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05010131CITY OF CUPER-t'INO ,�s**-'1*b IONg BUILDING DIVISION pERC�NTRACTQR£INFOR ,er3Y,. "'A.FPixro -:='.. BUILDING ADDRESS: PERMIT NIO 5010131 OWNER'S NAME: PERMIT ISSUE DATE iiiial ASHI BOINAPALL 01/24/2005 NE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing Job Description P with Section 7WO) of Division 3.1' the Business and Piuressime, Cad.. end my license is Li full react, am erre" in full r act,Cha REMODEL --DEMISING WALL IN GARAGE/WINDOW & Lie, a Dat Contactor ADD ONE RECEPTICLE ARCHITECTS DECLARATION I understand my plans shall W used as public mound, CONTRACTOR: ROY TURNER (T & A CONST.) Licensed Professional OWNER -BUILDER DECLARATION I hereby arfrm that 1 am exempt from the, Contractor's License Law for the following reason. (Section ?031.5, Business and Professions Code: Any city or county which mqui= a permit to construct, alter, improve, demolish. or mpair any slmaum prior hl its issuance, also recreates the applicant for such Permit 01x a signed statement .that he is licensed pursuant to the provisions Of contractors Locate, Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 1000) bf Division 3 of the Business and Professions Code) ter $3500 Out he is ,mt ar Nemfrom anthe,dthe,thebasis for te alleged exemption. Any violation of Section 7031.5 by any applicml or a Rat subjects the applicant o a civil Penally of APN Number Occupancy Type not more than five hundred dollars (SSW). P Y YP 1, as owner Prthe property, or my employees with wages as their abl,compensation, will do the work. and doe Someone is not intended oraffeted for sale (Sec.?0a4. Business and Professions, Code: The Conmcmrs License Law docs not apply to an owner of Required Inspections property who builds orimproves thereon, and who docs such work himself or through his awn employees, p,.video than such improvements arc not intended or offered for sale If. builder the ement is year orcompletion, teeowner- rden avetebding builder will have the burden of proving that M tliJ not Wild or improve for purpose of of Wavinghat he did sale.). ❑ 1. a3 of d com am C COnlaCllns CIN licensedcOn Verar's to t to Sec. 70,1 t the p ronsuvar the project (foopenaa, Business arta Professions Code:) project mess and :) Tic ms's cctoe law docs not apply to an owner of property who Wi Ids or improves thcmon and who eontracas for such projects with acomnemps) licensed pursuant to the Conuacities License Law. �O E] I. x,mor".�u d/er,See B& P C for aso is ren Owner [ ��! Date 'J /^ W RK S COMPENSATION DECLARATION 1 hereby affirm under penally of pe jury one or the following declarations: u 1 hon and will maintain a Certificate of Consent to self-insum for Workers Com sen. ration, as provided for by Section 3100 of the labor Codc, for the performance of the work for which this Permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, a required by Section 3100 or she Latour Code. for Or performance of Ne work for which this permit is issued. My Workers Compensation Lowrance ca&icr and Policy numbs am: Caniev Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 114SURANCE This section need not he completed it the Iermit is far one hundred dollars( HXB br IeaiJ 1 cenifv Nm in the performance of the work for which this Permit is issued. I shall not employ any fiction in any anamcr as to bceoyoe mbjen m the Werkcri Compensation Laws of Caldomia. Dale / —t f+ Applicant A I_ �j NOTICE TO APPLICANT: if, after making this CeiliGcam of Exemption, you should Weems Subject m the Worker's Compensation provisions of the labor Code. you must forthwith comply with such provisions or this pmmR shall W deemed mvoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a coutfucGnn lending agency for the Performance of the work for which this Noun, is issued (Sao 3099, Co. C.) Lenders Name Lender's Address 1 certify Nal 1 have read this application and sura that the about MIMMallun is carted. l agree to comply with all city and county ordinances and sur, laws relating above-mennslrvnion,and hereby amhonprepresenulives,(this city mercerupon the rabic -mentioned propertysi fan inspection pmch (We) indemnify agora Ib save, and keep harmless the City or Cupertino against me may Ca pen5a5nnit, may In any Way a[CNc against Said City ino.matufjtlds the S ouSand m consequcnee of the gmming of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT CE Issued by: Date SOU REG{L'A;{IONS. �G Re -roofs � I u�^^ ( 4 ��— Slgnamrt of AppIfMaVContrazlot Dam d HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the apPlicam or future building occupant shore or handle baruJuus material M defined by Ne Cupertino Municipal Code. Chapter 9.12, and the HeaIN and Safety Code. Section 25532(a)? El Y. •cYNb All roofs shall be inspected prior to any roofing material being installed. Will Nc ePPliwmor fumrc builJin6 occupant tau equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hazaNnux air contaminants n defined by the Bay Arca Air Quality Management all new materials for inspection. Dixvia? t]Ycs �p Mu 1 have read the haallouss materials requirements under Chapter 695 of Nc Califor- nisHealth &Seely Code, Sections 25515.25533 and 25534.1 undcuand has iflW Wilding - Joanbt rtcnu n "'mmnan4 Nat 'I'S my mipomibility lu notify the rceupml of Ne nquireut tswhn'h ustWmet norhoiasumcebraceNfiramoraruPmry. `(j= Signature of Applicant Dale 7 y All roof coverings to be Class "B" or better ownec br tournicd agent Date OF • nYJJ CUPEI�TINO • • 0 9 Assessor's Parcel Number: J, c - b �) tJ a O Name of owner. Project address. Contact person. Net square footage of lot. Square footage First floor: Second floor: Garage: TOTAL: Existin " v _ • �_.� Proposed Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? On what floor(s) is work being done? E fs i a'irirc Brief description of work. Code editions: 2001 CBC 2001 CPC Effective 11/1/02 (Y - N)2001 CFC (Y - N)2001 NEC RECEIVED LIAN111111 0 2 (Y - N)2001 CMC (Y- N) (Y M PLOT CKED B3G;, 7t�'�;,,, CHE oATE �----- — Plan Review Process Work Book Page -8-Revised 4/28/04 PLANNING DEPT ,)ATE $LDGe I)EPTe pan rll�, x 3JI h... • SA s At --i (2or.at_I .N I -Fl Iv o G/ - ,. �MII M• �1 n 1 , � 1 (-) h. Nom h�e $LDGa pEP—U ao, 127/?,e-rlT/.19iLI7D Tp RAM S6 � - /! C3 ► LS c-)4)Go C NC) ;-S�L-Uti�G �,c 1ST `} I✓G1�G/Z �i✓ O i= �+li h�. l I D (n LG71&1V6 jO /57' /}JD t A/� Jam/ ST' /AT" v2, Sff:r-...�-'i"•�.tlC.r .. Cts 1L1evv'' GctT L c --T' A -T P co,4- T (, CEiv/��a 1u rs r IV v �� 5 Susi,✓ 4 I 1 of 1 0 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32644006.00 DATE ISSUED.......: 01/24/2005 RECEIPT #.........: 28359 REFERENCE ID # ...: 05010131 SITE ADDRESS .....: 21398 METEOR DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... 0 OPERATOR: conniew COPY # : 3 OWNER SASHI BOIMAPALLI ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1325 RECEIVED FROM ....: SASHI BOINAPALLI CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ...: , TELEPHONE ........: e -E ID UNIT QUANTITY BPERMFEE VALUATION 3,500.00 BPLANCHK PERMIT FEE 104.76 BENERGY PERMIT FEE 104.76 BREMFIXT NO. FIXTURES 1.00 EPERMITFEE FLAT RATE 1.00 BREMRECEPT NO. OUTLETS 2.00 BSEISMICRE VALUATION 3,500.00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT ----------------------------- OTI•IER 337.31 TOTAL.RECEIPT : 337.31 0 AMOUNT ---------- PD -TO -DT ---------- THIS REC NEW DAL 104.76 0.00 ---------- 104.76 ---------- 0.00 139.80 0.00 139.80 0.00 50.28 0.00 50.28 0.00 1.20 0.00 1.20 0.00 38.37 0.00 38.37 0.00 2.40 0.00 2.40 0.00 0.50 ---------- 0.00 ---------- 0.50 0.00 337.31 0.00 ---------- 337.31 ---------- 0.00 NUMBER ----------- - M/C CITY OF CUPEkTINO CITY OF CUPERTINO• PERMIT APPLICATION FORM APN # 3 2� 4 -7 ate: I — ,�_ A- os— Building Address: Mailing Address (if different from building address): Owner's Name: Boiler <= 100,000 Btu Phone #: -4vg 9 1 I Contractor: 6Z0 U24EP, License #: Contact: Phone: C0 8)306 sosq Cupertino Business License#: e r Fax: BBOILER4 Boiler> 1M to 1.75 M Btu Building Permit Info: BBOILER5 Boiler> 1.75M Btu Bldg ®' Elect Plumb ❑ Mech ❑ Job Description: D2•� q�(A iµ cqex--Ca kct Qele9�'0✓WrmCYO .40x30 � � Residential 13' na Ind/Off/Comm/Quasi Commercial ❑ Sq.Ft. Floor Area: Con. Tax for BQ Zone $/Sq.Ft.: Cost of Project: 3 ^r moa Hotel and Motel Occupancy Group: Type of Construction: Constax — Resi/Mobile Please check this box if the project is a BELEC1000 Elec 600V <= IOOOA second -story addition: ❑ Project Size: Standar Large ❑ Major ❑ ELECTRICAL Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING tors C( C CITY OF CUPERTINO • CITY OF CUPERTIN(? PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 1.0 Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Change BUILDING 3of3 z Op R ;i an ;1=p W Sad e apt �aaC 3mE C 7-Q 1� z)z �)o jU N � J I CITY OF CUPERTINO BUILDING DIVISION PERMIT -�. ONTRACTnR INFORMATION ,x . , �, i'. BUILDING ADDRESS: 9119P MFTRnR DR PERMIT N'05010131 NER'S NAME: PERMIT ISSUE DATE ASHI BOINAPALL 01/24/2005 Ti HONE: SANITARY NO. CONTROL NO, ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMBMECH 0 0 0 0 LICENSEDCONTRACTOR amle,SDECons or CON I hereby affirm that 1 am If under provisions ops 9 (mmmcncing Job Description p with Section Division 3of the Busiaaz and professions Code, and myliccnso is the Code, and effect. REMODEL --DEMISING WALL IN GARAGE/WINDOW & L enseCleamdcont"' Damm elm Lie.. Dam Conlan ADD ONE RECEPTICLE ARCHITECTS DECLARATION I understand my plans shall be, umd as public records CONTRACTOR: ROY TURNER (T & A CONST.) Licensed Pmfessirml OWNER -BUILDER DECLARATION 1 hereby xlErm Thal 1 am exempt from the Convenors License Law for the following mason. (Section 9031.5 Business and Professions Code: Any city or county which requires a permit to construct, ¢iter, improve, demolish. or repair any suuctme prior m its issuance, also requires the applicant for such Permit o file a signed Statement that he is ferried pursuant o the previsions of the Contractor's Liccnse Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7(XX) of Division 3 of the Business and Professions Cole) or Nat he is exempt therefrom and IM baso fop the alleged exemption. Any violation of $3500 Section 7031.5 by Dry applicant for a permit subjects the applicant to a civil penally of ppN Number Occu Type not more than five hundred dollars (S500). ane p y 1, u owner of Ne pmpeny, or my cmployw with wages az IMir sole compensation, will do the work, and Int rounure is net in¢naed or offered prosaic (Sce. 1(64, Business and Professions Code: The Contractor's License Law ones apply to Required In 1 not an owner of propeny who builds or improves thereon, and whodas such work himselforthmugh his �W7 e7 own employ=. provided Thal such improvements are not intended or offeretl for sale. If. kis y-. however, the building or improvement is sold within one year of completion, be owner- budve der will hathe burden of proving that he did not wild or improve for pantose or sale.). q 2 FEB io ��5 ED 1. as owner of the property, am exclusively contracting with licensed convaaora m CWCJ TTCCoaVSbrY Li ransomer Law e project doxiiinotaplyE. o an wneBusronandrty wh i Wilds oma law coca not apply an owner of preen} who soda. rr improves thereon. and, who contracts for such pmjecu with a contractor(s) licensed pursuant to the Contractor r ��On License taw. G02" ®lam caempt &r Sc. B&PCfor this scuon V boner Date 3W1.JKKr.RSrCOMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a CCnlOcareof Continuo self -i ... m far Worker's Compcn- lation, u provided for by Section 3100 of the labor Code, for Ne performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Competuation Insurance, u method by Section 3100 oflm labor Core. (m one performance of the work for which this permit is issued. ' My Worker's Compensation Insurance cattier and Policy nontoxic art: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ems; section need not weompleted if the Permit is for one hundred dollars(S I f10) ()r ICSS.) I cenify that in the perfam o occ of the work for which this permit is issued, l shall not employ any .Win any an sputa bee m`wbject to the Workers Compensation Laws ofc.lifomjp. Datr�Ml (�r-F iLL�I Applicant NOTICE TO APPLICANT: If. after making this Cclairicarc of Exemption, you shouW bocome subject to the Worker's Compensation previsions or the laws Code, you must forthwith comply with such prevision or lois farm it shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby al0rm that there is a construction lending agency for tut Performance of Ne work for which this permit is issued (Sec. 3090. Civ. C.) lenders Name Lender's Adtlmis 1 certify Nal I, bavc read this Application and suis that the awvo informationis carat 1 agree Io comply with all city and county ordinarues and state laws relating to building construction, and amhorive teptesemalives of this city m enter upon Ito teupn t for shove -me judged property for exetors which ma (we) agree to lave, indemnify and kap harmless the City of Cupertino agaimt costs and a sectors which may in any way accrue against Baia City J\ l � MS incoities,jnce of the n ennuyanee of the growing of this permit, ^ lV/ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOU Issued by: Dat L��10pp�S'� cY�ysi" 0g Re -roofs Srgnam.f of Imanuu nuxmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant amre or handre bV2nlUna marrhal Ax deGncd by the Cupertino Municipal, Code. Chap., 9.12, and the Health and Safety ode. Section 25532(.)? ❑Yes �Mo All roofs shall be inspected prior to any roofing material being installed. sore thea applicant or future wildin pn g occupant useequipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove g cmit,jE,?rus air comeminantsuJcfncJ by the Bay Ana Air Quality Management Air Qu Distrin? all new materials for inspection. ❑Yes ,?lo . 1 have mad thc hmardous mamrials requirements unuer, Chapter6.95 of the Cafror- nia HcaIM& Safely Cale. Sectiom 25%5.25533 and M534.1 understand thnif use wilding docs no en haat a tenant, that o n my me,eashilily to notify the occupant or It, myuim a ts„ st et aril,ilaaanaofacattireateoracrpaay. ,Signature of Applicant Date \ �� 'All roof coverings to be Class "R" nr hrrrFe Owner rr mhon cd ¢gent