07020034 77-777.77-7777777..
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
�aRAT+�x I�CRMTIf�I •
PERMIT NO.
BUILg1Nf'tgA$ESS:-ONROVIA ST SITYAM tt INDIRA DAVULURU 07020034
ti l 4 b M PERMIT ISSUE DATE
OWNER'S NAME:
SITYAM & INDIRA DAVULURU 02/07/2007
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
i no LICENSED CONTRACTOR'S DECLARATION Job Description
UF 1 hereby affirmthat I am licensed under provisions of Chapter 9(commencing
:z m with Section 7000)of Di'ion 3 of the Business and Professions Code,and my license is FILL P()O L— REMOVE EXISTING GROUND CONCRETE POOL
y in full force a e!f L
? License Q 1 le•
y 0,1
w
Date ARCHITECPSC S DEC r RA N
7 C< I understand my plans shall be used as public records
>yU
W y Licensed Professional
H OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
no following reason.(Section 7031.5,Business and Professions Cotte:Any city or county
`e m V which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior w its issuance,also requires the applicant for such permit to file a signed statement Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
F (commencing with Section 7100)of Division 3 of the Business and Professions Code)or $7500
u5§ 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 ofNumber Occupancy Type
not more than five hundred dollars(5500). 3 5 6 2 3 0�L 8 �
❑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
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.).
❑1,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 does 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.
Q I 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.
❑I 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 are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenify that in the porfo ante f c wor for which this permit is issued,I shall not
employ any pe b' to the Workers'Compensation
Laws of Cali
NOTITD APPLICA :1f,afur makin is flare of Exe you uld
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z"" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
LLl Q Lender's Name
Z Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
Lf~i'- corecL 1 agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize 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 and expenses which may in any way accrue against said City n
V Z in consequence a grantin of this permit. Date y
►' APPLICA N RST DS AND LL COMPLY WITH ALL N -POI Issued by:
SOU c TIO �,l
!/ Re-roof::
Signature of XplilicarittContragidr Dale Type of Roof
HAZA US MATERIALS DISCLOSURE yp
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupenino unicipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof shall be inspected prior to any roofing material being installed.
❑Yes Ar.."obuilding
Will the applicant occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes o
I ha v a hazardous materials requirements under Chapter 6.95 of the Califor-
nia He Safet odc,Sccd ns 25505.25533 and 25534.1 understand that if the building,
d t torte y have a ten t.that it is my nsibili[y to notify the cecup of tit
quireme which muni et prior to i e of a Certificate of Da cupan S ignatui a of Applicant
Date
All roof coverings to be Class "B"or better
Owner or authorized agent ate
CITY OF CUPERTINO
2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 3-F623018. 00
DATE ISSUED. . . . . . . . 02/07/2007
RECEIPT #. . . . . . . . . . BE000000410
REFERENCE ID # . . . : 0%020034
SITE ADDRESS . . . . . : 21546 MONROVIA ST
SUBDIVISION . . . . . .
CITY Ct'PERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : Sl:YAM & INDIRA DAVULURU
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : SlYAM & INDIRA DAVULURU
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPERMFEE VALUATION 7, 500. 00 147 .96 0. 00 147 .96 0. 00
BSEISMICRE VALUATION 7, 500. 00 0. 80 0. 00 0.80 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 148 .76 0. 00 148.76 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 249 .23 VISA
---------------
TOTAL RECEIPT 249 .23
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
704 DEMO
RECEIVED
FEB 0 7 2007
BY
_ CITY OF CUPERTINO
DEMO V103�
CUPEk INO PERMIT APPLICATION FORM
APN# S 15(P_23- O i S Date: 7
Building Address: _
Owner's Name: Phone#:
Contractor: ' , /� �rl 5 , /- License
Contact: r� Phone#:
Applicant/Contractor:
B Permit Info:
Bld Elect Plumb Mech
ob Description: /� ,,jj ,,
Residential: r—� �� L L 0-tw"0L e cl-KI_ rcij:
Sq.Ft. Floor Area: (_,j _ 501 $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUII.IDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG