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B-2017-0374CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1147 KENTWOOD AVE CUPERTINO, CA 95014-5807 (359 31 018) OWNER'S NAME: SRINIVASAN RAJAGOPALAND RAJAGOPAL USHA OWNER'S PHONE: 650-438-7744 LICENSED CONTRACTOR'S DECLARATION License Class ELECTRICAL Lic. #692291 Contractor ALTAP ELECTRICAL Date 07/31/2018 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby 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. 2. i /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. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/07/2017 hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: I, 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three 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. 2. 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. s. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/07/2017 CONTRACTOR: PERMIT NO: B-2017-0374 ALTAP ELECTRICAL SAN JOSE, CA 95160 ISSUED: 03/07/2017 NO: (408) 309-8290 BUILDING PERMIT INFO: X BLDG X ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: UPGRADE MAIN PANEL FROM 100 TO 200 AND, SAME LOCATION Sq. Ft Floor Area: I Valuation: $2300.00 APN Number: Occupancy Type: 359 31 018 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM by: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofAppl Date: 03/07/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health &Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent:, Date: 03/07/2017 C� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 —� (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org misc ❑PLUMBING F-1 mEmAwAL I—IFT.FCTRTCAT. I—IMTc('.FT.T.A-�JFnTTS PROJECT ADDRESS /q / / �(� �+ �a G I /(v� 77N# i \I/� [/} OWNER NAME A �( �( c/ t PHONE / s- d -,e-/.3,?-77,4t41 L/ 3 � 7 / ,i t 4 EMAIL STREET ADDRESS ' t 7 T� e-4-Lt%o G � Q. �� / ` CITY, STATE, ZIP Cv�er-�'i'ti.o FAX CONTACT NAME I/(a r Wl lijA d S� C`�k Z CL �c • i 0J/ PHONE , 92,1 p E-MAILU STREET ADDRESS /� d /®" f C❑{ CITY, 0. STATE, ZIP S��5 0'e. c,4 ❑ OWNER ❑ OWNER -BUILDER OWNER ARGENT YCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHOECT 1-1 ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /4) LICENSE NUMBER �9 z LICENSE TYPE cr-t o BUS. LIC # Z /�c�pr� COMPANY NAME / ^T / t � Z/ 'e C 1 �. t �a E-MAIL %, f.� �e (e G` r =' cq d yoL 6n C. FAX -4.. STREET % 1 L / G"f ®G Ct ie� ESS CITY, STATE Sdr P S� C,4 / L O ONE PH 6� 3 9 ' D Z 9 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ sFD or DUPLEX ❑ MULTI-FAMLLY BUILDING: ❑ CONLMIERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK U TOTAL VALUATION: $2, By my signature below, I certify to each of the following: I am the property owner or authorized agent td act on erty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Ke Date: �/ SUPPLEMENTAL INFORMATION REQUIRED OEEICE USE ONLY ❑ OVER-T)E.COUNTER r� f' ❑ EXPRESS © STANDARD v ❑ LARGE F, Cl MAJOR MEPMiscApp_2011.doc revised 06121/11