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05110110 (2)BUILDING DIVISION NAME: 1 hereby AfErm thst I aro licensed under provisions of Chaptu 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Cade, and my liccnxe is in full fame and effect License Class Lic. g Dam Commater ARCHITII DECLARATION I undenund my pIw shall be Used as public recards OWNER -BUILDER DECLARATION I hereby alarm that 1 em exempt from the Conuaeofs License Law for the fallowing mean. (Section 703 1.5, Bahamas and Profession Code: Any city or county which requires • permit m coosuuct. alar, Improw, demolish. or input, Any nractum prior W its issuance. Mgr requires the Applicant for such permit to Ole a signed suamem Item he is licensed pursuant he the previsions of the Canrator's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profesalml Cade) ar that be is exempt dasefrm and the bash far the alleged easmpdon.Any vtoladm of Section 1031.5 by any applicant for a permit subjects the appli=to a civil penalty of set mom than fmn hundred dollar (5500). [j I, a owner of tiie property. m my employees with wages as dais ale camperuation, will do the work, and the smmum h ret intended or Offered far We (Sec. 7014, Belimss and Pmfm hone Cade The Commemes License Law that ret apply m m owner of property who buildsorimpmves thur mat, andwbodecssuchwank him ulfor through his own employees, provided limmeh Improvements ranothmended"ofered fornle. if, howenA the building orlmprovemenl4 sold within arm year of mmplatian, the owner. builder will have dm burden of leaving that M did at build or Improves for purpose of sale.). VL As owner of the property, am exclusively contracting with Headed conuanom he mmuan the project (Sea 7040, Business and Professions Code:) Tia Canmemts L)- mve law does em apply in an owner of proputy'who builds mimprovas W—. And who contnns for such prjecu with a commm r(s) licensed pam=L m the Canumnm's Lmera Law. BdPCfm [I1 Am exempt m dp'jee �ts -mjeoa_ I hemby dTma under perdty o(peajuryom of the folmwing declamdae ❑ I haw and will mainelo a Cealloam o(C---I m Self -imam fm Warkse-Compen- aW nn, a provided for by SeNan 3700 of the lahm Code, fm W Performuem of da work for which this permit Is Weed. ❑ f ban And will maintain Workers Compeearm Iwmmtt. a required by Seaton 3700 of the Lecher Code, for the perfornwm offt work Idewhich this Permit h Weed My Worker's Compensation bnunne carrier anal Policy number Am: Canter. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section nerd at he completed If the permit Is forme hummuldallam (SI00) or ten) I unify dint in the perfmmanm of da wank for which this permit b lsnte0. I sled) not renmam nu. 05110110 PERMIT ISSUE DATE 11 /21/200S SANITARY NO. CONTROL NO. BUILDING PERMTI'INFO BLDG ELECT PLUMB t� t� Job Description ADD BATH & CLOSET IN (E) MS BEDRM Area NOTICE TO APPLICANT: If. After making this Cani0cate of Exemption. you mould become Subject in the Workers Compensation previsions of the Labor Coda you mac O O forthwith comply With each provisions or this permit Shall be discount ranked. z'tiCONSTRUCTION LENDING AGENCY E^a I hereby aBirm tha drum Is a construction lending agency for the performance of a 7 Ne work for which ft permit Is Wised (Sec. 3097. Civ. Q W� Q L mimes Name ] z Lenders Addm_v V O I cudfy the I Mn read this Applications and sum the the she" infotmatim Is IT, miacct 1 agree m comply with ail city and county aNinarces and rote ism mhun{ m O SV-: building construction. And hereby authoriso apmunutim of this city m enter upon da [Li above-mendoned Property for hopcedon purposes gyp (We) agree to Saw, indemnify and loop harmled, the City of Cupcnino again ti TA Ilabllides,judgments, costs and expeecs which may In any my acnes ,CO.,a mid City in V APPLICANT UNDERSTANDS Araunfing Is peraft. N WILL COMPLY WITH ALL NON -POINT A'ODIssued by i SOURCE RFGULNS. / _ I.. / HAZARDOUS MATERIALS DISCLOSURE Will one applicam or fumes building aacupantnore w handle hvtsrdous material ted by Use Cupertino Municipal Code. Chapter 9.11, and the Health and Safely ;action 25532(a)7 ❑Yes ®'Flu Will the applicant or future building occupant use equipment or dcvima which oadne air conumlmoto As defined by the Bay AMA Air Quality Managcmcnt 7 QYe Co. Re -roofs Type of Roof Required Inspections 106 Date TBI All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. I haw read she luzaNews materials mquircrrtenu un&r Chapmr6.95 afthe Coffer. I nice Health&SafayCo.Sca=2SM,25533and25534.1umlcnund tha ifda building till does nal baAmara.m ncraly a an4 dor It h my responsm ibility rally No occupant of thc myulreme�whichmua be met priormhsumce of aCcrdfcaa of Occup��w I/ Signature Applicant Date All roof coverings to be Class "B" or better 0 0 CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37508048.00 DATE ISSUED.......: 11/21/2005 RECEIPT #.........: 32006 REFERENCE ID # ...: 05110110 SITE ADDRESS .....: 10335 JUDY AVE SUBDIVISION ....... CITY .............: IMPACT AREA ....... OWNER ............: RAJASHEKAR RACHAKONDA ADDRESS ..........: 10335 JUDY AVE CITY/STATE/ZIP ...: , RECEIVED FROM ..... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... TELEPHONE ........: FEDROS SAMADANI LIC # FEE ID UNIT QUANTITY ---------- BPERMFEE ------------- VALUATION ---------- 5,000.00 BPFIXTURE UNITS 3.00 BPLANCHK PERMIT FEE 115.56 BENERGY PERMIT FEE 115.56 BREMVENFAN NO UNITS 1.00 PPERMITFEE FLAT RATE 1.00 BSEISMICRE VALUATION 5,000.00 ELECTRIC SQUARE FEET 40.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT ------------ 516.44 516.44 U OPERATOR: conniew COPY # : 3 AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 115.56 ---------- 0.00 ---------- 115.56 ---------- 0.00 27.00 0.00 27.00 0.00 154.21 0.00 154.21 0.00 55.47 0.00 55.47 0.00 45.39 0.00 45.39 0.00 38.37 0.00 38.37 0.00 0.50 0.00 0.50 0.00 3.20 0.00 3.20 0.00 38.37 0.00 38.37 0.00 38.37 0.00 38.37 0.00 ---------- 516.44 ---------- 0.00 ---------- 516.44 ---------- 0.00 NUMBER ------------------ 4579 r L 4 FST CITY Or CUPEk1INO TY OF CUPERTIN PERMIT APPLICATION rOR.M 6S //0//' N# 3 1-7 Fee Group ate: 11 /ZI�D� Building Address:�� Mailing Address (if different from building address): to 336 Boiler <= 100,000 Btu MECHANICAL Owner's Name: Boiler> 100K to 500K Btu MECHANICAL Phone #: 412.1 _ 34'13 v Contractor: MECHANICAL BBOILER4 License #: T5 D BBOILER5 Boiler > 1.75M Btu MECHANICAL , Contact: Phone: 40172 3 ol_p Cupertino Business License#: ei w S "MACIA41 Fax: Ind/OfFComm/ uasi BUILDING Building Permit Info: ArO D I N 6t WIhgQZ jSAT4 * aA6T 11415,N M SM +496A Bldg a Elect Er Plumb 3-- Mech D— Job Description: BCONSTAXR Constax — Resi/Mobile Residential °❑-- BELEC1000 Commercial ❑ Sq.Ft. Floor Area: BELEC1001 Elec 600V > 1000A q.Ft.: 42 5 Cost of Proiect:Occupancy Elec Svcs 600V <= 200A ELECTRICAL �ouD: rq/�• BUILDING BENERGYADD Energy Add Multi Please check this box if the project is a Type of Construction: Investigation fee L/ N/ second -story addition: ❑ 6r7oi ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL , BCONSTAX Construction Tax BUILDING BCONSTAX Ind/OfFComm/ uasi BUILDING BCONSTAXBQ 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 • 1 cd 3 F- L L tl^O✓ CUPEfZTINO 4 CITY OF CUPERTIN PERMIT APPLICATIONRM 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 PLUMING 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 PLUMING BPSEWER Sewers PLUMING BPSPRINK Lawn S rinkler/Backflo 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 13REMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install Afl;CHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREA NHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRA.PP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPONVER 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 2of3 ano' CUPEf�TINO C*Y OF CUPERTINO 0 PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmd1 Signs Add Brancb ELECTRICAL 13REMSIGNS 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 BTEAIPPERAl Temporary Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL YO EPERMITFEE Elec Permit Issuance ELECTRICAL FEE Mechanicals . foot MECHANICAL TFEE Alecb Permit Issuance MECHANICAL =PPERAUTFEE Plumbin Permit Issue PLUMBING G Plumbin Fees foot PLUMBING RNGC Plannin LR Comme/ Multi-Fam PLANNING RNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 it y a T 3 iiw r 3 } p n O - r.. m KitchenMEN Kz � ® s Cd v �o _— fn� - z CD. � @ Bath _ I ago 3.4. i 0 �^({ 70 7Ac D = A � n � D o x H & F DESI@I RACHAICOHDA RESIDENCE Dm z �� Nm r� < 116 BRIARVOOD WAY BATHROOM REMODEL I -� ° �'' C:),- � �, LOS GATOS, CA 95032 10335 JUDY AVENUE �o � o' � 0408-839-0624 CUPERTINO, CA 95014 j � 408-921-3473 6 _ 70'I n 1> o�o B& F DESIGN RACHAKI] M RESIDENCE D, z .a P P -0 M --1d m 116 BRIARVMD WAY BATHROOM REMODEL N LOS GATOS, CA 95032 10335 JUDY AVENUE �o 5 o 408-839-0624 CUPERTINO, CA 95014 c z v 408-921-3473