05020085 CITY OF CUPERTINO �sa.�r^Sxi�s2disw7i'F ' TM
BUILDING DIVISION PERMIT CO NTRACTORINFO,RMATION "•;
BUILDING ADDRESS: ABLE SEPTIC PERMITNO05O2OO85
1 0-177 GLENVIEW AV
OWNER'S NAME: PERMIT ISSUE DATE
Ak SATYA KARNALA 520 REED ST- 02 /14 /2005
ONE: SANITARY NO. CONTROL NO.
(408) 377-9990
CHITEC ,ENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
0 0 0 0
LLICENSED CONTRACTOR'S DECLARATION
1.7i. I hereby M.wt 1 am licensed%nide,provisions of Chapter 9(commencing lob Description
th Section 7")of Division 3 of On Business and Professions Code.and my license is
Bmbc aamerrw, REPLACE SEWER (TO PROPERTY LINE C O)
enscClan Z-4a2 Lie.Xm .2"I LI-0Co...,
f'9 ARCHfTECI-S DECLARATION
�i es 1 understand my plans shall he used as public records
7 or
G� Licensed Professional
g OWNER-BUILDER DECLARATION
<y I hereby of um Nat 1 am exempt from On Convamors License Law far the
00 fallowing moon.(Section 71313,Business and Professions Code:My city or county
K g ff which inquires a permit to construct,alcor,improve,demolish.or repair any stmcwre
y'r^
prior reits isswrme,also mquiry the applicant for such North to filcasignedsumment
Out he is licensed pursuant to On provision of the Conuacmri lions Law(Chapter 9 Sq. Ft. Floor Area Valuation
'I-O (commencing with Section]000)of Division 3 of On Business and Professions Codi or
i Nat he is exempt therofrom and On basis for the alleged exemption.Any violation of �t1.'1 .n
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of yaftp'' }be1O0 Occupancy Type
not mom than live hundred dollars(5500).
El I,uawmrOftheprvpmsy,mmyemployeeswiNwagesu Cc miceompenudon,
will do the workand theavunure is wt invndcd.,offered forsale(Sec.?W.Beath..
and Professions Cada The Contro rs License law does not apply In an Owner of Required Inspections
pmpeny who buildsorimproves thereon,and whodaasuch work himself or through his
own employees,provided Nat such improvements are not immndcd.,offered for sale.If,
builder,it Wilding or improvement is sold within one year of c provefrNeowner-
howeer will have in burden rimp o ement i IhPl he did not dyed or improve for purpose r,
conatr
O I,as owner of the poorest,am exclusively convecting with licensed conuacmrs to
come La des not (sec.?O n Business and Py who but COde:)The Contractor's Li-
cense law bots not apply ro an owner of property who builds or ant to M Contort and
wheLac%for such projects with a eanvacmr(s)licensed pursuant m Ne Contractor's
0
License sus LBW. \\
❑1 am exempt undo Sec. .B d:P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby a?mm under penalty of perjury one of On following declarations:
1 have and will maintain a CemOcam of Commit,to self-imure for Workers Compen.
satian,u provided for by Section 37W of On labor Cade.for the performance of the
work for which this Demur is issued.
❑1 have and will maintain Worker's Compenution Insurance,u requimd by Section
My Of Ne labor Code,far Ne peRarmaneeOf the work for which Cis permit is issued
My Worker's C.Umat�Insurance carrier and Policy number am:
Gamer. �Js1 Q. siNJ` PolicyNo.:LY.�i,1,5 �
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('thissection recd not Inc,completed lithe permit is foram humbled dollars(SIM)
m mss)
1 cenifv Nat in the Performance of the work for which this permit is issued.I shall not
employ any person in any mannerso as to become subjecOo thc Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making N6 Ccnifsam of Ea nernon,you should
become subject in the Worker's Compcmalion provisions of the Luxor Code,you muse
.,z fOMwith comply with such provisions or Nis permit shall be deemed revoked.
'Z'O CONSTRUC13ON LENDING AGENCY
[--� I hereby affirm Nat Core is a construction lending agency for the Performance of
Qi
On work for which Nu permit u bound(Sec.309?,Civ.C.)
CL
!enacts Name
U z Lenders Address
U O I certify Cu I have read this application and sun:Cat Ne above information is -
(-'
building
1 ora m comply with all city and nepme oNimnas and sum laws relating e S
�U buiom-nommimod i.nand hereby
iced..a¢Preanuti.rs of Niscity mcnmr upon the
r D.1 ahovc(We)are Property for its nify ad liccis s Lam
(We)ora to save,indemnifyandkap hay roar On CityOf rsCupertino dCity
f log incomesnneco Ong nts rasing of Ois pswbicb may in any way acmuc againsuud City �+k
U Z APPLI ANT of DERS grassing permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU E L ONS.
.1 '0":S Re-roofs
Signature Of pplicam/Convacmf Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building occupant are.or handle haardous material
as defused by the C.penl..Municipal Code.Chapter 9.11.and do Health and Safety
cede.SecFI enzss3z(a)?Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building decorum use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conuminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
Ihaventad Nehmard%usm mrialsmquimmonuundcr LTapmr6.95ofOcCalifor-
nia,no, &Safi COM,mount SN,i myresponsibility
and Z553a.1 undersand Natifthe tanof0.
Joel tC Aly hoMamnank Nat it is my mxpouihilitYm nauly lM aeuPanl of Nc
M ta d.hic s,lc met prior missseam ,of.CerurmmofOccupmq. Signature of Applicant Date
n "
O cr Or auNorimed.,.I Damm- All roof coverings to be Class "B"or better
Community Development
att10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
1 _ Building Department
JOB ADDRESS:03-) 1 Fe U V i C W act PERMTT�#5
OWNER'S NAME: PHONE #(o`j L4
GENERAL CONTRACTOR: p,13 le ;C FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO /
qlan REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # O Date: /
Building Address:
/ 03 --) -1 /JU 1 CJ C3`U�
Owner's Name: Phone#:
C,(Wc, C., C� g3�
Contractor: Phone- License #:
,e o ) 77 �q6.7 X17fS
Con ct � 147-1Phone: —� Cupertino Business License #:
Buil ' g Permit Info:
Bldg ❑ Elect ❑ PluMZN
Job Description:
O O zwxr c Ie -cvf
ResidentiaNy U Commercial ❑
Cost of Projec
• OOD_ �
Qty. if
A licable Fee ID Fee Description Fee Grou
PPERMITFEE PlumbingPermit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING