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08010007 CITY OF CUPERTINO BUILDING DeVISION PERMIT NT12t1GCTOR�TNT t3RYV1ATI(yl� BUILDING ADDRESS: PERMIT NO. 10876 E ESTATES DR MURTY DASARI 08010007 OWNER'S NAME: PERMIT ISSUE DATE MURTY DASARI 10876 E ESTATE DR 01/02/2008 NE: SANITARY NO. CONTROL NO. ARCHTIECTIENGINEER: BUILDING PERMIT INFO BLDG EIECr PLUMB MECH LICENSED COMRSDECLARATION �Ey I hereby afRrm Nm 1 am licensedd underuMcr provisions tf Chepar 9(ammcming lob Description nzj with section 7")ot'Division 3 ofthe Buslomessand Pr011essions Code,and my license is REPLACE MAIN LINE SEWAGE FRM HOME TO CITY LINE & mfmle Class dertenLIC.0 PROP LINE CLEANOUT Danmclau Co. 0 Deer Gan eei U c ARCHITECTSDECLARATION Iunderstand my plans Nat be used u public ncm,tla �sea t; Licensed Professional i 3 OWNER-BUILDER DECLARATION f I hereby mTrm Net I am exempt(mm the Connotes License Law for tW D o following moon.(Section 703 1.5,Business and Prefmmas Coin:Any city or aunty _3 f which requlens a permit to consumer,aiar.improve,dcmalbh,or input,my structure Z_i Prior W its issuance.elm requires the applicant for such pe mit m file a signed statement that hcisRemand pursuant mthe Provisions ofthe Contractor's Lammen Law(Chaper9 Sq. Ft. Floor Area Valuation $ (CD mmencingwith Suction 7000)ofDivision 3ofthe,Business and ProreulonaCode)or $650 .. that he LL eampt thmefrom and the bub for the ailcged exemption.Any violation of Section 7031.5 by try applicant fa a permit mbjats the applicant to.civil penalty orpbt Number Occupancy Type oar more than 0w hundred callan($5006 369220011A p y Yp Cl 1,as wooer of tine property car my mploycns with wgu as then rola eompenudon, will do the.,it.and thesncwm LL ta.1mu nhd a offered ferule(Sec.7044,Bummus and Professions Cade:The Contractors Lianse Law dao an,apply m an Cutout of Required Inspections property who hili Id.m iso prows thmaon,end aha does mch work himul r or through his awn employers,provided that man improvements as nainandad oroRered for We.It, homer,the Wilding a improvement LL mid within arc year ofeamyletb,the awour. builder will hew thou Written of proving dor he did not Wild or Improve for purpose of ilia.). Err.as owner of the property,.m exclusively co.u.ot,ends licensed cenumtan he V construct the project(See.7044,Business and Professions Code:)The Contracmes U.Ccme law data not apply m an Owner of property who Wilds or ImFmws themon,andwho connctsfor such projects with a conmmror(s)licensed pu,mant to the Contractors ��\\\\\\V��License Law. LJ `� . ❑1 mu map,under Sec B"P C for this mason Owner Dim,�gp� WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of the following declarations: Dlura and wN maintain.CeniBam of Consent to ml(-inset fa W.rkee•s Cmpem on.an provided for by Sumian 3700 of the labor Code,for the petformana of thou wart for which this permit is iuoud. ❑1 haw and will msimin Workers Compensation Inwnna.as acquired by Section 37M.1 the Labor Codc,fa Ne pe,rammct of the work far which this permit is Issued. My W.rker.Compensate.lnmrnme artier and Policy number see: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CrNeseoiou mod oatbecmpleted ifdse permit is fortune hundmd dellam($IBM ' to,lite.) 1 ardry that in the perfurmana of the work fa which this permlt is ivad.I shall not employ any penin to my mmrcrm bac a ubj nathe Worker'Compensation Law.of California.Data ApPliam An. 1 ,. NONCE To APPLICCAN'.If.after nolking thLL Certificate of Exemption,you should banme subject to the Worker,Compensation peavisiou of thou Labor Code,you must .J O fnMwith comply with even provisions ar Ibis pc mil shall W deemed revoked. z " CONSTRUCTION LENDING AGENCY w�+ Ihemn totem dsat them 1.a comemcunn lending. F r . mmr for the perfarmana of C the war,for which rob permit i.iunee(sec.3097,cin.c.) O Lenders Nam. � z lender,Aadtca, U Q I certify Nu I have mad this application and sus that the aWw Information is w COMM I agree m comply with all city and C.Wty.NI.anM' and man law,mlating m Q Wilding construction,and barely authorise repnxnuuves of thLL city to enter upon the W aW.-mmOrou d propcny for impaction purposes gL (We)agme to save,indemnity and kap ha,mlem the City Of Cupertino agaimt rn tmBlties,judgmcnts.aN and expanses whim may In my wry accrue against Paid City f,Z in Consequence of dsc granting Of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL 101-POINT Issued by: Date S U�RCeERFeG�1LATIONS. J `Uq `—�—� �N,�1yJ Type J Signet.of AppllcauXor raaor Data roofs i/ HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant onform Wilding Occupant mar"a mpatsuma handle limitationsmariai U defined by thCaperton Municipal Code.Chapter 9.13,and thHolmand Safety Cade,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. [3 Yes Evia WIII the applicant or future Wilding occupant um equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove it haatdnu air Cmuminsm,u da0rcd by the Bay Ana Air Quality Management all new materials for inspection. .0 cG ❑Yes ZNO I have read the huudau maatabmqulrenanu under Chvpar5.93 of the Califor. nb HOI "Seely Cade Secdi 25505,25533am125534.Iw*mvWthati(the building duce mt m,mmly hew.anent,thatlt a my mrpomildlhY m bury set amupenr nr the ,egmacom ewhichmustbemetpd.,toissues=oftCcmfimm0" panty. Signature of Applicant Date wyp" �^ J 1 a All roof coverings to be Class"B"or better Owner or vutharimd agent Daa' CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36922001 . 00 DATE ISSUED. . . . . . . : 01/,02/2008 RECEIPT # . . . . . . . . . : BS000003597 REFERENCE ID # . . . : 08010007- ._ SITE ADDRESS . . . . . : 10876 E ESTATES DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MURTY DASARI ADDRESS . . . . . . . . . . : 10876 E ESTATE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4534 RECEIVED FROM . . . . : MURTY DASARI CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MURTY DASARI ADDRESS . . . . . . . . . . : 10876 E ESTATE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4534 TELEPHONE . . . . . . . . : • FEE ID UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 650. 00 0. 50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1PRSEWER UNITS 1. 00 2040 0. 00 20.40 0. 00 1TRAVD0C FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ------ --- ---------- ---------- ---------- TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 102 .48 MC --------------- TOTAL RECEIPT 102 .48 VOICE ID . DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING • 1 0 � 0 ( 000-1 CITY OF CUPERTINO . apt REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# 369 22 C) ` t0C Date: 01102( UO$' Building Address: 1 l o $-I b C CS h�e •Dr� C,,.P via , CA °1 S o l t' Owner's Name: Phone#: MU(LTy TP6Afl 4C)g 36 6 `171 Contractor: Phone#: Fax #: Contact: Phone#: Fax #: Contractor License#: Cupertino Business License#: Job Description: n _ l I n �,. y e 4�c.Q �f .e �^•�c�.rt� 1 ice,". _'� �3 (ke 1%,e- Lkaki Residential Commercial Valuation: fW 35e� oo 4& — yU�Y,5 Green Building Check list must be completed and attached to this application. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P lei / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1R-PSS sewer/sanitary sewer acoCITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE • Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPG SS Gas Piping System 5+ Outlets P / 1 PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 41 1 PLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B • st CITY OF City of Cupertino Building Department U P E kT I N® 10300 Torre Avenue 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 �ecurity taxes,workers' compensation insurance, disability insurance costs, and unemployment compensation ntributions. 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 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. 0( All the work authorized by this permit • B. _ A portion of the work C. _ None of the work If B or Cis checked, Coco leie 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 P 0 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). I Property Owner's Signature: 1 (Dk, MvAY Date: b� Job Address: tQll" C_A�0-'W f/tfl ' CA Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. 0 Community Development 10300 Torre Avenue -/' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: J o B 6 f �� ' PERMIT # .N V-;) U4 °S�1 0/ 00 OWNER'S NAME: (D a�)ani' PHONE # o 36 $ GENERAL CONTRACTOR O w%,k&y 9 FAX# p I am not using any subcontractors: Wqr-,0j AIII/ 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