B-2016-3132 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3132
20995 PEPPER TREE LN CUPERTINO,CA 95014-2919(359 12 019) TITAN GENERAL
CONSTRUCTION INC
FREMONT,CA 94539
OWNER'S NAME: PARTHASARATHYANURADHA DATE ISSUED,:11/16/2016
OWNER'S PHONE:408-309-1550 PHONE NO:(408 883-8668
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class fa Lic.#948867
Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018 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 TEMP POWER(100 AMP)POLE
Ihereby 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.
%,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
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 APN Number: Occupancy TYp :
and state laws relating to building construction,and hereby authorize 359 12 019
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 Cu ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST PALLED INSPECTION.
Signature • Date 11/16/2016 Issued by:MELI r---.
Date: 11/16/2016 I
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 roor'mg 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:11/16/2016
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 MATER ALS 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,Sectr��ons 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino unicipal 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 equip ent 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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections`25503 5533,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:11/16/2016 I
I certify that I have read this application and state that the above information is CONSTRUCTION L NDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructio lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(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
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 flublic records.
Licensed
Signature Date 11/16/2016
Professional
MEJ . . ' GENERAL PERMIT APPLICATION
t� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,,-st,4 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 I S C
RT P4O (408)777-3228• FAX(408)777-3333•buildinq c(D,cupertino.orq
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PLUMBING CI MECHANICAL 2 ELECTRICAL ❑MISCELL' OUS
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❑OWNER 0 OWNER-BUILDER ❑.OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME b at ce K �l•t 9 I LICENSE NUMBER p 44,14 LICENSE PE BUS.LIC r 3 if_?ff
COMPANY NAME ` /, EMAIL /
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STREET ADDRESS p) z.4 l°1 fit ��'iy_aNj i^v/9 0 f CITY,S 1E,Z1 / 55 ( PHONE,) T 5i, ,79.2g
ARCHITECT/ENGINEER NAME !7 LICENSENUMBER ( • BUS.LIC�#' �j, Q
COMP A.NY FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
i USE OF 0 SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN MIDLAND ❑ YES PROJECT IN 0 YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK
I 144 rq.- 0-vr.?, .9b-A3-e,),.._ rOf e i R. ii-vv---(
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TOTAL VALUATION: 5GG @E16REDBY 1
application and the information I have rovided is correct. I have read the Description of Work and verify itthis I agree to eco p
By my signature below,I certifyto each of the following: behalf I have read t is
ppPiy with all applicable local
ordinances and state laws relating to building c* stru.'.•. a.- orize representatives of Cupertino to enter the above-i ntifie propbI or inspection purposes.
Signature of Applicant/Agent: � Date: // `'- /b
SUPPLEMENTAL IN •RMATION REQUIRED I
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IVEEPMiscApp_2011.doc revised 06/21/11