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06090254�a;FyFy 3�V •ii �a ttii rn� `pG .SE CITY OF CUPERTINOBUILDING PERMITM. BUILDING AODRESSIVISION PERMIT NO. 06090254 1228 WEYMOUTH DR OWNER'S NAME: PERMIT ISSUE DATE SASHIKALA OBILISETTY & MAH SH E: SANITARY NO. CONTROL NO. ARCHRECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby alarm Net 1 am B¢nsd under prevision or Chapter 9 (commencing with Section TOM) of Division 3ofthe Business and Proreasiov Cade, and my license la In full tome Walloons. KITCHEN REMODEL- SINK AND COUNTERTOP REPLACEMEN c7au use. { Dau COm Dam ARCHITECT'S DECLARATION ARATION 1 understood my pons shall be tied as public records Licensed Pmfcssioml OWNER -BUILDER DECLARATION I herby affirm that I am attempt from the CanuacmA Lkcnse Law for doe (allowing moan. (Section 103 1.5, Business and Profession, Cade: My City or manly S1500 which mquira a perlNl id cormarm, alta, Improve. dem.ilah, or repair any sumbed Sq. Ft, Floor Area Valuation prior a its issuer. also requires the applieanl for such permit to Ole aslgnod comment Contractor's uava Law (Chapter 9 that he la licensed puvaant a dm pocviakvafthe (eommevin{ with Section 7000) of Oivtsion 3 a(tie Budneuand Profeaiov Code) or that he Is exempt therefrom and tie basis (a du alley l exemption. Any mlad6n of { Occupancy Type Section 7031.7 by A" applicant for a permit mb*L1 the applicant m a civil penally of not mom Nm fie hundred dollars (5300). ❑ L property, a my empleyeo wllh Netrmk eompewation, hewerk. Required Inspections 9 P oom ru n and orowradfuralepply 70 N, Business cWmiemrs w(8 dotiewons Code: he Limo Lae dam ret apply lf an owner of and Coder Thr Cmueemra whon, but property rad who hla work Mruecised nsuchot ored amPemywyeesWilds frou{h that suthrmogandwho am in owneer.then,pini,ordthatwenimpocwmentsanenal deededaroncrtd owner - thato owner. builder. the buil r improvement is mid widtinam year of compledfor purpose builder MB have the burden of proving Nat ha did ret build or Improve far pugtou of the b ti le�.)P. as owvr of Ne property am exclusively contracting with licensed conmcmrs to " 7044. addreas ProfaNaus Code:) The Commoner over LI• _ mmtrocl the project (Sec. alk came IAw does not apply to an owner of propeny who builds or improves themm, and, who contracts rot such pockets with a contractor(s) licensed pursuant an be Common's License Law. 0, "a rreggaffeYYmpl u'nd/pr See. BAP C for Nism an Owner Lam/ r " ' � Dau WORICERIS COMPENSATION DECLARATION 1 hereby ewer under Penalty of perjury ane of the following decimations: 1 have end will maintain aCmdacom of Covent to saf-imum for Women's Camper- ation, as provided for by Section 3700 of the Labor Code, for the performance of the woo for which this permit is Issued. ❑ 1 have and will maintain Workers Compensation Irutuana, a required by Section 3700 o(Bte Labor Code. for the perfomanem offt work fa which this permit is Issued. My Workers Compenudan huurence artier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sectio need not be completed Rtic permit Is fora.. hundred dh8atr (3100) or ma) 1 century Npt In me perfaramce of the work reef which Be, pemtlt Ise issued, I shall rat employ any person In my an sham became mbjeel m Ilan Workno Com =O. Laws of Califoml m AppBant NOTICE no APP CAM': If. net making this Certificate of Exemption, you shouhl become subject in Ne Workers Compensation provisions of the labor Code. you muss ' forthwith amply with such provkiov or Nk permit shall ha damcd raukad. i 'y CONSTRUCTION LENDING AGENCY I Imreby ARm div duo is agevy far Ne perfameme of s ed (Sec. 30lending,C ' the wart for which this permit la issued (Sec. X171, CN, C.) Lenders Name Leaders Aadmas 1 madly that I haw road this application and mu the use above infoma d.. is ' Coma I as= to comply with all city and county ordinances and rue laws relating in building construction, and hereby munoriu representatives of this city center up.. the k- above-mentioned properly far ivpection purposes. (We) agree t0 aw. Indemnify and kap hVmleat NC City of Cupertin0 egalml If Ilabllltlo,jadgmena, moss and experms which may I. my'MyaccNeagamt cold City >' in amrgusnce of No grandng of this Permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT y �n C —e^ e Issued by: Date i SO rE�p ULA NS. o �O r��% b� ' V' Re -roofs Type of Roof Signature of ApplianuConlamor Dau HAZARDOUS MATERIALS DISCLOSURE Will the applicant err runes building oaupust ame m beadle haallov materiel as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Cade, Section 23532(a)? All roofs shall be inspected prior to any roofing material being installed. CYa �ONu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building =upon, um equipment or devices which molt haardous air cmmminanla as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yo, WHO I haw mal the haarthms materials requirements undmChapur&95 orthc Califor. nia Health& Safely Code, Section, 23503,23333 and 25334.1 understand thmlf tie building Jas ml currently have a unmt that it Ir my Immoodhlllly m notify the aeupant of the mqu' mentswlaimnmaunamatpaarmiamaa�r7,caalEcem` err. �'� Signature of Applicant Date ' K� All roof coverings to be Class "B" or better Owner m mthmircd agent Dau CITY OF 46UPEkTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 0— <c W�EM07N DIZ. PERMIT # 060 f el,22-( OWNER'S NAME: ,5 H AL,,4 Q I Ll S i PHONE O 0z� 2 - GENERAL CONTRACTOR: GENERAL FAX # I am not using any subcontractors: --r-c? D 9- Z-? "-e!, Signature Date Please check avvlicable subcontractors and comvlete the followine information 60 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 D Date • a O V 0 00 01 r G D ` 1.0 vi 6 9v G r X1.1 U C� w N a � r G D ` 1.0 vi 6 9v G r X1.1 OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform i I I I • A. _ All the work authorized by this permit B._ A portion of the work C. �j�one of the work If B or C is checked, complete 2 or 3 below. I 2. A state licensed contractor will be hired to do: A. _ All of the work B._ A portion of the worlk (complete section below) Contractor Address/City Phone # State License # Type of work to bC C1fV13iiGd i i • 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. I i I Person/Firm Address/City. Phone Number Type of work to be performed I ............................................................................I.................................................................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information Dat (reverses se). siid/� �"�% ` - S �Gy� CGC-c� e: 2 Property IOwner's Signature: l/ n i , job Address: 12 Z g w'� ii /% Y ' Permit # City of Cupertino Building Department CITY OF 10300 Torre Avenue• CUPEkTINO Phone: J4081777-3228 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. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from 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 titan 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 compensatior• 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 em 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub:,Blk: Lot:_ APN ........: 36210035.00 DATE ISSUED.......: 09/27/2006 RECEIPT #......•••: 36222 REFERENCE ID # ...: 06090254 SITE ADDRESS .....: 1228 WEYMOUTH DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ......: OPERATOR: amyw COPY # : 2 OWNER ............: SASHIKALA OBILISETTY & MAHESH ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM ....: 0. SASHIKALA CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ...: , TELEPHONE ........: •FEE ID UNIT QUANTITY BPERMFEE VALUATION 1,500.00 BSEISMICRE VALUATION 1,500.00 PPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : 0 AMOUNT ------------ 122.03 122.03 AMOUNT - PD -TO -DT THIS REC NEW BAL ---------- 83.16 ---------- 0.00 ---------- 83.16 ---------- 0.00 0.50 0.00 0.50 0.00 38.37 0.00 38.37 0.00 ---------- 122.03 ---------- 0.00 ---------- 122.03 ---------- 0.00 NUMBER ------------------ AMEX , �_O• ` F CUPERTINO CITY OF CUPERTINO 003909-54 PERMIT APPLICATION FORM N# 3 I' rL i o O S 5 Date: C„ 'r- .971 2,00 b Bu Itg Address.1�- Mailing Address (iif` f different from building address): BAPPLOTHER Owner's Namen^ Jt� v Phone #: 4 2-65 V Z Contractor: ) g License #: Contact: Phone: Cupertino Business License#: Fax: MECHANICAL Building Permit Info: Bldg ❑ Elect Erl� Plumb Er Mech ❑ Job Description: C -i rc.;-t., PI Residential K Cok n,� Commercial El Sq.Ft. Floor Area: 30ovkr Sq.Ft.: Cost of Project: ¢ [500- O 00 Occupancy roup: Type of ons ction: Please check this box if the project is a Construction Tax second -story addition: El J ro'ect Size: Standard ❑ Laze ❑ Maor ❑ Ind/Off/Comm/Quasi 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> 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 1 of 3 C- CITY OF CUPERTINO CUPER-TINO 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 13UILDING 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 13UILDING BPLANCKREP Plan Check Repeat Fee 13UILDING 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 Instalt/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 Fumace MECHANICAL BREMFURNOV Relo Furnace > IOK 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Bance ELECTRICAL 2 of 3 CUPEI-TINO 4 ZT 10 CITY OF CUPERTINO PERMIT APPLICATION FORM Fee ID Fee Descrintinn Vent Fan Single Duct Ventilatinn Cvcto.nc Plan I BUILDING Res Pool BUILDING Temp Dist Svcs Business License Electrical sq foot Elec Permit MeIssuance chanical sq. foot ✓Tech Permit Issuanc lambing Permit Issu Plumbing Fee sq foot LR Comme/ Mull Long Range Resin Address Change 3 of 3 PL