaCa>cup�ri'ro ora
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI' ❑ RE'VISION, DEFERRED
PROJECT ADDRESS /
J A A) P APN
PERMIT
f DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY E)YES -
BEING ADDED? []NO ADDITION? NO
PRE -APPLICATION [3 YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES REC ED
PLANNING APPL NO PLANNING APPROVAL LETTER EICHLER HO➢rE?0 TOT L VA DATION:
�o tooco
By my signature below, I certify to each of the following: I am the property owner or authorized agent to a t on A property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b'I ing con tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:%? 6',_%{ t_
SUPPLEMENTAL INFORMATION REQUIRED -
-New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
pen -nit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
fonn if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 0621111
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OWNER NAME ` + ry� j PHONE
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OWNER ❑ OWNER -BUILDER ❑ OWN.ERAGENT
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DESCRIPTION OF WORK
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EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE
TYPE OCC. SQ.FT. VALUATION (�)
EXIST NTEW FLOOR. DEMO
AREA AREA
TOTAL
- - -
AREA
NET AREA
BATHROOM
REMODELAREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
e.d
-
PORCH AREA
DECK AREA
TOTAL DECK&ORCH AREA
GARAGE AREA; I DDETI ACH
-
I ❑ATTACH
f DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY E)YES -
BEING ADDED? []NO ADDITION? NO
PRE -APPLICATION [3 YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES REC ED
PLANNING APPL NO PLANNING APPROVAL LETTER EICHLER HO➢rE?0 TOT L VA DATION:
�o tooco
By my signature below, I certify to each of the following: I am the property owner or authorized agent to a t on A property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b'I ing con tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:%? 6',_%{ t_
SUPPLEMENTAL INFORMATION REQUIRED -
-New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
pen -nit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
fonn if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 0621111
Reviewed By: Phuong Devries
Date: 09/13/16
I TABLE OF CONTENTS I
Cover Page
Table of Contents
Form CF -1 R -ALT -05-E Certificate of Compliance
CUPERTINO
Building Department
EnergyPro 6. by EnergySoft REVIEWER f "c�01MMOM PLIANCE User Number: 1234
Reviewed By: Phuong Devries
Date: 09/13/16
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