08080077 CITY OF CUPERTINO
BMI
UILDING.DIVISION. PERMIT .TRAG�TQR INFORIVIATIO
BUILDING ADDRESS: PERMIT NO.
73/5 LILY C9' RAVI NUKALA - 08080077
OWNER'S NAME: PERMIT ISSUE DATE
!M] NUKALA 7875 LILY CT 08/12/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITIN O
BLDG ELECT PLUMBMECH
0 0 0 0
pop LICENSED CONTRACTOR'S DECLARATION Job Description
a 1 hereby-frim dust l sm licensed under provisions of Chapter 9(commencing P
n with Section 70(10)of Division3ofNeBusinessandProfessionsCodc.andmylicensee INSTL GAS WTRHTR REPLCNG OLD WTRHTR
m in BOB for¢and effe¢
j n z License aaa Is.Y
n F p Da¢ C mrxw
7W ARCHITECTS DECLARATION
6
U 1 understand my plans shall he used n public mcods
yn' Licensed Professional
a3 OWNER-BUILDER DECLARATION
E 1 Wrtby-Rum that 1 am exempt from the ConuaneYs license law for Ban
y o o fallowing resume.(Section 7031.5,Business and Pmfessines Code:Any city or county .
m Pi which require•permit to eonslmet-lies,before..demolish,or no mir any sue sine
z< Plmf In is lssuan¢,also rOquiwa Use applicant for such permiuo file a signed satemenl
E thnheislicensedpunuantbtheprovisionsoftheCmnuacmdLiczvelaw(Chapter9 Sq.Ft. Floor Area Valuation
x�3 (commeaing with Section 7000)M Divides 3 of hW Beat.and Professions Cnde)m $550
Q� that W is cusum,,lWrtfmm and use bus for the alleged eaamption.Any violadon of
Section 7031.5 by arty application for a permit abjecu the applicant to a cirll penalty of
atppm Number Occupancy Type
aoraethanfdwhindmddelara(5500). 35903013 W
1,u owner of die pmparty.m my employs-with wages u thmir ale compenadon,
will dm to work.and the structure a notintended or Offered for We(Sec.7046,Business
and Profession Coda The Contractors Lior".,.Law does not apply he an Owner Or Required Inspections
property who buildsorimpmves flo entand whodmessmh work himxlfmthrmugh his
owe employees,provided the sule impmvsmens art not intended moffeved forsale U.
bmwe,xu.the Wilding Or improerrant I.sold within one year of completion.the owner-
Indictor NO base the banded of poring WI he did nm build or improve for purgs¢of
sale.).
1,as Owner of the property am exclusivclY contracting with licensed contractors he
construct due Mjca(Sec.7014.Business and Professions Code:)Ibe Contractors U. .
cense Law dos cot apply to an myna of property who Wilds or improv therton.and.
who contncu for such pojecta with a conuanor(s)licensed pmma,b the Contractors
License Law.
❑I am exempt under See ,B A P C for this recon
Owner Date
ORKER'S COM CLARATION
40 I hereby um under penlltY of perjury rote mf IW fmlbwing decluuiOrts: ,
Ihawand will munuinaCersifieam of Comemmself-inwrtlm Workers COmprn d
anon,as provided for by Section 3700 of the Labor Code,for the perfom ence of the
woh for which this permit is issued.
❑1 haw;and will maintain Workers Compensation Insuran¢,a re uncd by Scenes
37000f NC Lober Code,for the peorsmmoc Of Ne wok for which NU R.i,is WOOL '
My Workers Compensation Indra¢carrier sed Policy number are:
Carrie. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlssexsion need rot he completed if the permit Is(omen hundred dollars($100)
or Ito)
1¢rofY that in the Performed of the work for which this Permit's iaucd.l shall not
amploy any perm.in aymanermut ccome subje Ins /o 'Co emum
Laws of Coliform m D
APPliand
NOTICE To APP CANT:I, rem of Exemption,you should
become subjca to e Workers ComN1=6 n provisions of Ne Labor Code.You mon
.0 O fonhwiN comPl rind such prorisimns a Nis pemhil Nall W d¢nmd nevmkcd.
P'Vi CONSTRUCTION LENDING AGENCY
[••i 1herby-Mbd the ft.isoemnstmction lendingagemy for Nc PMfurmancea
D: the work for which then ee Permit Is issued(S3197.Civ.C.)
QIdndcfs Name
r7 z Landers Address
U C 1 comfy that I have mad this application and scam Nu tW above infermadme is
D. !' corrin 1 agree N comply with all city and county ordinames and a=Is"mixing he
6 SV^ Wilding construction,and hereby shNoda reptesenttim of this city to tour upon the
127 shove-mentioned.u. m for inspection purposes.
CL (We)agree to ave.indemnify and keep harmles,Ne City Of Cuperunm against
to incoiocsjudgmcnh. mw and expenses sit. may in aY's'aY-¢sue against said City
Uz in caaequenee of dm irsnung of then permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —/('
SOURCE REGULATIO 2 7
VRe-roofs
Signeurt Applian D �!
Doll$MATERIALS DISCLOSURE Type of Roof.
hB ft—,PlI=,a fugue Wilding Occupant cart car handle hoodoo material �
u defined by the Cups u.Municipal Code.Chapter 9.13.and du Health and Safay
Code.seadmn 255324)7
❑res painspected All roofs shall be nor to any roofing material being installed.
Will Nc applicant or future building m¢upant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i�lrh, n=%air comuminam�s as defined by Ne Bay Ara Air Quality Management all new materials for inspection.
C]Y. {]N.
I hoc MM Ne hasrNw materials mquimmcnu under Chapter6.95ofNe Califor-
nia Hcalthd&SdMYCedc.S¢uou 25915,25533 and 25534.1 undcravb Nuirthe Wilding
doesnorcurmmly haw ones.that It ex my msporuihility to sooty the Ocaupad of Ne
myvia his which re met .toosinf.of.CertifiateofOccuvjrsv. ' Signature of Applicant Date
Owner Alam All roof coverings to be Class'%."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35903013 . 00
DATE ISSUED. . . . . . . : 08/12/2008
RECEIPT # . . . . . . . . . : BS000005756
REFERENCE ID # . . . : 08080077
SITE ADDRESS . . . . . : 7875 LILY CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAVI NUKALA
ADDRESS . . . . . . . . . . : 7875 LILY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4212
RECEIVED FROM . . . . : RAVI. NUKALA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : RAVI NUKALA
ADDRESS . . . . . . . . . . : 7875 LILY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4212
TELEPHONE . . . . . . . . :
• FEE IO UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- - ---- --- ----- --------- ----- ---------
1BSEISMICR VALUATION 550 . 00 0 . 50 0 . 00 0 . 50 0 . 00
I.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--- --------------- --------------------
CREDIT CARD 106 . 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- -----------------------
-------- ----------------------------
518 WATER HEATER
•
v8 c� o 77
A-K; OF CUPERTINO
' WATER HEATER
• CUPERTINO PERMIT APPLICATION FORM
APN # Date: q
()u
&59v3 �13A
, c ) c� us7 z-ooa
Building Address:
-18- 5 L7 Lt/ c1 cuP6Q1-7 Ivo � CA � O / 4
Owner's Name: Phone #:
OV—T- NvkA GA 408 496 13 e�
42
Contractor: Phone #:
0W N6 r1 v-:1 X06 4Z
Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
• Fax #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Residential ld Commercial ❑
Job Description: '/ 4 uQi 0�"
s�4 �0� l{a cciy� � �lM a� Ia rt:n
o-1 GI o,,•e. .
Strapped ❑ On Platform Bonded ❑ New Location ❑ Replacement
Valuation (cost of project): 0
Project Size: Express ��Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
• Green Building Points achieved: 77-
Revised 6/16/08
aiw
CITY OF CUPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
IPCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
/ 1PRWHEATR Residential Water B PRWHEATR
r Heater/Vent
/ 1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
•
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
• A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
. 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
........................................................................................................................................................:............................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: Date: AyC (2� 20 Og
Job Address: L C 9 .JA),, Permit# 0dF'0,?6 6`?'7
C-A 5o/4
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
City of Cupertino Building Department
CITY Of 10300 Torre Avenue
C U P E IST I N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
,r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE�TINO
Building De artment
JOB ADDRESS: g S La L- Y C7 PERMIT#�� Uf?
O
OWNER'S NAME: RAVZ AIU)<A &A PHONE # 4og '?C?6 134 4Y2 r
GENERAL CONTRACTOR. a P- tJ� pg� FAX #
y� Q S�zJ
I am not using any subcontractors: :'/ 01�� �5
ignature Date
Please check applicable subcontractors and complete the following information:
21 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 ,p
Uh� &cw: �„�C (270 Zo ocQ-
er/Co ' tature Date