04010008 CITY OF CUPERTINO ^'' • ''z. ,<'' . �''•' k
BUILDING DIVISION PERT, CONTRACTOR INFORM • N:°',;, -
BUILDING ADDRESS: """'04010008
1 nS-ln ATNTCTAT(IRTW T)V
OWNER'S NAME: PERMIT ISSUE DATE
VENKATRSA & VFNTTC(IP&L_SU 01 /Oc;/9nn4
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ
COO LICENSED CONTRACnOR'S DECLARATION
I hereby affirm that 1 am licensed inlet previsions of Chaphai
ter 9(commencing Job Description
n� with Section 90(08)uf Division of the BUSiicv and Prof....COdc,and mylicena is i
_pm
I.full finee and effect.
, icersse elan Liex E•`r /3 KITCHEN REMODEL/SKYLIGHT/WINDOW
rsC e`It° ° CumaCmr 3�' �0't9 CONTRACTOR: K' S CONSTRUCTION
ARCHITECTSDECLA ION
uI understand my plans shall W used u public records
C.
;off Licensed P.fesvanaI
g OWNER-BUILDER DECLARATION
+�<S I hereby affirm that 1 am exempt from the Contractor's License Law for the
p 0 following rtuon (Sectors 703 1.5,Business and Professions Code Any city or county
K m which ampores a Permit nr Construct,alter.improve.demolish,or repair any s ractum -
°_zi pnortn its tauenm,also.gmns the applicant for such permit to File a.signed Satanical
E�o that he is licensed pursuant its the provisions of the Contractor's License Law(Chapter 9 Sq.F[. Floor Area Valu�gt1o�t000
y (commencing with Section 7")of Division 3 of the B ustimi and Professions Cade)or
i $
that he is exempt tACrefmat and the buIs for Ibe alleged exemption.Any violation of
Section 9031.5 by any applimim fora pemon subjects the applicant to a Civil Penalty of - -___... APN Number
no,...thanr hundred danars(SSM). I I Occupancy Type
❑-I,ex owner of the Property,or my employees with wages as their sole compensation, 32646019 . 00
will do the work,and the awcma is not mtended oroffcred forsale(Sec.7041,Business
and Professions Code:The GonmCmrt License Law tom oat apply m an owner of FIN R d�'.��,``��``��TT��as``,��., actions
own eny who buiprovi impm u th unproved who ams smh wick h raffemrthmugh his • ��IL�p
n emplpycer,provided thasauch improvements ve not intended prpmercd fm sale.If. 1 rp�o
hmamwr,the budding or improvement is sold whin one year of compleuon,the nwner-
builder will have rate burden of paving that he did not build or improve for purpose of
sale.). 11 �t
❑1.a ownv of Ba:pfapcny,am exclusively coommung with Imenad conuacmrs to C C 1 2091
eonrlmel the jmai(Sec.9044,Business and Professions Cade:)The Cornracmis Li-
cense law dean not apply m an owner of progeny who Wilds or improves thereon,and
who La afor such projects with oeonuvmr(s)bcensedpuuuard so the Convacmrs pr, � Bate
who co Law. t�Lttr��,\I �`�itpdt
❑lam exempt under See ,B&P C for this rtuon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penslty of perjury ore of the following declvations:
have and will maintain aCenificmc of Consent to rdf-lire fm WorkehCompcn-
worku provided for by Section 3900 of the labor Code,for the perfmarman of the
for which this Perim is issued. t
❑1 have and will maintain Worker's Compensation Insurance,at required by Section
3700 of the labor Cad1e.for the`forrrksom mince of the work for which this permit ss issued
y
Carrier: CERTIFICATE OF EXCEMPT10Ny MOM WORKERS'
COMPENSATION INSURANCE
(ThsSection need Oat he Completed ilk permit is foram hundred dollars(SIM) 1
or less.)
I cemfy that in the perOnmance of the work for which this permit is issued.l shall not '
employ any person In any mmmr an as m become subject to that Workers'Comparalmon
lawaofcalifomis 1".
Applicant
NOTICE TO APPLICANT IL afar making this Certificate of Exemption,you should
Worried subject to the Worker's ComPenaoan provisions of the Labor Code.you must
,J O faMwith comply with such pr"vtshm,ar this Permit shall W dcemcd¢inked. i
Z ln� CONSTRUCTION LENDING AGENCY
'e+ l hereby affirm Nat there is a construction lending agency tot the Performance of
ai the work fur which this pcsmit is issued(Sec.3097,CN.Q
Igl Lemmas Nam^
Dz Landers Addrm•
U 0 1 cemfy Nat 1 have read Nis application end time that the above Orchards..is I '
D. (~ comer 1 agree m comply wnh all city and county ordinances and sate laws rclatmg to _
0 U bmldmg conswct=d hembyauthorve mpreeenaliws of this city to enter upon the
above-mentioned pmPeny foriupe Lion pa,sons. A
y y (We)agree to save.indcmnfy and keep bumless the City of Cupcnino against
N liabilities,judgments.cases and.;.sea which may in any way acme against said City
U Z in consequence of the granting of this perm it. l
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: Date
SOURCE REGULATIONS.
�G��°�`—�. �/t PY j Re-roofs Q _
srnalarc of ApphcanaC�mar i p m -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
Will the applicant or future building occupant smra or handle ha sous material
U defined by am Capenma Municipal Codc.Chapter 9.12.and the Health and Safety
code.Sa.ion 255324?
❑yes ❑Ns. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mare building=upon,arc egUiPment ordcvmes which If a roof is installed without first obtaining an inspection,I agree to remove
haardnus for conaminants u Joined by the Be,Area Air Quality Mimilibom all new materials for inspection.
vier?
❑Yes C)No
I have read the haxamous materials requirements under Chapter 6 95 of the Cali for.
run HCalNaSa@tyCodc,Sccticim 25505.25533 and 255341 unticrsuiW the dthe Wilding
doer not eunnnly have a¢nano Nat It a my mawmabibty on Wary the pccupat of the
im moments which must W met prior to Issuance of a CeMleme of Occupancy.
Signature of Applicant Dale
ownermtommi,cdagart Date All roof coverings to be Class "B" or better
40l o S3 O
114 APPRb(VEk
IN ACCORDANCE WITH THE Cl I -
CUPERTINO CODES, AND ORDINANCE
b
13W
SIGNED
This set of pans and spec,;,cati, nyl�;
De kept on the job at aq times ar, it is u,
lawful to make any Chi V- 111teiati � I N,
on some vqith,u w LIE! ss:on 1, r.
t'no.
the building DePL,, "ItY ;e
59 Of 111 1);J! rid -,VK6.Lali, i.
The stampil
NI SHALL NOT be he d/ P, be
approval of the v,/,'a 1-11 J any
/n P
I—-,
4-----------
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2,,ej
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CITY OF CUPERTINO•
CITY OF PERMIT APPLICATION FORM O
CUPERTINO
�N# Z (� `7 C ( Date:
Building Address:
Owner's Name: Phone#:
t/fin �a � (4 ) �3g-2151
Contractor:
y License#1 bl3
Contact: Cupertino Business License#: 7
Ki(e k�✓v2
Building Permit Info:
Bldg Elect -V� Plumb Mech
Job Description: > to(ArQo�
Residential 0 t,,�pu J,e.dU SkYl( 6,-{-Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
17 J
�Z ,OmO
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPI HER Other Appliances MECHANICAL
BBLDGFEE Bldg Permit sq. foot BUILDING f
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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 f
BCONSTAXBQ I Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC I Comm. Housing Mit. Fee BUILDING
# 2413 7
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'T
G SICITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPERTINO
L Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BOVERTRAE 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 Repipe 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 f
BPWATER Install/Alter Water Pipe PLUMBING
_ BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING J
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIltFIAN A/C Units <= 10,000 cfm MECHANICAL f
/ BREMAPPLI Appliance Install MECHANICAL J
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
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((, *CITY OF CUPERTINO+
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Grou
M _ p
BRERECEPT Rcptl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL _
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
/ I EPERMITFEE Elec Permit Issuance ELECTRICAL
l MPERMFEE Mechanical sq. foot MECHANICAL
f MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
BMISCELL Building Misc Fees BUILDING
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