02010035-F CITY OF CUPERTIINO
BUILDING DIVISION PERMRT mVVR ATOR i Nm(DRr\nATT(d
N--
BUILDING ADDRESS: PERMIT NO.
10284 ORANGE AV 02010035
OWNER'S NAME: APPLICATION SUB DATE
. 'I KUMAR ATLURI B RANJ ET AL 01/09/2002
Nr HONE: SANITARY N0. CONTROL N0.
10
ARCHITECT/ENGINEER: PHONE 4 BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
REPLACING PERMIT #90411 O-jFEEIS IDUEI I I I
0 W zju
m INSPIiCI IONS DAT ITISPEC. TO ARRANGE INSPECTION JOB DESCRIPTION
a I CALL 717.3228 MONDAY-FRIDAY 24 HOURS
RESIDENTIAL:
H y z FOUNDATION/PIERS/H.D.S. 'JTJ(J BEFORE REQUIRED INSPECTION.JOB ADDRESS ElSFDWL ❑ KITCHEN REMODE)
zz S z AND PERMIT 4 ARE NEEDED WHEN PHONING. ❑ ADDITION ❑PLUMBING RE-PIPE
LIFER GROUND
❑ MULTI-UNIT ❑STRUCTURAL
Y — PAD/SET BACK-CERT
a a RESIDENTIAL_COMMERCIAL_OTHER_ MODIFICATION
3 a tV GARAGE SLABSIPREGUNITE ❑ INTERIOR ❑CHIMNEY REPAIR
HAZARDOUS F[RE AREA
t J 1'nI'R NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IMPROVEMENT ❑ SWIMMING POOLS
s ar ❑ BATH REMODEUREPAIR❑ DEMOLITION
q p UNDERGROUND/SLAB 1� �s ❑ YES If ycz-1 undersmnd that a Class A rootnstembly is required C1 OTHER
PLUMBING ��
Z ELECTRICAL
❑ NO Initial LC.B.O.4
o
a 3 TDO NOT 1T POUR FLOOR UNTIL ABOVE HAS B.E SIGNED COMMERCIAL:
EXISTING ROOF COVERING p NEW BLDG/ADDITION ❑ DEMOLITION
PLUMBING
Number of existing coverings O TENANT ❑ FOOD SERVICE
MECHANICAL IMPROVEMENT
ELECTRICAL To be removed To be retained O OTHER
FRAMING VENTS 3 O
'h 1NS ULATION
PLACE NO RUBFLOOR LINTIL ABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING
ROOF SHEATH/DIAPHRAM X47 EXISTING: PROPOSED:
PLUMBING 4J ❑ Built-Up Roof ❑ Built-Up Roof
TUBS&SHOWER PAN ❑ Asphalt Shingles ❑ Asphalt Shingles
MECHANICAL p ❑ Wood Shakes ❑ Wood Shakes
ELECTRICAUPOOL BOND ❑ Wood Shingles ❑ Wood Shingles
ERAMINGISTAIRS/E.EGRESS 13 Other(Specify) Other(Specify)
INSULATION/VENTILATION Provide I.C.B.O.Report No.
COVER NO WORK UNTIL,ABOVE H,AS BE-N S GN D Provide Mfgr,Installation Specs.
.EX']E 2IAL SHEAR./HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
E'XT'ERIOR LATH/W-SCREED
SHOWER LATH 017 A,9-
No mA F.OR PLASTER UNTIL ABOV E HAS B E SIGNED
S jq1
SCRATCH COAT \SEWERIWATER
TEMPORARY APPROVALS
OCCUPANCY na
o.'
FINALS
PLANNING 777-3308'
6 GAS TEST
V) IbRADE(PW.777-3354)
EIRE
HANDICAP
.® ELECTRICAL
®.UPLUMBNG
M$CHANICAL
ENERGY'
rq
.VISUAL'FINAL ONLY
BUILDING
0CC UPANLY Or BUD,DL*!G IS NOT PERMITTED
1'NTII.BL'IL.DIN'G FINAL.IS SIGNED BY BUILDING
1NaPEt`ruR, " CERTIFICATE OF OCCUPANCY❑
PRE-INSPECTION: PLYWOOD: IN-PROGRESS
INSP. DATE INSP. DATE INSP. DATE
'TEA'R OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE INSP. DATE
'IMnTF- MRIHIA APPRnVFn ACCFAR TO ROOF R HIAILIL RF fP RMIOfD E Dn FOR ONSPIEC COON
'CITY.CDKCUPERUN® -
BUILDING DIVISION FERMICUNTRACT®M NF®RMAT
4
BUILDINGADDRESS: PERMIT NO.
102.84.. ORANGE AV 02010035
OWNEWS,NAME:.,. APPLICATION SUB DATE
KUMAR ATLURI B RANJ ET AL 01/09/2002
PHONE: SANITARY NO. CONTROL NO.
0 cd ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
m
LICENSED CONTRACTOR'S DECLARATION
z N& Job Description
o z m[1 I hereby affirm that I am licensed under provisions of Chapter 9(commencing
t,` W is in fulSection re and of Division 3 of the Business and Professions Code,and my license REPLACING PERMIT #B0411 NO FEES DUE
is in full force and effect.
C 6 License Class Lic,#
Date - Contractor
�
Ehh O W ARCHITECT'S DECLARATION
J I understand my plans shallbe used as public records
ty Licensed Professional
000
o OWNER-BUILDER DECLARATION
y 1 hereby affmn that1 am exempt from the Contractor's License Law for the
following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to conxtrucl,,alter,improve;demolish,or repair any structure $236682
µh 'prior to its issuance,also requires the applicant for such permit to file a Signed statement
en
a that he is pursuantlicsed' to th prov,Lsions of the Contractors,License Law(Chapter 9
(commepcmg with Section 7008)of Division.3 of the Business and Professions Code)
erefromS Ft Floor Area Valuation
or that be is exempt Ih �aad the basis for the alleged exetnplipn.Any violation I '3 5 1 9 0'3 1..`0 0 •-
'of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty
of not,from than five hundred dollars(s500). APN Number Occupancy Type
101 — FOUNDATION
0,1,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 sole'(Sec.7044, 1192 — P 11 -
,Busmess-and-Professions Code:.Thc Contractor's License Law does not apply to an 10 3 — UFER Required Inspections;
_ 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 104 — REBAR
offemd 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 105 — ANCHOR BOLTS
improve for purpose.of`ale')' 106 — SEWER & WATER
03,as owner of the property,am exclusively contracting with licensed contractors to 2 02 — UNDERFLOOR PLUMBING
construct the project(Sec.7044,Business and Professions Code:)The Contractor's ,
License Law does not apply to an owner of property who builds,or improves.thercon, 203 — UNDERFLOOR MECHANI CAL
- and who contracts for such projects with a contractor(s)licensed pursuant to the.
Contractors License Law.. 204 — UNDERFLOOR FRAME
❑1 am exempt under See," ,B&P C for this reason 205 — UNDERFLOOR INSULATION
at
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
"- I hereby affirm under penalty of perjury one of the fallowing declarations: 302 — TUB & OR SHOWER
13I have:dnd will'mnintain a'Ccrtificatc of Consent to self-insure for Worker's 303 — ROUGH MECHANICAL
Compensation, as provided for by Section 3700 of the Labor Cede, for the 304 — ROUGH ELECTRICAL
- performance of the work for which this,pctmit,is issued. 305 — FRAME
❑Lhave'and will'mainlain Woiker;s CompensationInsurance,as required by Section 3 06 — HOLDOWNS
3700 ofthe'Labor Code,for the*performance of the work for which this perniil'is
Issued.My Worker s'Competisation inxurancc coiricr and Policy numbcr'are:
307 — INSULATION
r.
Carrier:.....,...-„ Policy . 308 .i— .SHEETROCK
No.:
CERTIFICATION,OF EXEMFTION FROM WORKERS .
COMPENSATION INSURANCE I"''' .. 30.9 `= EXTERIOR' LATH
(TRis section need riot be compietec7 if the permit is for one hundred dollars 3.10 .INTERIOR LATH .
(s100)orless.) 311 — SCRATCH COAT
I ccrtify'thal lin the performance'of the work for which this permit is*issued.t 313 — ROOF .NAIL .
shall'not employanyperson in any manner'so as to become subject to the Workers' `
Compensation Laws of California,Date_ � ----. '
501 — FINAL ELECTRICAL ENERGY
APPlicarit � .
NOTICE TO APPLICANT:IL after making this Ccnificalc of Exemption,you.should 502 — FINAL PLUMBING ENERGY
Z become subject to the Workers Compensation previsions of the Labor Coils,,you must 5 0 3 — FINAL MECHANICAL ENERGY
0 forthwith'comply with such provisions or this permit shall be deemed revoked. _
.� CONSTRUCIONLENDING AGENCY' 504 FINAL -BUILDING ENERGY
b ' I•hcreby affirm that[here is a construction lending agency for the'perfoiiimnce 505 — FINAL ELECTRICAL -
Tor
the work for which this Permit is issued(Sec.3097,Civ.C.)
A Lenders Name . p 506 — . GAS TEST ..
>eraera Address 507 — FINAL PLUMBING .
U-0, I certify that I have read this applicaiion:rad state that the above information is 508 — FINAL MECHANICAL
irr4 H correct.I agreeto comply,with all city and connly ordinances and state laws relating
0 U to building construction,and hereby authorize representatives of this city to enter upon 509 — FINAL GRADE
>, W Ire.above-menronedproperty for in,pectionpurposes.
. 510 — FINAL PLANNING
E.4 44; . (We)agree to save,indemnify and,keep harmless the City'of Cupertino against
�-g CO)' liabilities,judgments,costs and expenses which may in any way accrue against said 514 — F NA PD' I-L~ WORKS
U Z City in consequence of the granting of this permit. /
IUIPLICA NT UNDERSTANDS'AND WILL COMPLY WITII ALL NON!1101 Issued 2 i 0 .I� I L Date
SOURCE RIIGULAI'IONS.,"
Signature of,Applicant/Contractor r ' '' Date _ Re-roo
HAZARDOUS MATERIALS DISCLOSURE .. 04 — ROOF IN-PROGRESS
Will the applicant or future building occupant store or handle hazardous material Type of Roof
as defined by the Cupertino Municipal Code,.Chapter9.12;and the Health and Safety
Code,Section 25532(a)� : -
o ves. o Ivo All roofs shall be inspected prior to any roofing material being installed.
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
nonhazardous air contaminants:isdefined by'the Bay Area Air Quality Management
,istricl7 all new materials for inspection. Applicant understands and will comply with
over ❑No all non-point source regulations.
`1,iave"read the hazardous materialsjjrcquirements under Chapter'6.95,of the
California Helth&Safety Code,Sections 25505,25533 and 25534.I understand that
if the building docs not currently have a tenant,that it is my responsibility Ip notify,the
occupant of tae repuiroments which most be'met pr'ior to issuance of a Certificate of
°.uPalley' Signature of Applicant Date
Owner or authorized;gent. Da-j All roof coverings to be Class "B"or better
0 'E