08100096 CITY OF CUPERTINO
RUILDIWI DIYISIRN PERMIT CdSNTItACTfJR IN1+'OR�V. IATION
BUILDING ADDRESS: - PERMIT NO.
11331 BUBB RD TBD - TO BE DETERMINED 08100096
OWNER'S NAME: PERMIT L$UE DATE
RAJU GOTTUMUKKALA 10/16/2008
NE: SANITARY NO. CONTROL NO.
ARCHrTECOENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 t�
Ire,
LICENSED CONTRACTOR'S DECLARATION
m 1 hereby.Hum that I am licensed under provisions of Chapter 9(commencing Job Description
with Section'!0(10)afDivision Sof the Badness and Profession Cad,and my lie=s COPPER RE-PIPE FM MAIN WTR LINE(@CURa)TO THRUOUT
in full force and erfout
j�Z Licemc Clan Lk.• HSE
F Dom Contractor
eARCHITECTS DECLARATION
Y l understand my plans slWl o used as public records
Zen
a l—n Uccascd Professional
5 OWNER-BUILDER Ce cmuraON
I I bcrtby at"nn Nat I em exempt fromm the Convenors Lkenu Law for tirc
cc following reason.(Section 7031.5,Business and Prefessio o Cade:Any City or county
u3 ff which her ires a permit m eoustruei,aper,improve,demolish.or repair my structure
prior to its issuance.also requires the applicant forsuch permit to Ek aligned summent
ss Nat he is licensed pursuant mthe provisions oftoo ContmcmrsLi¢n a aw(Chapw9 Sq.Ft. Floor Area Valuation
yF (commeminj with Section 7000)of Division 3 of the Business and Profusions Code)or $5000
e g$ that he is exempt mumfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by IM appfieset for a permit subjects the applicant to a civil penalty of Number Occupancy Type
.or mum than five hundred dodos(m). 3 5 6 2 3 0 4 5 A
1,as owner Of the property.or my employees with wages u their=a compensation,
will do der work-and the shun.isnot intended or offered for ask(Sec.70$4,Business
and Pmfassiona Cade:The Convacmes license Law does not apply to an awaer of Required Inspections
pmpertywho builds orimpmves Neaten.and whodoessuchwarklumulf orthrough his
son employees.provided Na such improvement,are not intended reoffered for sale If.
however,the Wilding or improvement is mid within one year of completion.she owner-
W ilder will have the uaden of proving that he did not Mid m improve for purpose of
sale.).
❑I.as owner of the property am exclusively contracting wide licensed Muacmn to
cersmsct the prejeen(Sec.7W.Business and Professions Code:)The Contractors U.
cc=law does not apply m m owner of property who Wilds or improves Hereon.ami.
wive contract,for such projects with a contractor(s)licensed pursuant in the Conuacmh
License Law.
❑lemexemptunder .Sec. _ ,B&PCfor Ni mason
��---�`� l6 °Sy
Owner Dau
WORKER'SC MPENSATION DECLARATION
1 hereby affirm weer penalty of pe7my one of Ne fallowing declastimts
1 hsm ant will munram a cenifimesof Cont m tel(-insure fm workers Compw-
ion,as provided for by Section 3700 of dee Labor Cade.fon the performance of tie
work for which Nu permit u isnN.
❑I have and will maintain Workers Compensation Insurance,u rryviud by Section
3700 of the UW,Code,for the preformance.fthe wart for which this permit is issued '
My Workers Compensation lmm=carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu orlon need rot ocompleted Hthe permit is fororo hundred&Ilan(5100)
or leu)
1 certify,Nm In the Mr..of the work for which this permh is iaucd,l"I her
employLavmo cafirsmis inanY mannerm tp the 6 rs'Cempensauon
Laws of Caifomia Dae
Applicant
NOTICE TO APPLICANT.If,Con making this provisions
exm of ELemptio d you u mask
bucowi subject y it Workers Cmn s or this
n pmviuons of d r labor Code-you most
.,O forthwith comply with such Provisions m Nis permit shal o dttmed rerokcd.
,z.i y CONSTRUCTION LENDING AGENCY
[-+ Ihemby affirm don Nem is a wasuuctinn lending agency for the performamen of
a
the work for which this permit Is issued(Sec.3097.Civ.C.)
Q lenders Name
]Z lenders Address
U O 1 emtiry that 1 have mad Ws application and sum deo the move information is -
fy cone,l agree m comply with all city and county ardinencca and suer Iowa relating to
C) Wilding construction,and hereby authorise mprescnutives of Nu city m enter upon the
LU aove-mentioned property,for inspection purposes.
(Wc)agree to save.indemnify and acep harmless the City of Cupertino against
to Imbilitiu,judgmens,casts and..proms which may in any soy accrue against a to City
U,Z in comet uc.of the granting of this Permit. / a/
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l 'G7lLlz�vg
SOURCE REGULATIONS.
�>r--« it Re-roofs
Signature of App t ..bmcho k
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding orsupsearo re or handle hamadous materia
as dented by the Cupedim Municipal Cade.Chapter 9.13.tad the Heath and Safety
Code.Section No zss3z(.)7
UTu All roofs shall be inspected prior to any roofing material being installed.
�
If a roof is installed without first obtaining an inspection,I agree to remove
Will the appWant or future Wilding occupant use equipment m devices which g
4 harabous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
t7
❑Yes �(Nu
1 have real the Msardaus maoriasre rthencnt,umkr Chapmr6.95of1M Caifor.
ni.Hcahb&Sacry Cada.Scnimu 25505.25533 and 25534.1 undcssnd thaiftha Wilding
does not currently have a a her,,Nm it u my responsibility to mdry the oeTupset or the
mgeirtmenu which mngW met Our m ismanecaf.Certificate ora 16 Signature of Applicant Date
or
All roof coverings to be Class° "or better
Owner or authomcd agent Dam' g R'
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMITRECEIPTOPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . : . . . : 35623045 . 00
DATE ISSUED. . . . . . . : 10/16/2008
RECEIPT # . . . . . . . . . : BS000006371
REFERENCE ID # . . . : 08100096
SITE ADDRESS . . . . . : 11331 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJU GOTTUMUKKALA
ADDRESS . . . . . . . . . . : 11331 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4941
RECEIVED FROM . . . . : RAJU K GOTTUMUKKALA
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---- --- ---------- ---------- ---- ---------- ----------
1BPWATER UNIT 1 . 00 40 .79 0 . 00 40 .79 0 . 00
1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
---------- -- -- ---------- ----------
TOTAL PERMIT 232 . 87 0 . 00 232 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- ------- ------
CREDIT CARD 232 . 87 AMEX
---------------
TOTAL RECEIPT 232 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------7- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
e
�(`D, CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
• CUPERTINO PERMIT APPLICATION FORM
APN# Date: G
3 O tJ�I 06
Building Address:
It 33J (S"6 cJi 9 sU t
Owner's Name: Phone #:
P—ASV GtoT-rUKU
Contractor: Phone #: 1, . 311• �� 13
Fax #:
Contact: Phone #:
�'_a,. C.•s Yb�- qu$' "llg• 4-72.3
Fax #: 5-1C 315. 2-9-34
Contractor License#: 7 O 6I r
Cupertino Business License#:
Job Description:
s. rnck , t.o Ac-, L--o- (o L- -L..
Residential Commercial ❑ (j
Valuation: Two
Project Size: Express Standard El Large ❑ Major El
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer.
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
r•
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
•
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
i 1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS - Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P o
1PLMBINSP Other Plumbing/gas Insp. P
j 1TRAVDOC Travel &Documentation Fee B
/ 1BUSLIC Business License B
Revised 6-16-08
0