06090074 CITY OF CUPERTINO
SUILDINC,DIVISION
PER 'CU R`eiC.'TQR I�NFURMATIQNz
BUILDING ADDRESS: PERMIT N0.0 6 0 9 0 074
21546 MONROVIA
Ow,
W NER'S NAME: PERMIT ISSUE DATE
SITYAM DAVULURU 09/12/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BLDGBUILDING PERMIT INFO
EO PLO MEOCH
j LICENSED CONTRACTOR'S DECLARATION lob Description
cornF 1 Wxby affirm Nal 1 am licenced under provisions or Chapter 9(commencing
,Zwith Schon 7")of Division 3 ofthe Businessland Prafessinru Code,and my license is
t� in full fares and eflac. INSTALL CAP AT MAIN .GAS LINE AT THE METER
{�f? License Class Lic.N
p Dam COmalemr
1q-7W ARCHITECTS DECLARATION
i a< I understand my plans Nall he used ace public records
1�
'
:t5 Licensed Pmfcssi...I
OWNER-BUILDERattempt
DECLARATION
:n o 1 Wmhy aRrm Not 1 1. exempt from the Contraclemmas ora :Any c Law for the
.O o following xuoa ertim 7031.5.IA,Busies and Profeasioli Code:Any airy car county
$En which required a permit re uirummL aims improve,Each
deem it t ore a sig any structure $500
-iy prior mits censed issuance,sun requires the
ovisio o for Code permit Lice to Lnedsummem
:Sp NatWisliccnxdpumuntroampmvialonsofthe ConMcursLiansclaw(CNpmr9 Sq.Ft.Floor Area Valuation
`meg (cammmemil with Section 7000)of Division 3 of Ne Business and Prefestiom Code)or
that he is exempt thsefsysm and the basis for the alleged exemption.Any violation of
Section 7031.5 by OM applicant for a Permit wbAcu the applicant m•civil penalty Of Occupancy Type
WE mom than five hundred dopase(SSW).
0 t,se owner of die Property.or my employees with wages as their sem compensation,
will an the work and th.uncture 4 not intendedoffered for sale(Sec.744,Business Required Inspections
and Pm(esdom Cade:The Canmcmrs License Law does tot apply m an Owner of q P
property who Wildsorixprovet lhenteon,and whodoms sch work himsdforduosgh his
awn employers,provided this such improvements ax not intend W areffered for Wes IL '
hawever.the Wilding or improvements is sold within one year of cempletim,the uwner-
Wilder will have the Wrdm of proving that he did not build a improve far purpose of
ole.).
0 1.as owner of the prapeny me mcludvely m-lactng with licensed centrwana in
madam,ate projen(Sec.7os4.Burin and profesdom Cade:)The Conuanota u.
come Law dors not apply m w owns of progeny won,Wilcs m improves ft..and.
who contacts for such projects with a conuacter(s)Iiansed pursuant m the COmramoes
Licence Law.
❑lama. an BAt PC(or this numst
owner �•dr Due 41 11
WORKS COMPENSATION DECLARATION
1 hereby air=under pnWty of Perjury arm of the fallowing declandmu
I haw and will co mum a CedBa¢of Cdame.a to self-Insurefar WOnkeesCompact,
suim,as provided for by Section 3700 Of she Labor Cade.fm dm performance of the
work for which this permit is Issued.
0 1 have and will maintain Warkees Compensation InaWasce,as xquxd by Section .
3700 of the Labor Cade,fn ft performance clam work far which this Permit 4 WurA.
My Workers Compensation Insurance artier sod Policy number ax:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
CnTh xedan need mtbccomplexd If the permit Is fame,Wn lred dollars(5100)
or las)
1 cemfy that in the performance of the work for which this Permit is hued.I small not
employ an person inm manrcrse bcempcwb' tm Worken'C den
Laws of Cahlonsia.Due B p1 / 7 a 0 ajtrow
Applicant --
NOTICE TO APPLICANT If.after making N Cenificate of Exemption:you should
become subject m to Woreefs Compensation Provisions of the Labor Code.you amt
.,O forthwith comply with such provisions or this Parent Mail W deemed devalued.
„zy► CONSTRUCTION LENDING AGENCY
F I hereby affirm that Nem 4 a construction lending aimmy for the performanec of
Ci the work for which this permit 4 issued(Sec.3097,Civ.C.) -
4 Q Lender's Name
,7 z Leaders Address
U C) I certify that 1 have and this application and sum that the aWw information is
LL Hcomet.l agree to amply with all city and county ardinances and sum laws misting to
U building commetimn,and hemby amhoriw m raenutives of this city to enter upon the
�"W above-rmr%a.cd property far inspection purposes.
G (We)agree to ave,indcmai fy and keep handless the City car Cupertino against
rA liabilities,judgmems.costs and expenses which may in soy way aernc against saidCity y/•
U in consequence of the rooting of this permit. Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WIT ALL NON-POINT Issued by:
SOy�CE R�Uy!�T�IO�NS,
IJ • y —"7�---� Y 12)1,5pA Re-roofs
Signnum o(ApplicantrCostancter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore building oompant store arhandle hnsrdom mamriai
as de0ned by the Cupertino Municipal Code.Chapter 9.12,and dm Health and Safety
Cora-section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya ON.
41 Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt hoiurdaus air cmuminanu a carne)by the Bay Area Air Quality Management all new materials for inspection.
District
❑Ycs ❑Nu
1 have mad the hnamaus mamrialsxquirornents underchapmr6.95 of the Callfar.
ma Hculd,&SefctyCode,5.6.25505,25533 and 25534.1 undcnund deal If are building
does not cumemly how a roues,that It is my responsibility In story tiro axupwt of the
xquirtmcnuw ich must be ton pose m. asmng aneerdneamar cupany. Signature of Applicant Date
Omer car amnari>< asem f 12-o,�0 All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
ac[ OF Fax(408)777-3333
40UPE(�TINO
Building Department
JOB ADDRESS: C+0S q 5 v ) PERMIT #
OWNER'S NAME: X51 Yrj V U L.Ut2..0 PHONE # to bc) q b'2-
GENERAL CONTRACTOR Q FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
ner/Contractor Signature Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35623018 . 00
DATE ISSUED. . . . . . . : 09/12/2006
RECEIPT # . . . . . . . . 35995
REFERENCE ID # . . . 06090074
SITE ADDRESS . . . . . : 21546 MONROVIA ST
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SITYAM DAVULURU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : SITYAM DAVULURU
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . o ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ------- --- ---------- ----------
BSEISMICRE VALUATION 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 38 . 87 0 . 00 38 . 87 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 38 . 87 VISA
TOTAL RECEIPT 38 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
ac, CITY OF CUPERTINO ow(goo7`�CUP
f�TINO PERMIT APPLICATION FORM
APN# �
6W �-0 I0 Date:
2 ,
Building Address: i Mailing Address (if different from building address):
1 N SI . Gum 11No, Ca OrSa, 14
Owner's Name: Phone#:
5Hy►4M DkVL)LVI?_, 6g0 0J 02
Contractor: I ps 7) License #:
Contact: Phone: ( .�o)cj epyU g 61—Cupertino Business License#:
Sii n7 D AV VU)" Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb i�K Mech ❑
Job Description: ]y✓e a,{ , o'_ Cor rcial O�jtl' '(�
Residential ❑ W i w o� i^'
Sq.Ft. Floor Area: Sq.Ft.:
iM' a a
Cost of Project: Occupancy Gro : J
Ao- R-
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard Laze ❑ 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> I M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi 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
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s% CITY OF CUPERTINO
CUPEI�F PERMIT APPLICATION FORM
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 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 Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers LUMBING
BPSPRINK Lawn S rinklerBackflo 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
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BRENL IRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFIXT Ligbting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMT-4 PP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER 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
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al, FCITY OF CUPERTINO
CUPERI INO PERMIT APPLICATION FORM
• uanti Fee ID Fee Descri tion
BREMSIGNADFee Grou
Rmdl Si s Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Mar uee ELECTRICAL
BREMTHEATR Theatrical Li htin Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD Scb S ecific PlanBUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S ecial ins ection B
BSW]M , UILDINGSwimmin Pool BUILDING
BTEMP Tem ora Power ELECTRICAL
BTEMPPERM Tem orar Bid Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical s foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbin Permit Issue PLUMBING
PPLBG p ig Fee sq foot PLUMBING
PLLONGRNGC
Pla ning LR Comme/Multi-Fam PLANNING
PLLONGRNGR
Pla ning Long Range Residential PLANNING
ZADDCHGI Address Change BUILDING
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