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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 1 of 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 2of3 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 3 of 3