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05110101 (2) •CITY OF CUPERTINO �' " (` BUILDING DIVISION PERMIT Rt" BUILDING ADDRESS: HENRY LLERENA FREMITNO'05110101 '10727 LARRY WY OWNER'S NAME: PERMIT ISUE DATE CHANDRASHEKAR SATRAWADA P O BOX 1851 11/18/2005 NE: SANITARY NO. CONTROL NO. (408) 891-3648 ARCH rECTIENGWEBR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� l� Sop ' LICENSED CONTRACTORS DECLARATION Job Description I thereby affirm that l am licensed under provisions of CMpmr 9(commencing p with Seed..7000)afDnvidon 3 of Ne Budoeaand Poleanlans Coad,ar d my Ikew is in full fame and effect. GAS LINE TO COOK TOP y ? License Clean Lk.M 9 F Dao; Conkeclor pA 1y /p pI ARCHITECTS DECLARATION p� 1.7 fAa p '16 f Iundcrsund my Plata CH ITed TS as DECLARATION 'I\\`Y n"I//'[`�+\all j e G Liceued Profcuiuna u VO OWNER.BUILDER DECLARATION Z I hereby afnrm NI I am a ampt from the Commuters License Law for the NOV G8 2005 p o fallowing won.(sec0an 1031.5,Buaw nand Pro(auiom Cade:Any City or county I$g which require,a perfelt m ao ecce,Iter,hnprow.demolish.or repair any structure $100 prior in iu issuance.alw notimma Neappliea l Wench Permit to fileaaigned,Wemul < Na he i,IkcwdPurmantmthe providou o(de Cmuacur,IJcew uw(cmplm9 Sq.Ft. Floor Area V nation +F{�g (commencing with Section 7000)of Division 3 of the Budnwnra Pra(wion,Code)m rk• S — Out he k exempt therefore,and the hunt for the alleged sea mcdoa Any violWun of Section 7031.3 by any applicant for a permit subjecu the appBcant b a civil p fMk!IY of i OcCupgtcy Type not mart Ihan Uw hundred da11aa 0001. O I,u owmr of the pmpmy,m my employ=withage,u Nehank=Pewtion, will dethe work.and one museum is not ktendedarolfered rorade(Sm.7044.Burow Required Inspections and Protegee.Code:The CaaYmtara Liamse I.J.ducat ICE apply to m Ower of 9 C Property who bulldsorlmprows Ne acm,and whodoeamchworkhimself err through but awe emPloyem.provided that such imprownwn art ml intended mo(fefed fmda If. howevm.the building or mperw rant is sold within oro year of eemplelim,the awmr- builder will haw the bureen of proving that he did ant build or improve for pulpa of .In.). �1,u caner of Na pmpcnY•am eacludwly common&with licensed comma.k Eomtmc1 the project(sea 7044.Broin and Profession Cade:)The Conkmmrs Li- Law dna not apply m an owner of pmpm yvho builds or improwa thercon,and, who common;(or such projecu with a conlra.7nr(n)Record pur mans in LeeCon0um1`3 License Law. plan uemin dm SCS Bd PC[arthk n - Due II 0 y O0. ER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of on,following dmlandonec ,-J i Nm and will maintain•Crstificem of Cower an xlf-mare for Workee,Compen- swan,u provided for by Section 3700 of m labor Code,for the performance of the wort far which Nu permit u ounce. ❑1 Mw and will maintain Workers Compemalon Iwonce,u regaired by section - 370o of the LAW Cede.for the perfarmanmaf the were for which Nin Permit Is iawd. My Worker,compensation le,unree arrior and Policy number Me: Cerner. Policy Na: CERTIFICATE OF EKEMPRON FROM WORKERS' COMPENSATION INSURANCE (Thi,section mod nmtbecampk¢d lithe permit kfmanc hundrudda0an(5100) I certify Nat In the performance of tho work for which Ni,permit IS issued.I&hall Am employ any permn in any manMrro;.s l�f2jua a subject ie Neworken'Campenutim Laws of Califamis D• 1 f{ J Applicant NOTICE TO APP.TANK'.If. r m W ne this Cenificate of Exemption,you should bmome Subject m the Worker,Compewtkn providom of due labra Code.you mull Oforthwith comply with amh provisions m Nu Parnell shall be deemed mated. z'0 CONSTRUCTION LENDING AGENCY v (-I 1 hereby allow that Nem is a construction leading agency for the pes(ormance of C> the work fur which this permit k iveee(Sec.3097,Civ.C.) W 0 Iander3 Name a en Z Lders Addw U O 1 certify that I haw nod this application and Mate that Ne Chow,kfamlation is W!•�. cortins I ager m comply with m city and county 0111.and Mau Ian M1411-111 m 0 SV^ Wlidineconmmdon,anehcmbyauNodmmprmenuliwso(NucilYWCnWUPnn Ne W abow-meMaeed property for inspection purpws gy (We)agree to un,indemnify and keep harmku the City of Cupertino agdmt cn Iiabiliden,judgments.co,u and expense,which may in my way acne against aid City U In cawgmnee of the grating of this permit. / /� �'�• ., APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RECU ONS. 4Ia I I f 4�a Re-roofs Signa.of Appll once OUS MATERIALS DISCLOSURE ale Type Of Roof Will the applicant or future building aecuPant Com or handle hvardom material as defined by the CupeNm Municipal Code,Chapmr,9.12,and the Hum am!Safety ode.Section 25332(.)7 P All roofs shall be inspected prior to any roofing material being installed. Cl yes yNo Will tho applicant or future building occupant w equipment or @elms which If a roof is installed without first obtaining an inspection,I agree to remove emit huardous air amu ninon u defined by the Bay Ana Air Qulily Management all new materials for inspection. DisuicE7 [3 Yes AN. I haw mW the hvardmss malenat,requirement,undmChapm69SofdmCaiifor- me Fkal"SlctyCode.Seetims 25503.25333 and 25534.1 undi,ula theifde building dna not currently how a tmem,than its my aspnmrbility m md(y Ns mcuPant of Ne requiremenuwhkhmmubcmetpnarmiumenec f cmdreamaraamaey SignatureofApplicant Date 1'I't/r g JJ owner ar,uln teen Date All roof coverings to be Class I'B"or better Community Development 10300 Torre Avenue ✓' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: 107.2l LA P," 1 , PERMIT# CCOPER-1N0 DSII�� OWNER'S NAME: SA19AWADAI PHONE # 09-:2 S'2- 273-7 GENERAL CONTRACTOR HCN" LLL-1?G N Pr IFAX # I am not using any subcontractors: *nAture 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/tontractor Signature Date CITY OF CUPERTINO CUP TYOF 0 PERMIT APPLICATION FORM N # 31 (o Da OOG Date: � I IIgIuS Building Address: 10 12 7 LAKKy W�\y Mailing Address (if different from building address): Owner's Name: C o A N,7) iA$'F1 E K4r(t ,SA-rp o AN Phone#: q08 --2N-2-2-7-7,,7 Contractor: Ry LL C R Gp/A License#: 5$7 13 O Contac : -7 O _-7 o 4 O Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb Iz� Mech ❑ Job Description: G A 5 LI N C (Lo Co o K7o P PK o M M -TE Residential 0 Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: p-p Occupancy Group: Type of Construction: Please check this box if the project is a Util second-storyaddition: ❑ roject Size: Standard ❑ Lar e ❑ Ma or ❑ Quant ity 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> IM to 1.75M 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 CITY OF CUPERTINO CUPE�F PERMIT APPLICATION FORM QuantityFee 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 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 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 BPTR.AP 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 clm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREl\fl;URN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREAUNHOOD Installation of Hood AECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNR.APP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREP ALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 "at CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group 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 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEII11PPERM 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 Plumbin g Permit Issue PLUMBING PPLBG , Plumbing Fee sq foot PLUNDING PLLONGRNGC Plan nin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3