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07050203 CITY OF CUPERTINO BUILDENG DIVISION PERMIT I EQRM4TION' BUIL 1 G ESS: PERMIT NO. 1�p1 LEBANON DR D & D CONSTRUCTION 07050203 PERMIT ISSUE DATE OWNER'S NAME: SRIDHAR OBILISETTY 1447 H1,MPTON DR 05/21/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITFCT/ENGINEER: TEMPORIiRY POWER BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description U3 F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is H in full force and effect. r ? License Class Lic•N F Date Contractor ARCHITECTS DECLARATION i < 1 understand my plans shall be used as public records )yU 'u.F Licensed Professional w OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the pO following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area _ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of saas�l- owner of the property,am exclusively contracting with licensed contractors to eonstnret the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exem n4er S B&P C for ibis teas n Owner Date W 'S 0M[PENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performaAc of the work for which this permit is issued,1 shall not employ any person' y m t to the Workers'Compensation Laws of Califomi D Applicant NOTICE To APP Rfff,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY [~-r C/) I hereby affirm that there is a construction lending agency for the performance of (x > the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name r7 z Lender's Address U 0 1 certify that I have read this application and state that the above information is [t. — correct.I agree to comply with all city and county ordinances and state laws relating to 0 building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ■" APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR U ONS. ZII Re-roofs Signat plrcant/Contractor Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal otic.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes If a roof i;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 1 have mad the azardous materials requirements under Chapter 6.95 of the Califor- niaHcalth&SafetyC Sections 25505.25533 and 25534.1 understand that if the building does not currently h tenant,that it is my responsibility to notify the occupant of the require n!L hi h u t be met prior to issuance of a Certificate of Z. —7 Signature of Applicant Date O All roof coverings to be Class"B"or better Owner or s cd agent Date CITY OF --UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34214008.00 DATE ISSUED. . . . . . . : 05/21/2007 RECEIPT #. . . . . . . . . : BS000001403 REFERENCE ID # . . . : 07050203 SITE ADDRESS . . . . . : 10171 LEBANON DR SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SRIDHAR OBILISETTY ADDRESS CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-2645 RECEIVED FROM . . . . : OBILISETTY/SRIDHAR CONTRACTOR . . . . . . . : ENLE WU LIC # 23939 COMPANY . . . . . . . . . . : D & D CONSTRUCTION ADDRESS 1447 HAMPTON DR CITY/STATE/ZIP . . . : SUIiNYVALE, CA 94087 TELEPHONE (4C8) 666-5298 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- -- BTEMP FLAT RATE 1. 00 62 .10 0. 00 62 .10 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 -- ------ ---------- ---------- ---------- TOTAL PERMIT 100.47 0. 00 100.47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 100.47 MC --------------- TOTAL RECEIPT 100 .47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF (:UPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM 0?050P03 APN# :54—,2 14 e TDate: W i 2 f I�,- Building Address: (01 -71 k(fb Q O(-),f) J) I v,e C(-k P0✓h?)C), CA q�j v 14' Owner's Name: P 1;�: Z 6tZ,c71 Cont actor: Phone: License #: 16,q 4�x VU 446) CC66-2-96 Contact: , Phone: Cupertino Business License#: SP,i -D 11� C�► 3 �z 1 3 Building Permit Info: Elect ❑ Job Description: Residential Commercial ❑ Cost of Project: ��,K��a,� � (, �3�v — �-�•� Qty. if Applicable. Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING