08120003 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT 94CO1VTRACT URMATaIQOr
BUILDING ADDRESS: PERMIT N0.
10316 TONITA WAY SRIDHAR P
OWNER'S NAME: PERMIT 156 UE DATE
NE:
A CONTROL NO.
ARCHrTECnFNGINEER: BURRING PERMR INFO
BLDG ELECT PUIMB MECH
.Op LICENSED CONTRACTOR'S DECLARATION
heJob Description
rd U F 1 hereby earn Nat 1 un limited ed under Provisions;of Chapmr 9(commencing I)
tS7 with Section](KMI)of Division 3 of to Business and Professions Coda.arW my license is
n�a imfull force and effect. SVC ENTRNC CABLE REPAIRED BY PG&E; MAIN PANEL TO
j2 License Class Lic.g
;i- Dam Conlramar BE INSPECTED BY CITY
eARCHITECTS DECLARATION
usV I understand my places shall be used u public records
g G< Licensed Professional
a70J OWNER-BUILDER DECLARATION
i F 1 hereby,IE.that 1 am exempt from the contrumh umse law far the
i p O following meson.(Section 701.5.Business and Professions Code:Any city or county
which requires a permit to eonsuuet.Won.Impmw.demolish.or repair any structure
prior to its issuance.size requires the applicant for uch permit o rile a signed Maximum
pp <
tax haislicensed pumanttoftprovisions ofdo,Comncmr'sLixuram Law(chapter 9 Sq.FL Floor Area Valuation
Y�$ (commencing with Section 7")ol'Division 3 of the Business and Promas(ons Cah)m loo
Nat he u exrmpt therefrom and the basis for the alleged exemption.MY violation of
section 70313 by airy Applicant for a permit subjecu the applicant to•civil PrealtY of APN Number Occupancy Type
trot roam ther five hundred dollars($wm 35915001 . 00
❑I,uawncr of do proptmy,mmY wplays with wagesastic'v Mak compewtion,
will do the work.and dics4umum is oat kmndw or Offered faraak(See.]We.Busircss Required Inspections
and Progm cssiaCade The Contractor's Liaise Law does WE,,ply te an owner of q P
property who builds or improves thercon,and who ds such work himself car through his
Own employs,provided that such improvements are not intended oroBcred fmsale If. .
however.the building m improvement is sold within ou year of complation.the owner.
builder will have the buNea of proving Nat he did Out build or improve for purpose of -
s+k.).
al.as owratr of the property,w exclusively contracting with licensed morman s to
mvuua the pmjm(See.7044,Business and professions Cade:)The CoolracWs U.
mese Law dens not apply to an owner of pmpcny who Wim,or improves therein.add.
w ho contra cu nor such pmjees wits a contraxer(s)license d ptmusnl m tiro ContrxwYs
Luce"Law.
❑I oro exempt under Sm1- ,B k PC for Ws moan '
Owner i nk�/ Date /Z/d 0p' _
�O�f ERS COMPEIfSATON DECLARATION
1 Maeby aim uwer Nns ty of perjury oro of the folkwing dw]widors
I haveaw Wl mainuin•Cert)Leaf Conscnttoself-inwrefar WorkersCmmprn _
tion,
work for r provides fpe by section 3]00 of the tabor Code.fm the performance of dm
which Nb permit is issued.
0 1 have and will maintain Workers Comp etsatian Insurance.as requited by Section
3700 offt labor Code,for to perfomanee of the were for which this permit is issued.
My Workers Compensation Wonnce carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thbsewm need mtbecompkvA ash permit is roomhuwreE Wait,(SIM) .
or has)
1 cutih Nat in the performareo or the wort,for which this lemic s mumd.l shall cwt
employ any person in any man rs to become subject mthe Wahers'Cmnpentaid. -
Law,or California.Dam
Applicant �q
NOTICE TO APPLICANT:r: ofcr mal b Cenifiam of Exemption,you should
become subject to the Woh s Compunkfio t provision of the labor Code,you mus
.J z faMwith comply with such provision Of Nb permit shall bo deemed rooked.
z2 CONsTRUCnON LENDINGAGENCY
[-n 41hercby,Dim that dem ice,couuusctinn heading agency for the pecumancea
rt> dm were(W which this Permit is him!(Ser.3097,Civ.C.)
A lenders Name ,
z Lenders Address
V Q 1 comfy Nal I have read this application and seam that the show inrormadma is
cone i-I agree m comply with all city and county ordinances and tau¢lava rtladng m
-C) building convection,and hemby autswce mpmsenutives of this city to emu upon the
W above-mandoned property for inspection purposes.
L1r (Wes)agree to.sve,indemnify and lamp hmmlm the City of Copesino agarol
(n Iiabilides,judgmens.caw itesp:nsea which may tarty way aecnmagaintseid City
U z in eonsagocame of the granting of this permit
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCED U ONS.
el�:4 12�p e8 Re-roofs
Sign iApplican✓C r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliesnt m future building occupanlstate or handle hauxamn material
as dented by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code,Scotian 25532,)7
❑Yes 03ao` All roofs shall be inspected prior to any roofing material being installed.
Will the applicantre drea
or future men use spawuipnmnl or devices w'hi.it If a roof is installed without first obtaining an inspection,I agree to remove
It hv=w airconumimna,as derimtl by the Bay Ames Air Quality Management all new materials for inspection.
suict7
❑Yes 4]No
I have mad the hamrd.mucrials re,eiremadaunder Chapter 6.95 of the Calimr.
nice Hui"SafeiyCodu.Stolons 25505,25533 and 25534.1 undersand Waif the Wilding
ds net currently have a lensne Nm It is my responsibility m nedfy tha occupant of de
requirements which mus me ' rtoissuancc or,Cutifium or cep Signature of Applicant Date
F.—M,or axo mac ase Dam. All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
•
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35915001. 00
DATE ISSUED. . . . . . . : 12/01/2008
RECEIPT # . . . . . . . . . : BS000006709
REFERENCE ID # . . . : 08120003
SITE ADDRESS . . . . . : 10316 TONITA WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SRIDHAR PALLA
ADDRESS . . . . . . . . . . : 10316 TONITA WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2932
RECEIVED FROM . . . . : SRIDHAR R PALLA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : SRIDHAR PALLA
ADDRESS . . . . . . . . . . : 10316 TONITA WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2932
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE 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 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 82 . 08 DISCOVER
---------------
TOTAL RECEIPT 82 . 08
0003
aln CITY OF CUPERTINO
CITY OF
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # v 0
Building Address:
l0 3r6 /op"ta- wQy CN�as firro
Mailing Address (if different from building address):
Owner's Name: d P.4, Phone#: k d8' 4 D 6, 50L6
Y�
Contractor: Phone:
Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
• Residential Commercial El
Job Description: Sarv:C� czA41r�YLc-,1GC,6ki-
�Cf-e hQ 1nf.0eca e�
Building Permit Info:
Bldg ❑ Elect E3— Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IVIII/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
11(90
Project Size: Express E2-Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan sett& the sheet index.
Points Achieved:
• For help, contact Build it Green at www.buildit reen.or
Revised 10/20/08
CITY OF CUPERTINO
CUPErZTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B •