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05010099 CITY OF CUI'GR'1'INO BulLowc DrvIs1oN PERMIT CONTRACTOR,INFORMATION, BUILDING ADDRESS: PERMIT N b5010099 W NEWS NAME: PERMIT ISSUE DATE SATYA DHAN 01/18/2005 ONE: SANITARY NO. CONTROL NO, 10D.te— CHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Lm that IDCON?RACnOrproviConsof CONJob Desert tion 1 M1creby affirm that 1 am licenwd under provisions of Ch.dc. 9(commencing - PthSection adkBice Division]of the Businmaand Prufcssinns CoJc.roil myliccns ismummeanderrrer' REPLACE FURNACE & ADD 3 ense Class � Lic.•cGUnlDECL al I Al ARCHITECTS DECLARATION 4bwW6 @W'asO/ L a 1 undcrsmnJ my plans Js roar Licensed Prokommil FEB �� 0 1 hcrchY a I OWNER-BUILDER C nvactorY hiccn aw,for me 2005 Go following reason,(Section T(OJ..aim y61ymccomy m which mquims a permit In construct,alter,improve,demolish.fir repair any structure [MR , q Ie;; tl ,.,5� 2 B 0 poor to is issurim.alsu acquires the applicant fofsuch .I,in file a signed summenl < thathcislicenYJPonuomb,theprovislansnrtheContracmrsLhcnmlaw(cnaptery Sq. Ft. Floor Area NL—�tl19. YH �Vy Valuation RI--O (Commencing with Section 7")of Division3 of the Business and Professions Code)or $ that he is exempt thcmfrom and the basis far the alleged exemption.Any violation of Section 7031.5 by any applicantfar a pnard subject,the applicant t.a civil penalty of 3JQ e100 Occupancy Type net mom man five hundred dnnars($!m0k Pane Y YP ❑I,as owner of the property.or my employees with wages as their sole compensation, will do the work,and de structure is not intended or approval for sale(Sec.TDaa,Business and Professions Code:The Contractor's Licemr law does not apply m an owner of Required Inspections property who builds or impa.ves thereon,and who does such work himself or through his din employees,provided that such improvements are nal intended.,offered for sale.If. however,the Wilding or improvement is said within one year of completion,me owner- builder will have the burden of proving that he did not build or improve r.(purpose or le.). L,a.won of the propert,am mewsively contracting with licensed commerce;to cranstarmil the projat(Sec,734A,Business and Professions Coi The Contractors Li rens,law does not apply to an owner of propcny who Wilds or improves thereon,and, who contracts for such projects with a c.ntramn(s)licensed purr mono the Contractor's License Law. ❑ I i mfw r Seo. ---(. B h p r for this mason wear. - WORKER'S COMPENSATION DECLARATIOly 1 hereby affirm under penalty of perjury arc of me fallowing declarations: 1 have and will maintain a Cenilicmc of Consent t.self-insure for Worker's Compen- 1031'W i.n,as provided for by Section J?W.f me labor Code,for the performance Of the rk for which this permit is issued. I lave and will maintain Wokers Compensation Insurance,as mquimal by Section of de labor Code,for the performance of the work for which this permit is issued. y Worker's Compensation Insurance rainier and Policy number artmera 'Pal icy No.: _ CERTIFICATE OF EXEMPITON FROM WORKERS' COMPENSATION INSURANCE (This section need not bccompmu d if the permit is Roane hundred dollars(Vir or less.) 1 certify mm in the Performance or me work for which this Permit is issued.l shall not employ any person in any manners as m become subjecuo the Workers Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccni lieam oI Escrarion,you should become subject to the Worker's Compensation provisions of the labor Code,you must � z momwi th comply with such provisions or this Permit shall be deemed revoked. - ZN CONSTRUCTION LENDING AGENCY 1 hereby affirm that mere is a construction lending agency for the Performance of 1' the work for which this permit is issued(Sec.309?.Civ.C.) 110 Lender's Name b lender's Address � z J C) I ttnify that 1 have read this application and sum that the above information is - y I"' carted.1 agree to comply with all city and county ordinances and sure laws relating to - Z)U building construction,and hereby automatic representatives of this city to enter upon the = a above-mend.ned Property for inspection purposes. (We)agree to sass,indemnify and keep harmless the City of Cupertino against h liabilities,judgments,costs and exponent which may in any way accrue against said City j z in consequence of the granting of this Permit. A FPLJCA FR STAN US ANA WILL COMPLY WITH ALL NON-POINT Issued by: Date SO RCJ REG ATIONS, s Re-roofs Signet ecof ApplicanUComracmr t D to HAZARDOUS MATERIALSDISCLOSURE Type of Roof Will the applicant er future building occupant sore or M1anJlc hamdous mateoai as derned by me CuPeninn Municipal Code.Chapter 9.11,and the Health and Safely ode.QYes 255]2(x)? ON. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or Idiom building accentual use equipment or Jcvims which If a roof is installed without first obtaining an inspection,I agree to remove it haeardnus air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. Istria? ❑Yes ON. I have mail the hvaNrms materials myuimmenl.s under Chapter 6.95 of the Califon nia Health S SafctyCWc,Sccuum 15505,25533 and255Ja.1 underswd mat if the building does not can have a tenant, at't is my resWrin mlity w nndly de occupant of the requi nrsw It as,Win., Ir.ismanceofaccnlrilm rap y. Signature of Applicant Date Owner tar aurh.rircJ agent / Data All roof coverings to be Class "B" or better CITY OF CUPERTINO `b FURNACE/AC OUPERT ®® INO PERMIT APPLICATION FORM APN # Date: / Building Address: I 0�4KC 19735" she A 1 V e Owner's Name: Phone #: SO-411 a I .�n �sl. kod ' L n 9, - Contractor: Phone: License #: �han � cel S 766 - 76-5 19 a`71 9 Contact: - Phone: Cupertino Business License #: .__. 1 rzv , d 93k 69 02.3 -77 Building Permit Info: . Bldg ❑ Elect Plumb ❑ Mech Job Description: n a �0 0 o D P5,1 v 0,j n Uz G� , Residentia—E],, ___. _ Commercial ❑ __ For Residential Insta ations: Attic ❑ 1" floor '— 2"d floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation• ❑ - - - - New installation Planning Approval Required ❑ Cost of Project: 2/ Type of Construction: Occupancy group: Strapped 11 On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if A ble Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING' BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mach Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit-Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO i m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 31632037 . 00 DATE ISSUED. . . . . . . : 01/18/2005 RECEIPT # . . . . . . . . . 28299 REFERENCE ID # . . . : 05010099 SITE ADDRESS . . . . . : 19735 DRAKE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SATYA' DHANUSHKODI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2435 RECEIVED FROM . . . . : PAVITHRA SATYANARAYA CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : ®FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------------ ---------- ---- - ----- ---- -- - -- - ---------- --------- - BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 0 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- --------------- - ----------- -------- ---------- OTHER 176 . 24 VISA TOTAL RECEIPT 176 . 24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ==------------ -------- ---------------------------- -------- -- ---------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL r'"`� - - Community Development JCu0 Torre Avenue pertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: 1973s- -�)12 A K r j21 V E PERMIT # . S O l D OWNER'S NAME: SaTy p KD PHONE # GENERAL CONTRACTOR R V i p X L 6 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating aG h Q n i c a I Gr-a -718- Insulation ( gInsulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor tgnature Date CITY OF CUPERTINO i m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 31632037 . 00 DATE ISSUED. . . . . . . : 01/18/2005 RECEIPT # . . . . . . . . . 28299 REFERENCE ID # . . . : 05010099 SITE ADDRESS . . . . . : 19735 DRAKE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SATYA' DHANUSHKODI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2435 RECEIVED FROM . . . . : PAVITHRA SATYANARAYA CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : ®FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------------ ---------- ---- - ----- ---- -- - -- - ---------- --------- - BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 0 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- --------------- - ----------- -------- ---------- OTHER 176 . 24 VISA TOTAL RECEIPT 176 . 24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ==------------ -------- ---------------------------- -------- -- ---------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL