06020033 CITY OF CUPERTINO � f �>
BUILDING DIVISION PERMIT y,aCU1VTRAC4 QR TNFORMATIU i..
9'd+u+cS'+Sd" AM
C'
BUILDING ADDRESS: KURUPPU PODIBANDA M AND I 'ACT 006020033
775 LILAC WY
:R'S NAME: PERMDTISSUBDATE
KURUPPU PODIBANDA M AND IN IRA 02/07/2006
1 PHONE: SANITARY NO. CONTROL NO.
ARCHITE.Cf9ENGINEER: BUILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
0
Sop LICENSED CONTRACTOR'S DECLARATION JobDescription
r�u i hereby aflren Nm I am IhmmeE under Provisions of Chapter 9(earromm inj
inhb Section 701D)of Division 3 of the Business and Pfofesiou Code.and m y license u
full tom andeffect. KITCHEN REMODEL 136 ',
'p LicenseClaa tie'` ELECTRICAL OUTLETS & LIGHTS
&g' Dem cmtracior
ARCHITECTS DECLARATIONREPLACE CABINETSOVEN REMODEL
I understand my plias shall Mused u public mcnrN ,
;�] Licensed Pn+fesalonal
OWNER-BUILDER DECLARATION
yyrsn I hereby maso .(Rem on 1 an exempt from the Conlns Co Liemse Law for the
`C O following mum.(Section 703 LS,Business and o",de o demolish,
Code:Any<m or county
$
which requlrcapermit 10 regions,the simnimpmw,deermiti orrepairend structure
_z y pilaf tar its Issuance,amd p also nquithe tiro applicant far suchCon rami'm Ole a ai{aN sssmmcm
F< Nnbelall¢nsed pursuant to the provisions of the Contractor's l3uae law(Chapter Sq.Ft,Floor Area Valuation
sF B (commencing with Section 7UID)ofDhiam3ofmcBusinnsaWProfessions Code)err $11568.
e'3 s Nat he is exempt therefrom and the buts fo gm si1e{ed exemption.Any viclatim of
Section 7031.5 by any applicant for a permit subjects the appliunt to a dvil penalty of APN Number Occupancy Type
not mos Nan Rw hundred dalWs IS300).
0 I.u owms of Ne pmper y,umy wployeca wIN vngu u Nab role eompenatian,
Be
will do thewaek,and the saunua h notinmMed oronand foule(Sec.70th,Busircss Required Inspections
sod Predicted..Cade:The Cmun ctara License law does not apply m so owmf of q P
me
property who loycox proo ed thatuthern imuW who doeaaech work oroffe edNmugh lila
ownemi,the Wilding
Improvement
hentis semenuare not ntanded your
for owner,
hander the bw Me or impmvvment Is held within ou Wild of completion,Ne owner.
of
builder will haw tiro burden of proving that be did Ms Wild or improve for purpose of
uleJ.
0.1,a owmr or tise property.am eadaiwly contracting with licensed conueemrs to
construct arm project(See.7014,Business and Profealaa Cade:)The Cmracmri Li- ylTn
cave Law dos not apply m an comer of propertywho Worms or impmvu thereon.and
who contracts for such projects with a eommose a)licensed pursuant to the Contractors
Us.Law.
I
13780rO
ire exempt under Sec ��..-� \� BB PC for Nb sato.
Dam,; � b 4
WORKERS COMPENSATION DECLARATION
_. 1 hereby affirm under penalty of perjury one of the following declarmaa: V
Olt
am and will maintain aCeNfinse of Cogent mself-Insum for WoetelaCunpen-
,u proWdcd for by Section 3700 of the labor Code,for Ne performance of Me
for which NH permit Is issued.
Mw and will maintain Wortar's Compensation Insurance,a required by Section
of Ne Labor Calc,for the performame of the wok fu which this panels Is loud.
arkers Compensation Iuunnaunix W Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EKEM MON FROM WORKERS
COMPENSATION INSURANCE
Obmaecdm nttd nmlhewmplend if tie peemh is Toone handmd&H=(SI00)
or Ws.)
1 certify Net In the perfaemamm of Ne wars far which this permit is issued.I shall no
employ any person in any m rsoambewmesobjcci=WorW.en Compenation
Laws of Calirmais,Dem ..(�..�--��
Applicant_
NOTICE TO APPLICANT:If,ober making Nis CeniOcem of Ekbortumn,you should
become subject N the Workers Compensation prevision of the Lahnr Cade,you must
.,O fomawish comply with such provisions or this permit shall be deemed mwked.
Z syN.. CONSTRUCTION LENDING AGENCY
[r I hemhy 11M.Na Nen is a coatnctim lending agency for ft perfu n.of
�i the work for which this permit 6 issued(Sec.3097,Civ,C.)
dQ Ia aim's Name
z Landers Address
U Q I certify that I Mss read this application W state Nu the above infomtatiun is
LL E cornea I a{ne to comply with all city W county oedinanca Nd state lam nelalin{to
0 building construction.and hemby authorise mpnsenutivu of this city to enter upon Nc
{i7 shove-mentionW property for inspection purpues.
py (We)agree m save,indemnify and teep harmless,the City of Cup,artinut against
Tet Ilabllitia,judgments,cut ad expenses which may in any way accrue almost said City
u 7 m connn
qume of Ne gaming of this permit.Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2.-'� —� 6
SOURCEEOULATIONS,
\1 Re-roofs
Signaum ol'ApplicautCommuclor I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
lDimiWill No applicant an,furan building occupant am orhandle haemo s material
Med by the Cupenmo Municipal Cade,Chapter 9.13,and the Hexth and Safety
.Scedm 255320)?
❑YegtAll roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or fwum building occupant use equipment or @vias which If a roof is installed without first obtaining an inspection,I agree to remove
ct?
hitd...air conmerninan s u define d by Me Bay Area Air Quality Management all new materials for inspection.
Oyu -B.No
I have mW the huaedauscommiaismptimment underChaptorti.95afthe Califor-eal"SarctyCoh,Sections25305,33333 v423534.1 undcnlwd thaifNe buildingnot cumndy hew a count that It is my responsibility m notify the occupsot of Ne 1
requlnm niswhichmustbe etPloemmaancconeertificsmar�aIpapIumy. Signature of Applicant Date
~�` \_' 2 4 Q Ob All roof coverings to be Class "B"or better
Owner err authorized agem `
new
rte_..
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35904008.00
DATE ISSUED. . . . . . . : 02/07/2006
RECEIPT #. . . . . . . . . : 33099
REFERENCE ID # . . . : 06020033
SITE ADDRESS . . . . . : 7775 LILAC WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KURUPPU PODIBANDA M AND INDIRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4208
RECEIVED FROM . . . . : KURUPPU
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : KURUPPU PODIBANDA M AND INDIRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4208
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11,568.00 191.16 0.00 191.16 0.00
BENERGY PERMIT FEE 191.16 91.76 0.00 91.76 0.00
BPLANCHK PERMIT FEE 191.16 255.10 0.00 255.10 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICRE VALUATION 11,568.00 1.20 0.00 1.20 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 615.96 0.00 615.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 615.96 3247
TOTAL RECEIPT 615.96
•
• CITY OF CUPERTINO
Item 1 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35904008.00
DATE ISSUED. . . . . . . : 02/07/2006
RECEIPT #. . . . . . . . . : 33099
REFERENCE ID # . . . : 06020033
SITE ADDRESS . . . . . : 7775 LILAC WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KURUPPU PODIBANDA M AND INDIRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4208
RECEIVED FROM . . . . : KURUPPU
CONTRACTOR . . . . . . . . LIC # *OWNER*
COMPANY . . . . . . . . . . : KURUPPU PODIBANDA M AND INDIRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4208
• TELEPHONE .. . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
__________ _____________ __________ __________ __________ __________ ----------
VOICE ID DESCRIPTION VOICE ID DESCRIPTION '
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
•303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
•
qM& , CITY OF CUPERTINO PERMIT APPLICATION FORM
CUPERTINO
N # 35°�^ co'1_ Date: 2 '�
Building Address: I M 'ling Address (if different from b ]ding address):
7:7 -7S- L 11^ A- c, til A `4 v P� I-7 N 01 CA
Owis Name: Phone#: Z-5 Z — 0—D
n,) ,6 6,Vl D 4 . M K u RL) ►� O 40 8"
Contr c0 rD I g D A- H f< v R J i r v License#: Z
7 g4 ,' O 3
Co tact: Phone: Cupertino Business License#:
4,oq) 2-S Z-2og6 Fax:
Building Permit Info:
Bldg Q Elect gr Plumb Mech ❑
Job Description: 'ca I o`'' e-4-S a 'IKf-s ; C h on S'- CA �req
Residential �' rt p ^u.c r�b ^ tl v �^+ e1 Commercial ❑
Sq.Ft. Floor Area: q.Ft.: 3 b/
Cost of Proiect: ' g 3 Occupancy Groin 3
Type RRf Co�}struction: t S +4 Please check this bog if the project is a
K+✓ yr-1LI I Se, Ol^Cv CL second-story addition: ❑
Project 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
BB.OILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1,75 M Btu MECHANICAL
13BOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTA)MQ 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 of 3
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. AII of the work
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
be erfarmed
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.
PersorVFirm Address/City . Phone Number Type of work to be
erfarmed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is tree and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature: Mo-- �� �L— tom_ Date: 2 I f o 6
Job Address: 5 l'' Lr-r,w� CU P� i 6 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
City of Cupertino Building Departmec+
CITY40 10300 Torre Avenu w
CUPERTINO '° (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 outer 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. as an employer and
If you are an employer,you must register with the state and federal governmentemp y
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 compensati*
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 ntformation about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the US.Small Business Administration). For more specific information about your
obligations under state late,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 tate 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 Departatent, •
City of Cupertino
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All dimensions size designations given areThis is an original design and must not be Designed: 1/10/06i
subject to verification on job site and released or copied unless applicable ice has Printed: 1110/06 1
adjustment to fit job conditions. been paid orjob order placed.
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must not be Designed:All dimension.-size designations given are This is an original design and most no,be : 1/10/06
'v I/10/
subject to verification on job site and released or copied unless applicable tee has Printed: 1/10106
adjustment to fitjob conditions. been paid orjob order placed.
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C140E79B.kit JFp 1 Drawing p: 1