07080229 CTTY OF CUPERTINO
BUILDING DIVISION PERMIT mCON.TRACTORINEU ATION,
BUILDING ADDRESS: - PERMIT NO.
845 ROSE BLOSSOM DR SRINIVAS NALLAMOTU 07080229
OWNER'S NAME: PERMIT ISSUE DATE
845 ROSE BLOSSOM DR 01/14/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECTENGINEER: BUILDING PERMITINFO
ADDED.MMTER BEDRM, ANOTHER BLDG EO PLO O
Yp0 LICENSED CONTRACTOR'S DECLARATION -
O hereby enN licensedunderpmnsafChepmr9(mm.uncint ^^••^^^_ �•�^^••^•• •• ..,Iob.D escipVOA
with Sccdm 713111)of 0ivWon 3 ofJe Business and Professions Code,sM my license u
e in full force and efmcL 27�d ,
3 LkenY CI . Lk.
7
Data t Con ty DELL ARCHITECTS DE LLA A O!
Lyn IunderwnJ my phone siWl be ueJuPublic record '
y SSSS Licensed Professional
^rt OWNER-BUILDER OECe Conu ON
S<9 1 meso aRm that 11. exempt from the Comes Co License Law for the
D o which re moon.Permit
(Section 7031.4 Businw and ow,deaou Code:Any city or manly
$ which requlrtun permit re eonstrocL alter,impmw,dermitt .Tea sir ant structure
pnormits issuance.also requires t onviSh icand for anchpermitm Bleaai@ned aummw
< (bathe mcioll it porwant.the pro visions sl 3 de Cmut.aLicemelaw(Chopmv9 Sq.Ft. Floor Area Valuation
9 (m..Cmlagwith Section 700M and
ndthe basisfr the
the Bunnaemton.Any
yvi Codc)ad
.. Nn he u axwpl therefrom and the buss for me alk{cd exemption.Any violation of
Sacaan 7031.5 by my applicant for a permit anbjmm the applkand to.,M]penalty of APN Number Occupancy Type
nal mart dun Bw hundred dollars IS300)•
1,u owner of Uie psoprsty,army wployeu cold mgn u thehank mmpewtion,
and do thewrk,and the heContranotinmnddo LawdofmaW(See.in an weer of
and Ho(osions Cade:The wstheme.Licenseand
law doss rot apply if an Owner is Required Inspections
property who build.viinsprows o ins n,and who doe souchwort hhnulfedthmu{n his
awn em,the building
Nal ouch impmnmmu art mot
tied or lannrtd for We.U.
bawder the bw that t rimpmwmml u that
within oro yean of c prow:farn.thepose r.
of
"le.)L will low tiro burden of proving this he did Out build or impmw for purpose of
Yk.)
❑1,u ow.ar the property.w eaclusiwly cmusu ns with Iiceued mnoutan in
construct the p.jem(Sec.7044,Business and Pmfwimu Cade:)The Comacuse.Li-
cense law dura not apply he an owner of property who builds or Improve thereon.and.
who Contracts for such pmjecu with acentrumr(s)licensed purmant in the Conumeme.
4-nw law.
❑Iwuemptunder See .B@PCfortWruYn
D. Date
WORKER'S COMPENSATION DECLARATION
1 bemby alarm under penalty of perjury one of the following deGuuions: ..
haw and will maintain a Canifiate ofCmuent.self-iuurt fm Worker's Compeo-
aa,as provided for by Section 3700 of the labor Code.for the perfomanes of the '
work for which this permit is Issued.
❑1 ban and will maintain Worker's CompenYdon Insurance,u required by Section
3700 of the labor Code,for the perfamvtce of the wart for which Nis Permit is issued.
My Worker'.Compuu/Wm Inwrmuce carrim and Policy number w:
Cartier: L /"V Policy No.:
CERTIFIC
Card-
COMPENSATION
ATION I N FROM E ERS'
COMPENSATION INSURANCE
(This mention need not W completed if the{emit Is(mono hundred dollar(SIOM
okra)
I codify them in roc perfomuce of the work for which this permit Is tuced.l shill not
employ any pecan in my mannans an to become subject to the Workeri Co.pcwdoet
Laws of Califamia.Data
Applicant
NONCE TO APPLICANT:If.afmr..king this Ccnifiam of Ramrod..,you should
bmpme subject m Use Workers Compensation p.vluons of the labor Code,you muss
.J O forthwith comply with much providons or this permit shall be deemed.1twJ.
z^' CONSTRUCTION LENDING AGENCY
[-+'4 IMmhya?im that there lis construed..knlingageYY far the performance of
�i the work for which dubs permit 6 intend(Sec.3097,Civ.C.)
Id] Q Lender's Name
= z Lcmi Address
U O I«nify and I haw read this application and nam then the show information u
UL corrccL I agree in comply with W city and county ordinances and mu Iowa relating or
O rl'J Wildingconstruction,and hcmby mthorse representatives of this city to comer upon due
LT7 above-mentioned property for Wpecdan purposes
py (We)agree to ssn,indemnify and keep hamlet the City of Cupertino mom,
y liabilities Judimcau,eosu and'.,messes which yin any wyamn moral acid City
U in consequence o(the gran Un (thisp—L
^r APPLICANT UNDER A D W COMPLY WITH ALL NON-POINT Issued by: Date
5 RCE GUUTIONS.
1 DB Re-roofs
al{masa of ApplicuVContranmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof; .
Will the applicant or fumm building encupant nom car handle haurde us material
u de0ned by tM Cupertino Municipal Code,Chapter 9.1;and the Health and Safety
Code,Section 75531(.)7
❑Yu All roofs shall be inspected prior to any roofing material being installed.
Will da pp icam car metre btudin@ Occupant mo equipment or do iae womb If a roof is installed without first obtaining an inspection,.I agree to remove
I huardnm air mnumirunu as defined by the Bay Arta Nr Quality M....mnent all new materials for inspection.
Ouim?
❑yea
I Mw mewl the "m
aerial rtgmm un4rCNperG93ofthe Cnifor-
out Hmjib&Safety Cade-Seen U503.25533 534.I underamd that lfthe building
don Momentarily Mw a u my Nlidy in hyairy the occupant of Je
rtgmm _ whinwhiIt t�n�` ofACc Iloy��l� Signature of Applicant Date
Ownm.. I Dam All roof coverings to be Class"B"or better