03060024 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CU,N,T12CTUIi TNF,OItMA +IO
BUILDINGADDRESS: TI PERMITNOD3O6OO24
20996 PEPPER TREE IN
NER'S NAME: FERMTT 19CPEP0 3/2 0 O 3
.ASAD KANNEGANTI
HONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
�10 Zp LICENSED CONTRACTOR'S DECLARATION Job Description
rel 1 hereby aff on that I am licensed under pmWsiona of Chapter 9(commencing
z�� wide Section 70I10)of Division 3Of me Business and Pruleadmia Code,and my license is ADD NEW WALLS
w ��nni��
in fa¢o ettett FIN A L80
nZ inicanm Class IJc.I r ,vfa�,
Ltt- Dek Con DEC
oilS ARCHITECTS DECLARATION SEP 1 6 2003
I understand my plans shall be used u public recaN
3 Licensed Professional
^ OatNEm camaDER DECLARATION
R a I I hmmhy,afnm(Sco that 1 I.S.eacmpl from the Contns Co License law for the BUILDING 0 0 which
mreason.(Salim IIO LB.alnrss and Prafuelum Cate:My oily or county • •• �7
which requsma a permit also re enres the alar.Improve,demolish.or repair any swment
prior m lB laNadp pursuant
to ma lhovisio s,of forthe ch Contractor's
emdl m ane,e a Law IDNaem 3*aQtion
_ that he(coma is lk&wit punuanl7 the provisions,DisW.of the Beat is laanicad. Chapter9 Sq.FI.Floor Area
$ (commencing with Salon 70W)af Dividon 3.f ft Busl•...and Prokasinm CMe)ar
r3 Wt lo LL exempt titerefrom and the basis for the alle{W assumption.My violation of
Section 7031.5 by,ay applicant fora permit subjects me applicant to a civil penally of er Occupancy Type
not more than five hundred dollars(S500k
I,as owner of the pmpmy,or my mnployees with"gas as doer sok compensation,
will do the work.and me Mo..iswttamarind a offered forsale(Sm.70/1,Bodness Re Ulred Inspections
and Professions Cade:The Commodes License law does at apply k an Owner of 102 — P I ERS 9 p
property who bulldaar lmprnvca deereon,and whodoesatso arkhimself orthrough his 103 — UFER
awn employees,provided that such improwmenisrt na
aot Intended offeaed fmaalf.IL
however.the building or improvement is mid within one year of completion.the Owner. 104 — REBAR
builder will love the burden of proving that he did Out build or improv fa purpose of
sale.). 105 - ANCHOR BOLTS
❑1,an Owner of da,propcny.am exclusively contracting with licensed contncron m 106 - SEWER & WATER
convect Use project(Sec.7044.Business and Profession Cade:)The Comractors Li
cense law does not appy k an owner of property who builds or important,thereon.and.
202 — UNDERFLOOR PLUMBING
who contracts for such pmjccu with a conlramor(s)licensed pursuant to the Contractor's
Lie lo 2O3 — UNDERFLOOR MECHANICAL
.
❑lamxm da See. ,BaPCfath4reason 204 - UNDERFLOOR FRAME
nor D. Foo 205 - UNDERFLOOR INSULATION
ORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I herebyafnrm under pewtyaf perjury ane of dee following declantiau: 302 — TUB & OR SHOWER
❑I havemd will maintain.Cenifiateaf Consent ksel6Wure for WonersCompea. 303 — ROUGH MECHANICAL
anion,as provided for by Section 37W of the labor Code,far the For--ma Of We
work for which thispermhiaissued. 304 - ROUGH ELECTRICAL
❑1 ban and will maintain Workers Compensation Insurance,as"plead by Section 305 - FRAME
3700.(dw JaberCode.for the performance of the work for which this permit is Issued. 306 — HOEDOWNS
My Worker's Compeasam tiImu once caller and Policy number am;
Canter. PolicyNo.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS' 308 — SHEETROCK
COMPENSATION INSURANCE
(This scoon need notbccampleted isle petmit is foram hundreddollan($IBM 309 — EXTERIOR LATH
orkas.) 310 - INTERIOR LATH
I certify deal In dee performance of the work for which this permit is issued.I shall not 311 - SCRATCH COAT
employ any permn in my manner sec as to become subject to me Worked Compensation 313 — ROOF NAIL
Law.of Calif ono.Deck
Applicant 501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT:IL after making this Cer ineste of Exemption,you should
became subject an the Workers Compensation provisions of the Lein Cnde you must 502 - FINAL PLUMBING ENERGY
.JO forthwilb comply widomchpmvisiansorthis KnoeilshaBxdamcdrewired. 503 — FINAL. MECHANICAL ENERGY
Z ti CONSTRUCTION iso IONLENDINGAGENCY 504 - FINAL BUILDING ENERGY
-f" ichor which
doss there is con(Sce.3nrendin C.) far de nerfuomencc of
x� thcwuokforwhichlhlapermitleiasued(Sa.309],Civ.C.I 505 - FINAL ELECTRICAL
W Lender's Nurse
(L Q Lenders Add. 506 - GAS TEST
U O I certify that 1 haws read this appliatlon and sate Net the above information is 507 - FINAL PLUMBING
O F' correct,I agree w comply with all city and county mulnwes and more lawn relating to 5 - FINAL MECHANICAL
ulh .
U Wilding construction,and hoebyaodm representves atiofdo.city wvtuatpon me
W shove-mentioned propeny far Inspeedan Purposes 0 9 FIN GRADE
0. (We)agree to save,indemnify and lump homeless,the City of Cupertino against O F I N
li.bllillm,judgments.costs and expense.which may in any way seem against Old City
U in cons an a of me gmatus of this permit
r y
APPLICA NDERSTANDS ANO WILL COMPLY WITH AL NON-POINT Issued by'.�'1 A� WORKS Date
URGE RE LA NS.
�36�924yD'a Re-roofs
Signature of licant/Contrmmr Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me app seas,or future building Occupant skk or handle hasardaus material
as defined by the Cupenino Municipal Code,Chapter 9.12,and me Health and Safety
'a.Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
❑secs R No
Will the applicant or future building Occupant um equipment or dcvio o which If a roof is installed without first obtaining an inspection,I agree to remove
emit wardens air contaminants as do fined by me Bay Area Air Quality Management all new materials for inspection.
District]
❑Ya qV.
I have read me hvardnuam.terialsreyuirtntents under Chapkrd.Y3af the Cali(ory
ni.HcahhaSofelyCade,S=U..Z505,25533un125534.1�ui(de building
d urrentI low a tenant,data r my mt,paviNlity re no acupmt error
F.
emu bemapdorkissuanceor.courfl ne acupmcy. Signature of Applicant Date
o6/e{hoG 8
Owner or audeorimd agent Out. All roof coverings to be Class"B"or better
CITY OF CUPERTINO. �' "" "' € T '''•` �' �' f ``"
BUILDING DIVISION PERMITaONTRa�CyTQR,IN 'OAT,I, , ,
BUILDING ADDRESS: E AN'T'I PERMITNOO 3 0 6 0 0 24
20996 PEPPER TREE LN
WNER'S NAME: PERMIT 2003
RASAD KANNEGANTI
PHONE: SANITARY NO. CONTROL NO.
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
LOP LICENSED CONTRACTOR'S DECLARATION Job Descri tion
LupLs 1 he.by M Nat 1 am m
licensed under provision of Chapter 9(amencing p
.a�4s with Section 70f10)ofDNW..3ofthe Business and Pronasions CadC,aM my lice.¢is ADD NEW 'WALLS
<G in full(.rte and effect. FINN CO
zLicense Class Contractor ,Y `G
n Dam GOOlDECL -
Iq- ARCHITECTS DECLARATION
I understand my plan. hail he used as public meortls SEP 16 2003
�a
5 Licensed Professional
OWNER-BUILDER DECLARATION
ON �y
I hereby.(Bete on 1 1. exempt from d r Conveners License Law for the BUILDING
.O fallowing first.. etch 1 ]1131.5,Business and Pro.disc.ll Codc:Any s y or county hand
a�9 which its W,uat•r,also recnmvucLalw,ntforsudeermitt are Psigneday awnum v�.m
Fiy Prionniuissuamgalsurequires the epplieam(or��chpermittofileaxigncdsmlemcnt 3VIBT dtion
< that he I,licensed pursuant to the provisions of the Conlmctor+Ucansc Law(Chapter 9 Sq.Ft. Floor Area
(commencing with SCaiod70)0)of Divuian Sofdsc Bueimtsnm Profaasions Cadc)m
e3$ Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit ubjccu the applicant to a civil Family of 3C Occupancy Type
not mem than five hundred dollars(ML
1,u owner of the property.Or my employ.with waW u their role carepensatlon,
bill do thewah,a.d the swanre,is not intended or offered forsale(See.7W.Business Required Inspections
and Professions Codc:The Conmctors License Law does not apply to an owner of 102 - PIERS q p
property who Wilda or improves the.on,and who dassush work himsedforthrough his 103 — UFER
own employees,Provided that such improvements tie not Intended or offered for sale.IL
however.the building or improvement is sold within one year of completion,the owner. 104 - REBAR
builder will have dm burden of proving Nal he rot Wild ild or improve for purpose of
e 105 - ANCHOR BOLTS
❑1,as owner of the property.am mclmively contracting with licensed contractors to 106 - SEWER & WATER
consumer the prejen(Sec.7044.Business and predations Code:)The Contractor's Li- 202 — UNDERFLOOR PLUMBING
"me Taw does not apply to an owner of property who builds or improves Nemo.,and
who contracts for such projccu with a contradart)licensed pursuant o the Contractor's - UNDERFLOOR MECHANICAL
License V .
❑lam xmp der Sec ,B&PCforthbmasa 204 - UNDERFLOOR FRAME
wrcr D. o Poe 205 - UNDERFLOOR INSULATION
OR *S COMPENSATION DECLARA 301 - ROUGH PLUMBING
l hereby s(Bmm under penalty of perjury am of tk following declarations: 302 - TUB & OR SHOWER -
❑l Invaded will mdnuin+Ceri0esm Of Comemtoself-Insure for WorkeM1Compen- 303 - ROUGH MECHANICAL
Minn.a provided for by Section 3700 of the labor Code,for dm performance of the
work for which this Permit is housed. 304 - ROUGH ELECTRICAL
❑1 ban and will maintain Workers Compensation Insurance,as required by Section _ 305 - FRAME
3700 of the Labor Code,for the performance of the work for which this permitis issued. 306 - HOEDOWNS
My Workers Compensation Insavma carrier and Polity number am:
Canner: Pa0cyN..: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS' 308 - .SHFi,ETROCK
COMPENSATION INSURANCE
(Thus section need not be completed if the permit H intone hundreddollares(S10() 309 - EXTERIOR LATH
orbs) 310 - INTERIOR LATH
I,eertify that In the performance of the work for which this permit is issad,I shall not 311 - SCRATCH COAT
employ any Person in any menncrxnu N become subject u the Workers'Camlabounan 313 - ROOF NAIL
Laws of C+lifomia.Data
Applicant 501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT.If,after making this Corifcam of Exemption,you shtuld
become subject to the Worker's Compensation previsions of the Labor Code,you must 502 - FINAL PLUMBING ENERGY
,JO !anhwiNamptywiNsuchpmvisinn+orNiaPermit manmemmcdo:vwkee. 503 — FINAL. MECHANICAL ENERGY
.z. CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
j-r4 1 hereby elEtm that tMrt is.construction lending agency for f Performance of
ly'> the work for which this Permit isissued(Sec.3097.Civ.C.) 505 - FINAL ELECTRICAL
5 wag LmiLeadce.Adde 506 - GAS TEST
z lenders Aderess _ .
U O 1 ecnify that I have read this application and ante dual the above information is 507 - FINAL PLUMBING
IU F correct.I agree to comply with all city and county ordinances and sum laws relating m 5 - FINAL MECHANICAL
0 U building construction,and hereby authorise mP.senthdrtal Of this city to enter upon the
yw ahavameatinmd property for inspection putpacas. 09 FIN GRADE
`. (We)agree to save,indemnify add keep heartless the City of Cupertino ag+iml 0 FIN +I
r^y
liabilities,judgments.costa and expenses which may In any way accrvc against Said City
U intonugmneofthcgrmlingo(IhisPcrmil. S1 A WORKS
APPLICA NDERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by. Date
URCE RE LAT NS.
912 ,u 3 Re-roofs
Signature of plica.✓Camnnor I Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or rum.building occupant nom or handle hvudous materiel
as dcBned by the Cupenino Municipal Code,Charter 9.12,and the Health and Safety
code,Section 15532(.)7
❑Ya PN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building oceupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit m"'ohms air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District
❑Yes �Nu
1 have mad Ne humorous materials re,inemem under Chapter 6.95 Of the Cslibb-
nia Health a Safety Code,Scetiom 25505,25533 and 25334.1u un ui(de Wilding
d rte tly have a tennnt.Nat it is my resrondhihly m n^ ce.peat of the
Ft
c c mu Wmetpriortoissuanceofaccmrlcam Occupancy. Signature of Applicant Date
I w 06/O3 2tr.3
/ All roof coverings to be Class "B"or better
Owner or aumoriud.gem Dam
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 belo R EC
�D
n s 2003
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 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.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(/rev a side).
Property Owner's SignatuDate: AC,�o a j1 On 3
2�
JobAddres . It pr, 00FA,1Rge L& QE CUA6RTtw6 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
0 - C*Y OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM U� °6 Ll
APN# 77
Date: 061D,312-0 0 3
Building Address: , /;20996 P6PA'RrAGE LANC
"cr CC)pCRTINo, CA -95014
Owner's Name: Phone#:
PRASAD KANAj42 A" r1 (4oz) -7 S-7- 8060
Contractor: a J�lkk n License #:
Contact: 'I v '' )l�J� - Cupertino Business License#:
7B1dgl)C
' ding Pi it Info:
Ele t Plumb ❑ Mech ❑
ob es 'ption: )�/ Q
Residential E] T CLQ mercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: / ej"`�j"D Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER OtheTAppliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK 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/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 > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC I Comm. HousingMit, Fee BUILDING
2-
1 of 3
lof3 �^
Cry OF CUPERTINO •
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
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
Alk BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
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 Pipe PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLkMiAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
• CITY OF CUPERTA
of PERMIT APPLICATION FORM
CUPEkl iNO .
Quantity Fee ID Fee Description Fee Group
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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sips,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
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE I Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
UBMITTA
#1
Jr1
°
APPROVED
CUFERT►NO D ORDINANCES
r /ttsq G
DATE P L,—� c�aJl UUo A .L.\-Val
SICNED� / o,f- . C I LJI gilt Z�.R cam
chis set of dans and ..uications Mus,
be kept 0 the jc' all times and it is un
lawful to ME, any changes or alterations
on sam , without vi iiton permission fram a
e p w
_ the building Dept., City of Cupertino.
The stamping of this plan and specifications Q�d K C(z V'. D
SHALL NOT be held to permit Or to be oh dt a`� JUN
approval of the violation of any prcvisibfl< 0 3 1003
,f anv City Ordinance or Statb Lew. By