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CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�leiT4CTORIOItMT�ON
BUILDING ADDRESS: PERMITNO.
18930 NEWSOM AVE SUNSTAR SUNROOMS 07110028
OWNER'S NAME: PERMIT ISSUE DATE
SRINIVAS VADHRI 2748 WILLOWREN WAY 12/20/2007
PHONE: (925) 931-0739 SANITARY NO. CONTROL NO.
ARCHiTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a 0 0 0
O p LICENSED CONTRACTOR'S DECLARATION
U3 p 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
<a with Section 70(10)of Division 3 of the Business and Professions
CoCode,and my license is ADD SUNROOM
.'y in full force and effect. u Z 3
F-p .0.E
�� License Cl Lie.N -
Date � 0 O Contractor ✓A C ^/ n Myr^
a ARCHITECTS DECLARATION
re a 1 understand my plans shall be used as public records
A U _
Licensed Professional
y OWNER-BUILDER DECLARATION
j<g I hereby affirm that I am exempt from the Contractor's License Lew for the
00 following mason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
—y prior to its issuance,also requires the applicant for such permit to file a signed statement
z�-
_� that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor AreaValuation
Z t—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $32441 32441
e R R that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 4p Number Occupancy
not more than rive hundred dollars(M). 3 7 5 3 5 010`�7 p y Type
❑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
and Professions Code:The Contractor's License Law dors not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employers,provided that such improvements are not intended or offered for We.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.).
[11.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
sense
❑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:
k;J nave 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 is Labor Code,for to performance of the work for which this permit is issued. '
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califorgj2// /
Applicant --
NOTICE TO APA Y,,If,ancr ifiaking this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Q
z CONSTRUCTION LENDING AGENCY
..
[-r ►+ I hereby affirm that there is a construction lending agency for the performance of
LY. 5 the work for which this permit is issued(Sec.3097,Civ.C.)
❑ Lender's Name
Z Lender's Address
U 1 cenify that 1 have read this application and state that the above information is
(y correct.1 agree to comply with all city and county ordinances and state laws relating to
0building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
h.q t4 liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date 2
SOURCE R =.,
Z2120 Re-roofs
Signature of Applicant/Contraetor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hayardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes EM_
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove
emit haiardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently hake a tenant.that it is my responsibility to notify the occupant of the
requirements which m met 'o an f a cerrifirate of Occupancy Signature of Applicant Date
'�'" ( z o All roof coverings to be Class"B"or better
.cd
Owner or authori agent Date g
W7 bong
CITY OF CUPERTINO '
��noF PERMIT APPLICATION FORM
CUPEkrINO
APN# Date:
35- 0/0 //LI/to z
Building Address: Mailing Address if different from building address):
Are.
Owner's Name: Phone #:
?- q3/— z
Contractor: License#:
un +ar .0m5 70,5,-7-/3
Contact: Phone:6S0- 7Zz-2_36/ Cupertino Business License#:
Arl )rn.L' r Fax -36y-o q'7'.;I,
Building Permit Info:
Bldg L� Elect Plumb ❑ Mech ❑
Job Description: tv .T) S
Residential P' Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
/6,
Dao
Type of Construction: Please check this box if the project is a
VAI second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax -Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
Community Development
" 10300 Torre Avenue
IS
"! Cupertino CA 95014
Telephone(408)777-3228
CIR OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
Mia 0-7 00-Z OC----
OWNER'S NAME: ,<� �/� PHONE # 4.5^®-7.2-�-a34/
GENERAL CONTRACTOR: , W-4 S FAX # 6-S-0-30- 0<132
I am not using any subcontractors: 2//AA=,, Z
A;7
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor 901inature Date