03060199 (2) CITY OF CUPERTINO - c
BOLDING DIVISION PERMIT CON' R,r CTt�R INFORMATI,
BUILDING ADDRESS: PRASAD KANNEGANTI PERMIT NO03060199
OWNER'S NAME: PERMIT ISSUE DATE
IliTIONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF-CH
C� 0
I00
LICENSED CONTRACnOR'SDECON Ib Dtion
LL 1 hcrchy affirm that 1 am licensed sealer provisionsons of of Chapter Oescrl
hapter 9(commencing p
SZd� with Section lIXlB7 of Divixioa 3ofm.Business and Professions Code,and my license is 'I
+< mfull force and affect, KITCHEN REMODEL
j License Class Lt.,It
'-e�cc Date T'SDECf �������
qg ARCHITECTS DECLARATION
a u 1 understand my plans shall k unit as public rccnrJs
4 ut� Licensed Professional - 9-6 3
g OWNER-BUILDER DECLARATION SEP v LnOU
a S 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
❑O following reason.(Section 7031.5,Business and Pmfessinns Code:Any city or County
$ which requires a permit to cnashoet,alter,improv,demolish.or repair any structure
°yy priorm its issuance,'also requires the applicant for such permit m file a signal statement
Eec that he is licensed pursuant It)tho provisions Of the Contractor's License Law(Chapter 9 ea Valuation
yI- (commencing tui th Section 7")rat Division 3 nfthe Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35913043 . 00
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more than fivehundred dollars(SSW). P Y YP
0 1,az Owner of the property,or my employees with wages as their sole compensation,
will do the work,and the shouted,is not intended of offered forsale(Sec.1044,Business iui — dInspections
and Professions Code:The Conquerors Liccnse Law does not apply to an owner of 102 - PIERS
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such iraprevemente are not intended proffered forsale.lf. 103 — UFER ,
however,the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving Nat he did not build of improve for purpose of 104 - REBAR -'--
xa1`')' 105 - ANCHOR BOLTS
❑1,as owner Of ci property,am exclusivelynd contracting Col licensed eenosnors i-
epnsgma the pmjen(Sec.1044,easiness and Professions Cole;)The contmcmr's Lb 106 — SEWER Fc WATER.
cense Law does not apply to an owner of property who Wilds or improves demon,and 202 - UNDERFLOOR PLUMBING
who contracts for such project with o contractor(s)licensed pursuant o Ne Contractor's
License Law. 203 - UNDERFLOOR MECHANICAL
rtem exempt min Sec. ,B A,P C for this moon
owae 204 - UNDERFLOOR FRAME
KE S MPENSATIONOFLLA14rioN" ` � 205 - UNDERFLOOR INSULATION
Ihercby efErm antler penalty of perjury one pf thNCefa(TBpwing deplar.Bpn:: 301 — ROUGH PLUMBING '
❑I have and will mainuina CCalrtea¢of CDnWntiOWif-lnaurefar Workers Compen- 302 — TUB lit OR SHOWER
sation,as provided for by Section 37M of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
work for which Nix permi l is issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Workers Compensation Insurance,as required by Section
TIDO of Ne Labor Code,for the performance of the work for which this permit is issued, 3,05 — FRAME
My Workers Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Cartier, Policy No.: _
CERTIFICATE OF MEM PTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or This section need not he completed into perm it is foram hundred dollars(51 W) 309 — EXTERIOR LATH
I Culdl) 310 - INTERIOR LATH
e enlfy that in the performance of the work for which this permit is issued,I shall not
any named California Dust mannersn as to become subjectgothe Workeri Compensation 311 — SCRATCH COAT
Lawso( ahmia.Daae
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this Ccrtilicam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject m the Workers Compensation Provisions Of the labor Code,you must
.JZ Nnhwithcamplywith such powisimuorthis pe,.,Ishut]kdeemed revnkcd. 502 — FINAL PLUMBING ENERGY
? CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I heathy affirm that there is a construction lending agency for the Performance of 504 - FINAL BUILDING ENERGY
the work for
ddresch this permit is issued(Sec.3091,Civ,CJ SOS . — FINAL ELECTRICAL
W� ❑ Lender's Name ,
Lender's Address
U Z 506 - GAS TEST
UO 1certify that Ihave read his
tyandcounand dishow NetNeabove mmutionis 507 - FINAL PLUMBING
F building 1 agree m comply with all city and county ordinances of and city
laws relating to
U shave-mentioned
ntioneclloe,end ly for by inspection authoriserepresentatives this city 1p tour upon the jFIN1MECTNWG(
AL
G above-(We)a ree I.a.fodeparictian keep s.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against 0 9
o-F-t In Iiabilides,judgmenu coaiterdeapenses which may in any way accme against said City 5 U X77 in copse ante of Nc granting of this permit.
APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 RKS Date
SOURC U ATIONS.
->-b Dle4 � Re-roofs
&g tore oPAppl can Gontrecter Date
Y5191. HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hastroduus mnerial
as derided by the Cupertino Municipal Code,Chapter 9,12.and the Health and Safety
Code,Section 25532(.)? All roofs shall be inspected prior to an roofing material being installed.t$Nu
41 Will the applicant or future building occupant use equipment or Jcvieck which If a roof is installed without first obtaining an inspection,I agree to reinove
trail hmnrdnus air contaminants as defined by the Bay Area Air Quality Moo,emcm all new materials for inspection.
District?
❑Yes No
1 have mad Nc havardnus materials uquimmenu under Chapmr6.95 of Ne Califon
nia HC.Ith Y SafetyCWe,Secduns 25 W5,35533 and 25534.1 understand tha if the building
Jxs not ctly hawthm it is my respomsiM1ility m nndly Ik a:eupant of the
tend me_
hicC ustberpcl�donuismaraceof.CcrdentoGerd trey. - Signature of Applicant Date
C JC XY'
ow oraut Drize agent Date All roof coverings to be Class "B"or better
STELLING ROAD
121'
Job:Kitchm Remodel
Address:
Prasad V.Kanneganti
20996 Peppemee Ln
Cupertino,CA-95014
Pac#359-13-043
10' 28' Date:06/302003
MBR Scale:1/16"V
aa Z
Bed 1; ; y
rn
Bath 1 cn
O
Bed o � .� � o ml. � _ � W
z, a v Na rm W
Beth lca
a c a N =' C)
N m 3. d z
Living/fa
m,ty
mom Stun
Laundry PPO
l7 Caz ge 6 P.
pining u 0
o_ Kitchen
26 O l�-s rJ
62'
Wy
STELLING ROAD
121'
Job:Kitchen Remodel
Address:
Prasad V.Kanneganti
20996 Peppettree Ln
Cupertmo,CA-95014
Pac#359-13-043
10' 28' Date:06/302003
MBR Scale:1/16"=F
Bed 1
i
i
h
flBath2
Bed 2 00 z
Q
a
Living/fa 25' W
roily 8' H
room Study
W
Laundry
Dining p
7 rl
62' CA'
G O
C�
J
60" 43'
Wl8x36 W30x36 W30x36
CW24x36 30"Microwave Pantry 36x90
C36x36 % 30"Gas Range % B36x36 B21x36
a o
v m m
e
rn
x
N
3
3 I
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3
u it
Job: Kitchen Remodeling
iv La Cl
24'Dishwasher 112106 Prasad V.Kanveganti
36"x72" ( g` 20996 Peppernee he
Refrigerator CupeRmo,CA-95014
w E irr�—_—�D
W36x18x24 Wl8x36
M'y lj W30x36 Pac#359-13-043
I1--1
') �l Date:06/302003
60" N 34„ mac'
Scale:W'=P
OWR-BUILDER VERIFICATION•
NE
. 1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. )C All the work authorized by this permit
B. _ A portion of the work M
C. _ None of the work D (2 T n 9 T
If B or C is checked,complete 2 or 3 Belo JU ' 3 0 2003
2. A state licensed contractor will be hired to do: By
A. All of the work
B. _ A portion of the work (complete section be w)
Contractor Address/City Phone # Yate 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(reveside).
Property Owner's Signatur . q J Date:
JobAddresV�0`�`]'bPL`'1sJ'611TIC— LIy,Ct1P-rk1/Na Permit# D Q
Any chafes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
Zo
C%Y OF CUPERTINO PERMIT APPLICATION FORM
•CUPEkTINO
APN# Date: 6�So�zoO 3
Building Address,`
, X09 `16 PCPPCRTi2CE L-Atoe CvPFRritvo0CA -9Sbl4t
Owner's Name:� PRA,SAb KANNEc;Aa.,'T / Phone#: (4p$) 757- ko60
Contractor: License#:
, \/� PI� AShD K AN �vC C3, Aiv'r 1
Contact: PRA S A a k A N N E G AN? Cupertino Business License#:
Building Permit Info: ��
Bld Elect PIUMPH- Mech lEr
Job Description: <
Residential ❑ erc• 1
Sq.Ft. Floor Area: $/Sq.Ft . -
Cost of Project: Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > 1O00A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY - Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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