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03090062 CITY OF CUPERTINO =��v' • �x«s rcy�. ' y�T%1 W •<r BUILDING DIVISION PERNUTANW �V©?.`fs1..R,f31. J�B lil �✓., s' I� . BUILD WG ADDRESS: PERMIT NO. 10327 TONITA WY KRISHNA MANDAVA 03090062 W NEA'S NAME: PERMIT ESUS OATS KRISHNA MANDAVA 09/09/2003 PHONE: SANITARY NO. CONTROL N0, 4082537828 CUPERTINO CA, 95014-2931 ARCHRECI'/ENGINEER: PHONE R. -�,BUILDING PERMIT INFO REMODEL HALL BATH BLDG ELECT' "PLUMB MECH' u00 O O O O t, 'a^ ` TO ARRANGE INSPECTION SOB DESCRIPTION TSP$CTIRNS g•'<�`'� eti CALL 777-3228 MONDAY-FRIDAY 24 HOURS RESIDENTIAL,i BEFORE REQUIRED INSPECTION.JOB ADDRESS 0 SFDWL C KITCHEN REMODEL m r- FOUNDATION/PIERS/H.D.S. AND PERMIT x ARE NEEDED WHEN PHONING. 0 ADDITION 0 PLUMBING RE-PIPE o < UFER GROUND 0 MULTI-UNIT 0 STRUCTURAL v MODIFICATION 1w PAD/SETBACK-CERT RESIDENTIAL_COMMERCIAL_OTHER_ OINTERIOR ❑ CHIMNEY REPAIR y GARAGE SLABS/PREGUNITE IMPROVEMENT ❑ SWIMMING POOLS a<f .. - x HA ARDO Ic FIR AREA 0 BATH REMODEUREPAIR Q DEMOLITION ao ;VbgR N4 t1IdGRE'I 'UN`R"tt'sA13Gv.Fi H,RSzEEECt;STGNEIS i•€.�. z [_1 OTHER UNDERGROUND/SLAB CYEs Bye-I aaeersuna NasaClass Aroor avmmbly is mended. Fs,c UNDERGROUND PLUMBING a51 UNDERGROUND ELECTRICAL C1 NO Iniral I.C.B.G.x COMMERCIAL; DO N07)- OCJR F QO %L N PtI A$o'�EiHAS BEEN SIG`tl ? )- UaSTTN .ROOF COVERING 0 NEW BLDG/ADDITION 0 DEMOLITION UNDERFLOOR PLUMBING C TENANT - 0 POGO SERVICE UNDERFLOOR MECHANICAL Number of existing coverings IMPROVEMENT UNDERFLOOR ELECTRICAL Tobe omn,etl Te be reteinetl 0 OTHER UNDERFLOOR FRAMING VENTS UNDERFLOOR INSULATION ';F4ACRiNFJ'SUB.Ft,OR,RI,iNRW'IP.,h,BO,' °,L3A$;FiEk`L*FS,IGNEFy a TYPE OF ROOF COVERING ROOF SHEATH/DIAPHRAGM EXISTING: PROPOSED: PLUMBING �U�2 Vis} K7 0 Built-Up Roof 0 Built-Up Roof TUBS&SHOWER PAN 0 Asphalt Shingles 0 Asphalt Shingles MECHANICAL C1 Wood Shakes 0 Wood Shaken LECTRICAL/I BOND U.Z--.13 0 Wood Shingles 0 Wood Shingles RAMING/STAIRS/E.EGRESS C Other(Sp afy) C Other(Specify) INSULATIONIVENTILATION Provide I.C.B.O.Report No. .WVERNRvt9 ICV „ ,A GYEIIA :aEEN IGNED,= iE`,. ° Provide Mfgr.Installation Specs. EXTERIOR SHEARIHOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR INSPECTIONFINACAAMPFCTION REQUIRED DATE INSP EXTERIOR LATH/W-SCREED SHOWER LATH JAN 2 7 2004 I+[If3T$Pk"44'R uSSTEA.`UM,I,R'ahRV>~HAS D11 SCRATCH COAT SEWERIWATER TEMPORARY APPROVALS OCCUPANCY Z_ ZO ;;FINMLS . :v�ti ,.',�,v"r,''.�o„SA•. 2, .v f�„'z1: . •-. PLANNING 777.3308 x > cns TEST IMPORTANT W M GRADE(P.W.777-3354) 'z FIRE-CALL(408)378-4010 When a permit has expired, a charge totaling one-half C) HANDICAP I the fees to obtain a new permit must be paid to WELECTRICAL "Z reactivate the permit. H D. PLUMBING j. .. O Z MECHANICAL ENERGY permit has been expired for more than one year, a VISUAL FINAL ONLY charge totaling the full fees to obtain a new permit BUILDING ,must be paid to reactivate the permit. ❑ CCCI,I+ANCYIF�»agUII. NGsIS NO•'APERMIOTED'�,Q ° ' Initials t(YNTIL�UILDbNb'fINAD'1S IgNI=kS "BCIILL3ING �- $Ii ' CT INSPEOR^" ` s" a v, q ,-, .,.�„v ;. , ...�, ;`_ CERTIFICATE OF OCCUPANCY ❑ PRE-INSPECTION: PLYWOOD: IN-PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF LNSPECTION: BATTENS: FINAL: INSP. DATE INSP. DATE INSP. DATE, NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTIxac�OR BUILDING ADDRESS: KRISHNA MANDAVA PERMIT N0.,U3090062 OWNER'S NAME: PERMIT ISSUE DATE KRISHNA MANDAVA NE: SANITARY NO. CONTROL NO. HITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB METH joS LICENSED CONTRACTOR'S DECLARATION .Job De crl tion I�� I hereby affirm that 1 am licensed under provisions of Chapter Y(commencing � F p a¢ with Section 7M))of Division 3 of the Business and Professions Code,and my license is N/ LED << is LfeneClas rfr"'' REMODEL HALL BATH /ate i License Claes Llc.M Oath Contractor f�tt eeQQ ARCHITECTS DECLARATION JAN 2 82004 C 8 1 understand my plans shall he used as public records )yU e top y Licensed Professional OWNER-BUILDER DECLARATION BUILDING COO 1 hereby.(Seta that 1 em exempt from the Cssions Co License Law for the ❑O following massa Permian)(131.5,Business and improve, demolish. Code;Any city or roomy COO which tats issures a e,also re constquires the altar,nt for such dcermit t or repair any structure °yam prior it) issuance,also requires the applicant for such permit to rile soigne]statement 'e_Yp that he is licensed pursuant to the provisions of the Contractor's Lice saLaw(Chapter9 Sq. Ft. Floor Area Valuation et— (commencing with Section 7")of Division 3 of the Business and Profession&Code)or Nal he is exempt therefrom and the basis for the alleged exemption.Any violation of 35914002 . 00 Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty of anC APN Number OCCU Type- not creat Ran five hundred dollars(5500). _-- - P yTYPe - --- - ❑1.as owner of the property,or my employees with wages as their sole compensation, will go the work,and Ne structure is not intended or offered for sale(Sec.7014,Business 10-1 FUUND and Profraeions Cade:The Contractor's License law docs not apply to an owner of 102 — PIERS d Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements..of intended oroRered forsale.If. 103 — UFER however,the building or improvement is sold within one year of eomplmion,the owner- buiFJer ,will have Ne burden of proving that he did not build of improve for purpose of 10 4 - REBAR st [11, 105 - ANCHOR BOLTS ❑1,asOwner ofone ctpnapeny ,Bexclusively Prmmctins with licensed conmctor i. - - - consumer Lawthe oes noel(See.o in owner of pandroperty rty who Professions ds or improves pro Contractor's Li 1 O 6 — SEWER & WATER ¢e Ltracts sr suchot pgmts own arofpmpeny whosedportRaccoodContra.md, 202 — UNDERFLOOR PLUMBING "M1M contracts far such projects with a conuacmr(s)Licensed pursuant so Jrc Contractor's 11��re uLaw. 203 - UNDERFLOOR MECHANICAL M]I am exempt under See. B A,P C for this motion owe 7bYeyll__2�Date /0 3 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION 1 hcrcby affirm under penalty of perjury one of the following declarations: 3 01 - ROUGH PLUMBING ICI-1-11 have and will maintain a Conditions of Concentto self-insum for WorkchComprn. 302 — TUB & OR SHOWER ,as provided for by Section 37W of the labor Code,for the performance of the 303 - ROUGH MECHANICAL for which this Permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 3 04 - ROUGH ELECTRICAL efthe labor Cotler for Ne performance of the work for which this Permit i¢issued. 3O5 — FRAME orkers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS er: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK or less] - This section need not NO completed if the permit is for one hundred dollars(S 100) 309 - EXTERIOR LATH 1 certify that in the performance of the work for which this permit is issued,l shall not 3 10 — INTERIOR LATH .employ,any person in any manner so as m boromc suit to RnWorkers'Compensation 311 — SCRATCH COAT Laws of California.Dao Applicata 313 - ROOF NAIL NOTICE TO APPLICANT:IL after making this CeniEcate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the labor Code,you must � Z fonhwim comply with such previsions Or this Permit shall he deemed revoked. 502 — FINAL PLUMBING ENERGY z CONSfRUCTONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY I thereby air,.that there,iv construction lending agency to, Performance of 504 - FINAL BUILDING ENERGY Lender's N x > thcder'sNfor which this permit isissued(Scc.309T,Civ.C.) 505 - FINAL ELECTRICAL Z1 Q ame z Lenders Address 506 - GAS TEST p 1 Gentry Nat 1 have read this opplicnion and soon that the above infmmuiun is 507 - FINAL PLUMBING cmrecl.1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorim representatives of Nis city to enter open Nr �U abovomentioned property for inspection purposes. FIN MEC:HAN CAL W (We,)agree to save,indemaify and keep harmless the City of Cupertino against IO 9 FIN fa/] liabilities,judgments,teats and cartoons which may in any way accrue against said City in consequence of grand ns of this Permit. Issued by:5 NWORKS Dale t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT S URCE REGULATIONS. c Re-roofs HAZA Signature of ApplicarDam HAZARDODO0b MATERIALS 1st re or h Type Of ROOF Willy the Cicanlser!Muneipal ode.Chapter 9.12, ban In Houldsund Smial as de.Sed Section the Cupertino Municipal Code.Chapter 9.12,end the Hcehh and Safety Code.Section 25532(a)? 0y. All roofs shall be inspected prior to any roofing material being installed. ' No Will the applicant or/,future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ,it hornrdous air contaminants u define]by the Bay Area Air Quality Management allnew materials for inspection. ❑Yes lDy No I have maJ the havallous materials requirements under Chapter 6,95 of the Califor. nia Health 6 Safety Code,Sections 25505,25533 and 25534.1 understand that if the brain, Joey a.(currently have a mnanl,that it is any mspm u ltality m notify thexeupanl of the requirements w�hlust^ barrel.priortuiouanccofa Ccrucateof Occur75� c3 Signature of Applicant Date , nen ser authori'rcJ Ogen, DDa1C All roof coverings to be Class "B"or better OWN#-BUILDER VERIFICATIOV 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 below. 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 icense ' ork t SEP 0 .ed 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 rtino Buildin Department office. Person/Firm Address/City Phone Number Type of work to be erfonmed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature; rl CRf (Q�n c�2 Dater `1 I I to 3 Job Address: (0 317 TON 1�l� w&t� f t Permit# A"changes to the information provided on this form shall be submitted to the Citv of Cupertino Build DeRartment. i City of Cupertino Building Department CITY OF 10300 Torre AvenueAft C' I DEKTI NO Phone: (408)777-3 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself,from possible liability if that person applies for the proper permit in his or her name. nl• , � 1 , ,,rir Contractors are required by law to be licensed and bonded by the State of California and to have a business license fiom.the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such,persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board in your community or at 1020 N Street,Sacramento,California 95814., Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper C*Y OF CUPERTINO CITY OF PERMIT APPLICATION FORM (J� D �0 Z CUPEkTINO N# Date: R /y/b 3 Building Address: (0 3 z -� -r O N i T / � W A`� 1 Owner's Name: kA,t SNIiA Phone#: �uU& A5 3 --79 18- Contractor: $-Contractor: License#: 6unl� Contact: Cupertino Business License#: Bu din Permit Info: Bld F Elect EIPlumbJ Me h Job Description: 60 Residential ® r ' 1 ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: r / Type of Construction: IF Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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> 1000A 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 # 23J � I of 3 a9 7 60Y OF CUPERTINO cuP TYOF PERMIT APPLICATION FORM Quantity Fee 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 PbIg 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 eOfFixtures 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 Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTI10 Tv o CUPPERMIT APPLICATION FORM QuantityFee 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 Insection BUILDING BSWIM Swimn-dng 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 Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 (O 31 T®N I -TA W R� Cep C- rK T I N-a APPROVED IPI'ACCORDA EWI HE CITY OR rJ �c) �LUYCVVM R�i C p N ORDINANCES x °) SEP 0 21 QAT. — M N W SIGNED —N _i This set of ra s and specifications MOST j CLOSET ` ! CLOSE be kept o e job at all times and it is un ° C I oil to oke env changes ar aiteratfcn= — 2° DR I_ 1 DR I; 2° DR `! .2° DR 1 w. n sa a with ut writ. . P� I ,r he building Dept., City of CuPartin®. CLOSET \ e stamping of this plan and spaciflol6ons 3'-7" d; 2 —8" HALL NOT be held to Permit or to be Ar N pproval of the violation of any proviaions DESK ,f any NO�$ence te Lew- or Stao 1. RELOCATE TUB FAUCET _J TO EXTERIOR WALL N �— 2. REPLACE EXISTING TUB 3. REPLACE EXISTING TOILET x (E) BATH RM MED (N) j 4. REPLACE EXISTING VANITY iG CABINET �? WALK—IN r7 .. .MIRROR � � - 5. INSTALL NEW GLASS SHOWER i ENCLOSURE 6. REPAINT ENTIRE BATHROOM COLOR BY OWNER ASC �� I WD - �__�}�- rr I t AREA OF WORK a � ;��; �- PAIR C SOLID V f (oo vL eLA- l (W (_C7 X (N) BEDROOM `� rtoeEt AT1032 (�f�rj+ !^(t`( .r. � .I PANTRY OVE UJ EO: EQ 115 CLOSET CLOSET 0f FEE-04-2004 11:25 MARK THOMAS CUP 4082535173 P.01i01 p SANligq� c`"�``� O�J,� a BOARD OF DIRECTORS DISTRICT MANAGER.ENGINEER MARK THOMAS&COMPANY,INC. JOHN , ATTOHARRISON. DAVID E.Ross f. �� JOHN M.GATTO Sslg81 IS N 6D � WILLIAM A BOSWORTH EPH F,BROWN IS7RICT COUNSEL ATKINSON•FARASYN. LLP 20065 STEVENS CREEK BOULEVARD,BLDG.C WENDELL H.KERR,JR. HAROLD S.TOPPEL CUPERTINO,CALIFORNIA 95014-2350 (408)2530071 PHONE AN (408)2535173 FAX File: CuSD-MOP Building Dept. -Cupertino Community Development Department-Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Residential'RemodeVAddition Name: Krishna Mandana Address: 10327 Tonita Way APN: 359-14-002 Control/Plan Ck No. 12092 Permit No. 03040092 ■ Videotape and Property Line Cleanout inspected. �- 2 No additional ditions/require ents by the District.• J q .J / C)Inspector: �1. ........ ..........:............... (, ' p�. r Date: .. cc: Home owner ................................. - SDNRENING SINITARI Sfw ERAGE SENVI(FS FOC CITI Of CUREANINO, PORTIONS OF THE (IIIE$ OF SARATOGA, SUNNIVA(F• ION ALTOS AND SURROUNDING UNINGOIPORIIER k1EAS Nw9 'In1 iNIi0•I5'Opif�l!viliyl rf('I,(brll TOTRL P.OS / 032-7 OCT 0 3 September 4, 2003 .L D7 City of Cupertino Building Department Subject: Special Inspection for Holdowns Permit Number: 3040092 Gentlemen, This is to certify that in accordance with Uniform Building Code, we have provided special inspection of the following: 1. Shear wall Holdowns These inspections were performed by personnel under the general supervision of the undersigned Registered Civil Engineer in the State of California. Based upon both inspections performed and substantiating testing reports, it is our professional judgment that the work requiring special inspections was substantially in conformance with the approved plans and specifications and the applicable workmanship provisions of this code. Sincerely ? 121044 Steven C Chu,MSPE No. 52160 CNN X/ - OF CAO ,4708)-12 5- 'K�0 750�; cupenin.,CA 95014 • Tel:(408)50U-99Z'13 /0302.7 7�A i 74 September 30,2003 City of Cupertino Building Department OCT Subject: Special Inspection for Rough Framing 08 2003 Permit Number: 3040092 Gentlemen, / This is to certify that in accordance with Uniform Building Code,we have provided special inspection of the following: 1. Rough Framing These inspections were performed by personnel under the general supervision of the undersigned Registered Civil Engineer in the State of California Based upon both inspections performed and substantiating testing reports,it is our professional judgment that the work requiring special inspections was substantially in conformance with the approved pians and specifications and the applicable workmanship provisions of this code. Sincerely R Steven C Chu,MSPE f N0. 52160 cI m s y Of CAUF�R� CI'PY OF CUPEWIANO 'tea •�+t - '°'- r BUILDING DIVISION PERMIT °ghCONTRACTQRINFORMATION , BUIL DING ADDRESS: / 03 Os'f� KRISHNA MANDAVA h PERMIT"03090062 WY •R'S NAME: PERMIT ISSUE DATR E: SANITARY NO. CONTROU N0, ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH ion LICENSED CONTRACTOR'S DECLARATION b F I hereby affirm that I am licensed done, mvisions of Chapter Y(commencing {■T Job Description pct With llforcnod.ffifDivision 3ofthc Busincxs and Ptnfcssiom Code,Add mylicenuis REM( 19� c in full force and after. j�J? License Claim LIc.0 ia•nDate Contractor ARCHITECTS sDlicATION I understand my pins shall used as pubrecords JAN- Q 8 2 004 5ye �o� Licensed Prodessinnat OWNER-BUILDER DECLARATION BUILDING a S 1 hereby offom that 1 am exempt from the Contmmice ors Lnse Law for the p O following mason.(Section 71121.5.Business and Pmfeuinm Code:Any city nr county - m which requires a Permit to construct,alter,improve,demolish.or repair any structure ¢a prier 4o its issuance,also requites the applicant for such permit fle a signeJ.ga¢mem 2`Yp that he is licensed pursuant the provisions of the Contractor's License Law(Chapter 9 Sq. FL Floor Area Valuation ZI- (commencing with Section 7000)of Division 2 of the Business and Professions Code)or that he is exempt Reminded and fie basis for Ne alleged exemption.Any violation Of- 35914002 . 00 Section 7031.5 by any applicant for aperout supecu Nc applicant to a civil Penally of ApN Number _ Occupancy Type not mom Nfive an hundred de0ars(S5M). --' - -- ----- P y _-- - ❑I,as owner of the property,or my employees with wages as their,Wn compensation, will do Use work,and Ne slmctum is not intended mattered for sale(Sec.7044,Business and Pmfossions Code:The Condamine,Lt..law does Of apply to an owner of 10 2 - P I ERS d Inspections property who builds or improves dimmon,and who does such work himself or through his owncu loyees,providedthussuchimpmvemcnuerenotintendedoroReredforsale.IL 103 — UFER however,Ne building or improvement is sold within one year of completion,Ne owner- builder will have the burden of proving Nat he did not build or improve for p r osc of 10 4 - REBAR fa1cj 105 - ANCHOR BOLTS I,u owner of project property,am exclusively confessions with licensed entracmrs m - —.. construct uumcm 106 - SEWER & WATER moast ho cont does not with aophropeny who licensed to she Contractor's 202 202 - UNDERFLOOR PLUMBING who camncu for such projects with a condanorM licensed pursuant m she ContranorS cense Law. 203 - UNDERFLOOR MECHANICAL I am aempt under See. B&P C for this reason Firm 4"t'- � 99/03 204 - UNDERFLOOR FRAME WORKER'S COMPENSATIONDECLARATION205 - UNDERFLOOR INSULATION 1 hereby affuunder penalty of perjury one of the following declarations: 3 01 — ROUGH PLUMBING ,e and wiB maintain.Cenifemeoftooum to selFinma,tar Worker',Comped- 302 - TUB be OR SHOWER un,as provided for by section nM of the labor code,for the Performance of 3 03 - ROUGH MECHANICAL work for which Nis permit is issued ❑I have and will maintain Workers Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL 2]M of the labor Cods.for Ne Performance of the work for which this Permit i,issued. 305 - FRAME My Workers Compeasnion Insurance carrier and Policy number are: 306 — HOLDOWNS Carrier: Policy No.: _ CERTIFICATE OF EX EM Pn10N FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCKOr 1et - (This section need not M completed if the peit is fm one hundred dollars(SIM) 309 - EXTERIOR LATH 1 certify mm Certify Out in the performance of the work for which this permit is issued.I shall not 310 INTERIOR LATH employ any Person in any manner u as to hecomc subjcuo the Workcr'Compensation 311 — SCRATCH COAT Laws of California.Date Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.If.after making this Cedifcat of Exemption,you should 501 - FINAL ELECTRICAL ENERGY kCOme subject to the Workers Compensation provisions of the Labor Code.you most � z forthwith comply with such provisions orthis Permit shall hedeemed mvokcd. 502 - FINAL PLUMBING ENERGY z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I herehy M.Nat here is a comtedctinn lending agency for on performance of 504 - FINAL BUILDING ENERGY x > use urwhich hisp mitlsisscd(Scc.2M],Civ.C.) 505 - FINAL ELECTRICAL l7 A IsndC,'s Name Lender's Address z 506 - GAS TEST 7 p 1 Certify Nm 1 have mad Nis application and sum that the above iwsmmning is 507 - FINAL PLUMBING 1 corten.l agree m camplY with all city and county ordinances and sate laws relating m building construction,and hereby authorin representatives of this city to enter upon the U abovcmmntinnee Propcny for inspection Pdgmscs. FIN MECHAN CAL y (We).&am to save,indemnify Add keep harmless the City of Cupertino against 0 9 FIN to liabilities,judgments,costs and expenses which may in my way accede against said City r) NG ;J7 in consequence or rise granting of this perm it. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date S URCE REGULATIONS. Re-roofs Signemrc of Applica0VConsrecmr Dam HAZARDOUS MATERIALS DISCLOS R Type of Roof Will Nc applicant or fuwu building mcupem smrc or hon Ic hamrdous material fined by the C.Penin Municipal Cmfe.Chapter 9.12,and the Health and Safety Section 25522(a)7 �/� All roofs shall be inspected prior to an roofing material being ' ❑Yea ]CI No p p y ginstalled. Will the applicant or�future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hmmddm air contaminants in darned by the Bay Arca Air Quality Management all.new materials for inspection. OCL? `A ❑Yes D9No I have read the basmNas materials requirements under Chapter 6.95 of Ne Califon .is Health d Safety Come,Seeumn 25515.25522 ad 25574.1 understand Nm if the Wilding docs not currently hats a tenant,Nat it is my responsi hility m domy the osecuPnt of the requirements which must be met pride u issuance ora CCNmate u(Qcu no�rr5 0 Signature of Applicant Date urt6fMl2 13 aur authurizeJ sacro Dam All roof coverings to be Class "B"or better