06040024 CITY OF CUPERTINO a'w c.: s
BUILDING DIVISION PERMIT dICONTRA.CTQVINFORMA'�ION
BUILDING ADDRESS: KUMARAN SANGAREDDI PEaMrr"°.06070024
10334 PALO VISTA RD
OWNER'S NAME: PERMIT ISSUE DATE
KUMARAN SANGAREDDI
NE:
SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+O p
1 WorbY LICENSED CONTRACTOR'S DECLARATION Job Description
w affirm Nat 1 are Beamed under provisions of Chapter 9(commencing
:Z� with Section 7000)of Division 3 of Oc Business mal Professime Code.snd my licensee
m ullforcomdcffcm. FILL CONCRETE POOL IN BACKYARD
s i Licence m
contractor n _
ECL
££ As shall x use DECLARATION
i C< I undersand my plans shall be used as public retards
ayU
to
-aN Licensed Profeasirnal
thatI.OWNER-BUILDER DECLARATION
I bemisy arrom that I ern ucmpt from TM ContnctoYs Littnse law for Ne (p/
:cc following mason.(Section](01.5,Business and Prefcssinm Code:My city or county
m which requires a permit w eowmcL aleq improve.demolish,nT repair any svuetme
-xi prior us its issuance.also orquires the applieam For such permit in file a signed summent
m< thaiheislieemedpunuanuotWpmvisionsofthc Con=toes Limnmlaw(LTapter9 Sq.Ft.Floor Area Valuation
of w (commcncingwil Sadon7000)of Diveion3orft BusinmmdPmfessiom CM)ur $3800
$ dot he is exempt thmefrom and tbe basis for the alleged exemption.My violation of
Section 7031.5 by arty applicant for a permit subjects de applicant to a civil aurally of APN Number Occupancy Type
not more Run fiats hundred dollen(S500L
the
wark T dproperty,re I, employees with wage uTheirrole ermpcwtiess
will tlr the Work.andCodc,TOe hYCWm ianmsLicesntended eLwha offered fs set apply in an Cronin r Required Inspections
and eri,Prohe builds.,
The ms thecmfs nd who law dao ort apply lf rt Cromer is q P
propertywhobuilds orimpmvu Thereon,andwho aressuchwork himselfaT for
he
howemplmym,provided th rovemimprovements are not euMcamoldered for sale. r-
bowder.the Wildingorimprovementa=to within ore ildofmprovefrtheoweer-
bailam will have the When of proving Chat W did not Wild or improve for purpose of
sate.).
❑1.as owner of the property,am exclusively convicting with licensed contractors or
construct The project(Sec.7044,Business and Professions CTsdeJ The Contractor's Li.
emus Law does hot apply To an owner of property who Wilds or imposes thereon,and.
who contracts for such projects with a conraemt(s)licensed pursuant to the Conmctmes .
LkC.La
❑1 ase uempt under Sec .B&P C for the mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty,of perjury me of the fallowing declarations:
1 have and will maintain a Certificate of Consent to self-intim for Worker'sGmpcn-
satirn,as provided fm by Section 3700 of the Later Code.fm du performance of the
work for which this permit is issued.
❑1 have rod will maintain Workces Compensation Insurance.as saluted by Section
37M of are labor Code.par the performance of the work for which this permit is issued.
My War puma alrommonaessmicrandPalicynumberans
Grier. Policy RO
CERTIFl TEXEMPOF SATIONONFRANCE ERS'
COMPENSwT10N INSURANCE
(7hisse ction Treed not he completed if ins permit is fmone hundred dollars(SIM)
or less.)
I verify Nm in the pertolmence of the work for which this Permit is issued.I shall not
employ any Panama in any mmnerm as no become subject in the Workers Compcmatim
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:IL after making Ne Certificate of Exemption.you should
become subject in the worker Compensation penveiwu of the tabor Code,you mea
.J O foMwida..,I,with such provisions or the permit shall be deemed revalued.
Z a-' CONSTRUCTION LENDING AGENCY
[- � lbemby aRmT that Vert e a construction lending agency for the perfurmmm of
rl 7 the work fur which this permit is Wood(Sec.3097,Civ.C.)
aA Lendoes Nitric
M z krauts Address
U O 1 certify Nat 1 have load this application and state that The above information is
Lt. concur.I spore m comply with all city and county rmimnoes and auto laws relating to
OU building construction.and hereby authorize relrresenntives of this city To enter upon The
G amm mentioned property for inspection purposes,
(We)agree to save,indemnify and keep hornlm the City of Cupertino against
.Fs to liabilities.judgments,costs and expcmcs which may in my way accrue against said City
U Z in Coastal...of the gaming of this permit.
rw APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sOVRCE REGUL ONS.
Re-roofs
natulo of ApplicanUConane Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant time or handle boarious material
ss dunned by theCupertino Municipal Cone.Chapter 9.12,and the Health and Safety
Code.section ss532(07
❑Yee aftAll roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or furore building overprintuse cyuipmcnl per devices which P g
coil harardnus air conamirunes u defined by The Bay Area Air Quality Management all new materials for inspection.
Dimnct7
❑Yes $9.
1 have and Or hvamssusmaurials requirements under CNpW 6.95 mfaw Califon.
nia Heald&SafetyCode,Sectimr25505,25533 am125534.1 understood thaddic Wilding
data rot cure lly hast a terror,Nat it is my responsibility W noddy the meopmt or the
mquimmems whk met prior to issuance of a cerhrcate of Occupanry. Signature of Applicant Date
- All roof coverings to be Class"B"or better
or or aotborimd agent Dow' g
Community Development
Y 'moi
Cupertino CA 9 014
y Telephone(408)777-3228
CITY OF Fax(408)777-3333
'UPEkTINO
Building De artment
JOB ADDRESS: Q /I Cl M/Y PERMIT #
0(001
OWNER'S NAME: r 11 IPHONE #
GENERAL CONTRACTOR FAX # p
I am not using any subcontractors:
f 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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35702053 . 00
DATE ISSUED. . . . . . . : 07/07/2006
RECEIPT # • • • . . . . . . : 35135
REFERENCE ID # . . . : 06070024
SITE ADDRESS . . . . . : 10334 PALO VISTA RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KUMARAN SANGAREDDI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : KUMARAN SANGAREDDI
CONTRACTOR . . . . . . . : I LIC # *OWNER*
COMPANY . . . . . . . . . . : KUMARAN SANGAREDDI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- --------- - - - - ---------- ---------- ---------- ---------- - ---------
BPERMFEE VALUATION 4 , 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ------- ---
TOTAL PERMIT 105 . 26 0 . 00 105 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -------- ----------
OTHER 105 . 26 MASTERCARD
TOTAL RECEIPT 105 . 26
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
704 DEMO
•
CITY OF CUPERTINO ow004
• CUPER,TINO PERMIT APPLICATION FORM
APN# 367 .OZ - 063 Date: 0.1'0,7 06
Building Address:
(p PAL V/SrA RD G)PGRTNo/ CAt1501(1
Owner's Name: Kolq/VR/�r4 S rJ(nAPfJ�D� Phone#: (,ft?) 725 J
CF 6 z
Contractor: ogc,F MA-A44 License
-W:' a,c) Y363
Contact: wv M "ANCupertino Business License#:
SAN�AR�i D�
Building Permit Info:
Job Description: TIU &W-RE0- P001- N
f
Residential: ER Commercial: ❑
Sq.Ft. Floor Arca: Cost of Project:
I ` o
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BSEISMICOM Seismic UILDING
BSEISMICRE s BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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