B-2018-1237 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1237
ROCKWOOD
CONSTRUCTION
CORP
SARATOGA,CA 95070
OWNER'S NAME:VENKAI-ACHARI BALAJI AND BALAJI LAKSHMI DA'Z'E ISSUED:07/24/2018
OWNER'S PHONE: PHONE No:(408)568.6474
LICENSED TRDECLARATION- BUILDING PERMIT INFO:
License Class @ Lic.4685684
Contractor ROCKWOOD CONSTRUCTION CORP Date 04/30/2020 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed ander 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:
TEMP POWER(100 AMPS)
I hereby affirm under penalty of perJm•y 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 3700 of the Labor Code,for the
y 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 die performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1000.00
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 Type:
and slate laws relating to building construction,and hereby authorize 35709 045
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 WORT{IS NOT STARTED
may accrue against said City in consequence of the granting this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all ll non-point
source regulations per the Cup no Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
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Signatures-�=--=- Date 7-24-2018 Issued by:Kim Dunbar
Date:07/24/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of theRE-ROOFS:
fallowing two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. 1,as owner of the property,or my employees with wages as their sole Installed without first obtaining an inspection,l agree to remove at[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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sce.7044,Business&Professions Code), Date:7-24-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BUTTER
r. 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 rend the h r-rdous 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 25534.1 will
mit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
per m
s. I certify that in the performance Health&Safety Code,Section 25532(.)should I store or handle hazardous
e of the work far which this permit is issued,f moterial,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 Ah'Quality Management District I
Worker's Compensation laws of California.If,atter making this ccrtificatc of will mainmin compliance with tire Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Counpcnsation provisions of the the health&Safety Code,Sections 2550. 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized a en. .---
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APPLICANT CERTIFICATION Date:7-24-2018
I certify that I have read this application and state that the above information Is CONSTRUCTION LENDING A FNCY
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-point source regulations per the Cupertino MunicipalARCPU7RCT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used se public records.
SignatureLicensed
Date 7-24-2018
Professional