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07020033 CITY OF CUPERTINO BUILDING DIVISION PERMIT CC1 ► C) Z I URM�AT f fit% BUIL LNG AgDRESS: PERMIT NO. 1546 MONROVIA ST SITYAM & INDIRA DAVULURU 07020033 OWNER'S NAME: PERMIT ISSUE DATE SITYAM & INDIRA DAVULURU02/07/2007 jNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH © 0 0 Q i O p LICENSED CONTRACTOR'S DECLARATION v(: I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Div' n 3 of the Business and Professions Code,and my license is CONNECT TEMPORARY POWER y in full force and cft z Liccnso Cl Lie.ff F Date Con ARCHITECTS DECLARATIOW y U 1 understand my plans shall be used as public records yC in Licensed Professional z y, OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 703 1.5,Business and Professions Cale:Any city or county .04 which requires a permit to construct,alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $100 U R$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �N Number Occupancy Type not more than five hundred dollars(5500). 3 5 6 2 3 01 E V V ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen. sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is forone hundred dollars($100) or Icss.) I certify that in the performan a rk forwhich is permit is issued,I shall not employ any person in any r b' t Workers'Compcttttatllnt Laws of California. Applicant NOTICE TO APPLICA :If,a to making thhs Certific of Exemption,yo ouk) become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z IV) CONSTRUCTION LENDING AGENCY [-+rte. I hereby affirm that there is a construction lending agency for the performance of LY the work for which this permit is issued(Sec.3097,Civ.C.) Wfs,Q Lenders Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is (y ►" correct.I agree to comply with all city and county ordinances and state laws relating to 0C-) building construction.and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs d expenses which may in any way accrue against said City .� V Z in conseghtencc o ra g of is permiL �-" APPLIC ND TAND AND WILL PLY WITH ALL NO POI Issued by: DateN#7 SO E TIONS./' Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOS RE Type of Rcof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Cede.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant orut building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Ycs o 1 have read the hasardous serials requirements under Chapter 6.95 of the Califor- nia Health&Saf ode,Secu 25505.25533 and 25534.1 understand that if the building docs not rat ave cetera-L that it is responsibility to notify the oc pant the roqu' n T, be tuattceofaccnifratr`ofoccup ey, Signature Of Applicant Date Owner or authorized agent r b1tc-- All roof coverings to be Class "B"or better CITY OF CUPERTINO 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 35623018.00 DATE ISSUED. . . . . . . : 02,'07/2007 RECEIPT #. . . . . . . . . . BS000000410 REFERENCE ID # 07020033 SITE ADDRESS 21546 MONROVIA ST SUBDIVISION . . . . . . CITY CU:?ERT INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SH-(AM & INDIRA DAVULURU ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR LIC # *OWNER* COMPANY SHfAM & INDIRA DAVULURU ADDRESS CITY/STATE/ZIP TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------ ---------- ---------- ----- BTEMP FLAT RATE 1.00 62 .10 0. 00 62 .10 0. 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0. 00 100.47 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 103 UFER 304 ROUGH ELECTRICAL . CITY OF CUPERTINO 003� TEMPPOWER �UPEkTINO PERMIT APPLICATION FORM APN# 31 y 3— O, Date: Building Address: Owner's Name: Phone#: Contractor: Phone: License #: Contact: / Phone: Cupertino Business License #: Building Permit Info: Elect A CC)n h Job Description: Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING RECEIVED FED 0 7 2007 BY