B-2018-0137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0137
7595 ERIN WAY CUPERTINO,CA 95014-4320(359 20 014) Alishetti Bhoomaiah And
Saritha
7595 Erin Way
Cupertino,CA 95014.
4320
OWNER'S NAME: DATE ISSUED:06/26/2018
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Allshetti Bhoomaiah And Saritha Date X BLDG YS ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commending —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:
IST FLOOR ADDITION(385 SF),2ND FLOOR ADDITION(709 SF);
I hereby affirm under penalty of perjury one or the following two declarations: BATH REMODEL(87 SF);KITCHEN REMODEL(131 SF);BALCONY
r. 1 have and will maintain a certificate efcousent to self-insure far Worker's (130 SR UPGRADE ELECTRICAL PANELTO 200 AMP;REMODEL
Compensation,as provided for by Section 3700 ofthe Labor Code,for the OTHER(1,047 SF);ADD 3 NEW SKYLIGHTS;NEW TANK WATER
performance ofthe work for which this permit is issued. HEATER AND FURNACE
x. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance ofthe work for which this
permit is issued, Sq.Ft Floor Area:1094 Valuation:$150000.00
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: Occuptmey Type:
and state laws relating to building construction,and hereby authorize 359 20 Ol4 R-3(Custom)
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 06/26/2018 Issued by:Jasmine Archbold
Date:06/26/2018
OWNER-BUILDER DECLARATION
1 hereby aMrm that I out exempt from the Contractor's License Law for one of the RE-ROOFS:
fallowing two reasons: All ..is shall be inspected prior to any raafing material being insulted.If a roof is
r I,as owner ofthe property,or my employees with wages as their sale installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the sh ucture is not intended or offered for inspection.
sale(Sec.7044,Business&Prafessioos Cade)
I,as owner ofthe property,am exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(See.7044,Business&Professions Cade), Date:06/26/2018
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 far Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe work for which this permit is issued HAZARDOUS MATERIALS DISCLOSURE
a 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 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
a. 1 certify that in the performance of the work for which this permit Is Issued,I Health&Safety Code,Section 25532(.)should 1 store ar handle hazardmrs
shall not employ any person in any marina 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 Are.Atr Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
APPLICANT CERTIFICATION Date:06/26/2018
I certify that I have read this application and state that the above Information Is CONSTRUCTION LENDv�1I -xmN'C'Y-,
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 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-polot source regulations per the Cupertino Municipal ARCA 1'1'EC'I"S INCLARATION
Code,Section
26/2018 Licensed