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11050136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21180 GRENOLA DR CONTRACTOR:JAYACHANDRA B AVULA PERMIT NO: 11050136 OWNER'S NAME: JAYACHANDRA B AVULA 21180 GRENOLA DR DATE ISSUED:05/17/2011 O"'NER'S PHONE: 4088969089 CUPERTINO,CA 95014 PHONE NO: CJ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL� COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL NEW ELECTRICAL STOVE ON KITCHEN (commencing with Section 7000)of Division 3 of the Business&Professions ISLAND. REMOVE EXISTING SINK&PLUMBING,RUN NEW 220V, Code and that my license is in full force and effect. 40AMPS WIRE FROM PANEL&INSTALL DOWN DRAFT I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32628057.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: ~'""��-�� Date: r OWNER-BUILDER DECLARATION J I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). V� ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain [have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: � E Date:___��1 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of Hork's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, co- and expenses which may accrue against said City in consequence of the Lender's Address .g of this permit.Additionally,the applicant understands and will comply all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date. • Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32628057. 00 DATE ISSUED. . . . . . . : 05/17/2011 RECEIPT #. . . . . . . . . : BS000013469 REFERENCE ID # . . . : 11050136 SITE ADDRESS . . . . . : 21180 GRENOLA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JAYACHANDRA B AVULA ADDRESS 21180 GRENOLA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAYACHANDRA B AVULA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY JAYACHANDRA B AVULA ADDRESS 21180 GRENOLA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0 . 00 39 .00 0. 00 1BAPPLOTHE NO OF APPLIAN 1. 00 63 . 00 0. 00 63 .00 0. 00 1BCBSC VALUATION 4, 000 .00 1. 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 4, 000 .00 0. 50 0 . 00 0 .50 0.00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 .00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 187.50 0 . 00 187 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 187.50 VISA --------------- TOTAL RECEIPT 187.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION P[ADDRESS: 21180 grenola dr. DATE: 05/17/2011 REVIEWED BY: bobs. PN: BP#: "VALUATION: 1$4,000 rPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RMAP1 USE: I I PERMIT TYPE: WORK install new island electric stove top. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1BAPPLOT 1 # $63 TOTALS: $63.00 Mech.Plan Check "00 $0.00 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 0.0 hrs $42.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the Det or addn'1 in o. FEE ITEMS (hee Resolution 09-051 L- 71,10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 Work Without Permit? Q Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldgr Stds Commission Fee: IBCBSC $1.00 $39.00 1ADMIN SUBTOTALS: $148.501 $39.00 TOTAL FEE: $187.50 Revised: 04/29/2011 I 0`-7) 0 GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228 •FAX(408)777-3333 •building(Mcupertino.ong MISC CUPERTINO ®PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJE ADgAESs , APN# O= _ ONE [__ �,--�� E-MAIL STREET ADDRESS •' yy r CTTYkSTATE ZIP FAX % )t.,Y i iri f CONTACT N i P16,y_:15`�y t, (�- E-MAIL STREET ADDRESS ^y y CITY,STATE, ZIP ]� q FAX ❑OWNER ❑ OWNER-BUILDER OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N LICENSE NUMBER LICENSE TYPE BUS.LIC N COMPANY N E-MAIL FAX STREET ADDRESS CI Y,STATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN oTRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK --? --> .L t<t." till -e ct _� r�: i f c.t.. �� d � .: . 2L.4 Y1 TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu'di construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Dater SUPPLEMENTAL INFORMATION REQUIRED _ � , x 51 - ---- I IIiY iM!I -. WIN- — _cam,• - MEPMucApp_2011.doc revised 03/16/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333- buHding5cuoerino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE,.. DiRESSI.) Yl` i APN�r -�,t .T_ BP# lat OWNER NAME 1 OWNER A_DDRESS DESCRIPTIONOFWORK: C : We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 4 m 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an °Owner- Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. M 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 6 3 _3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. On 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. J�j`M 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. m 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. A'm 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OianeiBuilde•Form 2010.doc revised 04/14/10 9PI-9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. J�V) 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. M 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur . Property Owner's Signature: Date: ; (J ---------------------------------------------------------------------- ---------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): N eti<) f Project Location or Address: LU 6, .ir L' a 4� i�' L Fi t Name of Authorized Agent: /�-i' I ►-4�� i2 L N1"/V A-r-_ Tel No t-t - `� 1-Lt4 C C-' Address of Authorized Agent: � v�C� � C+ ^- �'� - �� - -i +C LL- I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: A) I i2-0 11� Gvi,nerBuilderFarm 2010.doc revised 04/14/10 From, 5/17/2011 Jayachandra B. Avula 21180 Grenola DR Cupertino CA 95014 To, City of Cupertino Building Deaprtment. Sub : Authorization to pull permits and call for inspections. I hereby authorize Parachur Ranga Mannar to pull permits and call for inspections on the property on 21180 Gre.nola Dr Cupertino CA. Any question feel free to call me at 408-896-9089. Thanks and regards Jayachan a B. AvuIa. t PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUpel'MN0 (408)777-3228- FAX(408)777-3333 •building aecugertino.org PROJE. tADDRESS� APN# a� OWNER NAME �` "1-L PHO _ ry t E-MAIL ADDRESS �G�l CITY, STATE,ZIP FAX MTJE9f APP CANT NAME PHONE FE= STREET DRESS (- CITY,STATE ZIP !1 -VFAX t'OCL lu ❑OWNER ❑ OWNER-BUMDER 15t OWNERAGENT ❑ comm croR ❑coNT AcroRAGENT ❑ ARaBTEcr ❑ENGDOM ❑ DEVELOPER ❑ TENANT w EXISTING USE(S); PRO SED USE(S): OCCUPANCY(S): TYPE OF PARCEL CONSTRUCTION: AREA: FIRE Y NWUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N SPRINKLERS: T I --i Existing Proposed Floor Area: First Floor: ` s.f. s.f. Second Floor: s.f. s.f. ._ � Garage s.f s.f. TOTAL: SX. s.f. Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N - -� Is privacy protection planting required for the project? Y N Governing Codes: 2010 California Building Code (based on the 2009 International Building Code) 2010 California Residential Code (based on the 2009 International Residential Code) I �=JgWas on the Uniform Plumbing Code)aged on thee 20 2009 Uniform Mechanical Code) 2010 Cal' Code(based on the 2009 International Electrical Code) 2010 C) ��de This set ol°oWCA if i "A#dita*aot>tstlFADde job site cGdpgrtiacsMudi7aipdt seddawful to make any char g s or alterations on sarne,or to deviate therefrom,without approval from the Building Official. Tho st-amping of this plan and specifications SHALL NOT be h�);d to wJ-rnit or to be an spproval of the violation 01 ary provisiuns of any City Orcainance or State Law. ev,�.� f d'S" . ProjectData-Residential.doc revised 03/09/11 c:. �_ N —h } N l�i1 t, v m cu m io O L9 u 1 t Su �'ti ali °+�I(i S�iy41�'WIW�IiW ij"',!il i i 1911 1i 111 it lii4il "IIIIVa�l�l�dl�h'14161h1d'llvll��f��IV�I�I��h�I�u�IVVII��di��III+I vw � � Aly' s (21 G,-k D-r atP-Q- C+I-vuD ma EL A i Lf A 1 1Ft l.Vy1 m 2m 4m 6m ys floor®planner