B-2016-1762 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1762
7636 WEST HILL LN CUPERTINO,CA 95014-5057(362 27 024) RELIABLE&LOYAL
CONSTRUCTION
MANAGEMENT
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:07/28/2017
OWNER'S PHONE: PHONE NO:(408)509-2602
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#916332
Contractor RELIABLE&LOYAL CONSTRUCTION MANAGEMENT Date X BLDG _ELECT _PLUMB
05/31/2018 _MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. CONSTRUCT(N)2 STORY SFD 2514 SQ FT,(N)GARAGE 448 SQ FT,
I hereby affirm under penalty of perjury one of the following two declarations: (N)ENTRY PORCH 40 SQ FT,(N)COVERED BALCONY 129 SQ
DEF#1-TRUSSES-issued 03-19-2018
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -LANDSCAPE CHANGES-ISSUED 5-23-2019
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 Sq.Ft Floor Area:2962 Valuation:$520000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 362 27 024 R-3(Custom),R-3(Custom),U(Private Gar/Ag Bldg),U
and state laws relating to building construction,and hereby authorize (Private Gar/Ag Bldg)
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 understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5-23-2019 Issued b :Kim Dunbar
g y
Date:07/28/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 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:5-23-2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,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:5-23-2019
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of works for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lenders 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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 5-23-2019 Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1762
7636 WEST HILL IN CUPERTINO, CA 95014-5057 (362 27 024)
RELIABLE & LOYAL
CONSTRUCTION
MANAGEMENT
CAMPBELL, CA 95008
OWNER'S NAME: PAMU PRIYATHAM AND P]TTA HIMABINDU
DATE ISSUED: 07/28/2017
OWNER'S PHONE:
PHONE NO: (408) 509-2602
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:.
License Class @ Lie. #916332
Contractor RELIABLE & LOYAL CONSTRUCTION MANAGEMENT Date
X BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
05/31/2018
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
JOB DESCRIPTION.
license is in full force and: effect.•
CONSTRUCT (I) 2 STORY SFD 2514 SQ FT, (N) GARAGE 448 SQ FT,
(N) ENTRY PORCH 40 SQ FT, (N) COVERED BALCONY 129 SQ FT
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3706 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
Sq. Ft Floor Area: 29.62
Valuation: $520000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read, thisapplication and state thpt the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
362 27 024
Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U
and state laws relating to building construction, and' hereby authorize
(Private Gar / Ag Bldg),U (Private Gar /Ag Bldg)
representatives of•this'city to anter'upon the above mentioned property for
inspection purposes. Mia) agree to save indemnify and keep harmless the
City of Cupertino against liabilitiesJudgments, 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 understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Date 07-28-2017
Issued by: Kim Dunbar
Date: 07/28/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two: reasons: '
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. 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 wok, 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 a project (Sec.7044, Business & Professions Code).
Date: 07-28-2017
I hereby affirm under pe alty of perjury one of the following three declarations:
'1. I Have and will maintain a Certificate of Consent to self -insure for Worker's
ALL "All
ROOF COVERINGS TO BE CLASS A OR BETTER
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 mamtain,Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter -6.95 of the
Section 37001. 1. C
LabI,ior Code, for the performance of the work for which this
California Health &Safety Code, Sections 25505, 25533, and 25534. I will
permit isitssued.; • '
maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and the
s. I certify,that in'tho performance of the work for which this permit is issued I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shaTnot"employ any,person;i i any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
q
Worker's Compensation'laws iofCalifornia. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12
exemption, I become s'ubject,to the Worker's Compensation provisions of the
and
the Health & Safety Code Sections 25505 5533 and 25534.
"J f f f
,I, ��..' I.
Lalior Code; I:must fo , wit.' compI with such provisions or this permit shall
be',deemed revoked.
Owner or authorized age
i ;APPLICANT CERTIFICATION
Date: 07-28-2017
I certify that l,have read thisa [!cation, and state that the above information is
CONSTRUCTIONLENDINGAGENCY
correct. I agree. to comply with ;a11 city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relatin to�buildin con"structi n, and herebyauthorize representatives of this cit
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above,`nientidned property for inspection purposes. (We) agree
Lender's Name
to save indemnify an' ' eep harmless the City of Cupertino against liabilities,
judgments, costs,land �ezpenses which may accrue against said City in
Lender's Address
consequence;of the granting ofithispermit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18. I'
I understand my plans shall be used as public records.
Signature" Date 07-28-2017
Licensed