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08030152CITY OF CUPERTINO ON BUILDING DIVISION PERMIT C01id,"GT.OR INFORMA V But Lp1%'?DR`s;kXDLELIGHT WAY NATIONAL CONSTRUCTION PEAMTT NO. 08030152 ER'S NAME: PERMIT ESUS DATE RATHNAGIRI ARUNAGIRI 15319 CHATSWORTH ST 03/26/2008 PHONE: SANITARY NO. CONTROL NO. (818)221-6057 ARCHITEC (ENGINEER: BUILDING PERMITINFO BLDG EIJ:CT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Ot5SCr1p Ib Description I hemby affirm out I sm Ikmnsed under provisions of Chapter 9 (commencing with Section 7011th of Division 3 ofthe Business and Pmlcssinom Coco, and my licenses TEMP POWER in full fore am efmct. �/ O 1.4 Liven 1 s �/ I3c. If Ji" Ci Dam H— C'S c/ ARCHITECTS DECLARATIOI DEC 1 understand my Focus shall W sed as public mcords Licensed Professional OWNER -BUILDER DECLARATION I hmby affirm that I am exempt from the Contractors License law for the following reason. (Saxon 71131.5. Burineas and Pmfevinm Code: My city or county which ou irea a Permit to commuca slur. borrow. demolW, or minor any structure Fror m its issuance, slam requires the applicant forsuch permit m file a signed statement I.licensed to lit on Of the Contractor's Liana law(Charter 9 Sq. Ft. Floor Area Valuation this h pursuant povisi $500 vtd (commencing with Section 7000) of Di.n 3 of the Bust. and Pierruimu Cade) m that he s themrrand exempt om the bull for the alleged exampoon. My I.Imlun of 3 6 2 2 4 0 5 4! Number Occupancy e P y TYp Scotion 7011.5 by arty applicant for a permit subjects the applicant m a civil penalty of tel mom than fico hundred dollar (55018. I, u owner of de property. or my employees with wages as their sok compensation. Required Inspections will do mo work and the shucWm s mi intended or offered foreale(So.. 70th, Business and P Ixosl.ns Code The Contractor', License Law it. not apply m an owner of q p property who builds orimpon. therson,a d whodoe.mch work himself., thmuyh his Own employ=. provided Nu such improwmens me not immmmoRemd formic. It. however. the building or improwmcot Is sold within one your of completion. the Owner. Wilder will haw the Widen of proving that he did not build or impaow for purpose of ' us.). ❑ 1. as miner of on properly. am exclusively contMing with licensed contracwa to tax" oct the project (Sec. 7(u0d, Business and Promotions Code:) file Contractors U. come law does not apply in an owner Of property who builds or improves menton. and. . who contracts for such pmjecta with a contnaor(s) licensed pursuant in the Contractors . Licence Law. ❑ lameammptunda Set .B&PCforthtsmasson 10-1 —Dan- WORKER'S COMPENSATION DECLARATION 1 hreby airline under penalty of perjury mm orthe folowing decimiciame: ❑ 1 naw and will maintain. Cenificom.f Covent m self-luum rte W.rkeraeompen- salon, as provided fm by Section 7700 of the labra Code, for the perfomsatne of the . . work for which this permit is issued. ❑ 1 haw and will maintain Wmtrra Compensation Iuursnm, as required by Soction 3M.f 0m labor, Code, for me: performance of t e work for which this permits Issued. My Workers Compenau.n Inarmce ani. and Polity number am: Cacrkxip �� sw wt, Policy No.:/S zgo20�t CERTIFICATE OF EXEMPTION FROM WORKERS . COMPENSATION INSURANCE (Thitsectim teed rot h completed If tit pmmtit is forme hundred do0as (SIM) of WIL) 1 cenffy that in the perf cumn. of the work fa which this permit s issued. I Nall Out employ any porton in any manrcr an as m become subject in the Wori Compenudm Laws of Calif.mia Due Applicant NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should become subject to Ne Workers Compensation provisions of me Lahr Codc, you most foMwith comply with such pmvisimu or this permit shall be deemed my.ked. I CONSTRUCTION LENDING AGENCY 1 hereby alRrm Nat Nem is a construction lending agency for the perfmmmee of the work for which this permit In Issued (Sec. 3097, Civ. C.) ' lander', Name Undoes Address ' j I coolly Na 1 haw mad this application W sum that the above infommadun is ' conceit. I agree to comply with all city and county ordinances and awe laws misting in Wilding conswction, and hereby authurm mFreacouti ra or offs city in cue, upon the ( shove-mendoml property fm impaction Phomncu (WO) agree to saw, indemnify and trap harmless the Cly of Cupertino aylesl j Iiabilitiea,Judgmenu,emu mdcxpensea which may my way acmue gainstaid Gryin conson,tence of the i APPLICANT UNDERSTANDS ANranding of thin D WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATION 3 ��— C Re -roofs Type of Roof Signnumo ter D HAZARD SMA AIS DISCLOSURE Will the appliantm(u reWlld ocoupmtalam.rhmdie hewdoamateritl defined by Oe Caperton Mu Code, Chapter 9.13, and the Health and Safety Section 255324r All roofs shall be inspected prior to any roofing material being installed. QYes .." / If a roof is installed without first obtaining an inspection, I agree to remove Will the aMlicmt or fumm Wilding oaroPam use equipment in tmvlm which emh hovallonsair enured 0 defined by tit Bay Ama Air Qualify Management all new materials for inspection. District ❑Yea No Ihawmaldmhun wsmamrasmquimmenuundcr. Chapmr6.95ofthe Califor. nia Health & SafctyC.de Secures 25515.35533 md25534.I undersand mu ifthe Wilding dons not curmn0y hew •trema Net It s my neaponsihility m ratify the Occupmt of Nc numimmcnu which met prior to Issuance Ora Cortirmam ter rpm Signature of Applicant Date 3 All roof coverings to be Class 'W' or better Owneronul.Nada Dam' ® CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT is • Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36224054.00 DATE ISSUED.......: 03/26/2008 RECEIPT #.........: BS000004275 REFERENCE ID # ...: 08030152 SITE ADDRESS .....: 1197 CANDLELIGHT WAY SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER RATHNAGIRI ARUNAGIRI ADDRESS 1197 CANDLELIGHT WAY CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: MARTHA S P KANG OPERATOR: patg COPY # : 1 CONTRACTOR .......: NATIONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY ..........: NATIONAL CONSTRUCTION RENTALS ADDRESS ..........: 15319 CHATSWORTH ST CITY/STATE/ZIP ...: MISSION HILLS, CA 91345 TELEPHONE ........: (818)221-6057 FEE ID UNIT QUANTITY ----------------------- AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BSEISMICR VALUATION -------------------- 500.00 0.50 0.00 ---------- ---------- 0.50 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1ERT<200 UNITS 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 --- --------------- 122.87 0.00 ---------- --------- 122.87 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD -------------------- 122.87 VISA --------------- TOTAL RECEIPT 122.87 ... VOICE ID DESCRIPTION -------- ---------------------------- .... VOICE ID DESCRIPTION 402 TEMPORARY POWER -------- ---------------------------- INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: patg _ Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36224054.00 INVOICE DATE......: 03/26/2008 REFERENCE ID # ...: 08030152. SITE ADDRESS .....: 1197 CANDLELIGHT WAY SUBDIVISION ....... CITY .............: CUPERTINO .' . IMPACT AREA ....... OWNER ............: RATHNAGIRI ARUNAGIRI ADDRESS ..........: 1197 CANDLELIGHT WAY CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR .......: NATIONAL CONSTRUCTION RENTALSLIC # 22537 .. • COMPANY ..........: NATIONAL CONSTRUCTION RENTALS ADDRESS ..........: 15319 CHATSWORTH.ST CITY/STATE/ZIP ...: MISSION HILLS, CA 91345 ' TELEPHONE ........: (818)221-6057 ®FEE DESCRIPTION_____ DUE FOR AMOUNT DUE PAID BALANCE --------------- ------ ------------ ----- SEISMIC RESIDENTIAL PRINTING PERMIT 0.50 0.00 0.50 ELEC PERMIT ISSUANCE PRINTING PERMIT 40.790.00-7A\ RES TEMP POWER <200 AMPS PRINTING PERMIT 40.79 0.00 40.79 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40.79 0.0 40.79 ----122 87 ------0- 0 ----122.87 VOICE ID DESCRIPTION VOICE ID DESCRI TION ----------------------------`------------------------------ 402 TEMPORARY POWER -------- L F, L SIM - CITY OF CUPEkTINO CITY OF CUPERTINO TEMP POWER PERMIT APPLICATION FORM APN # Date: Fee Description Fee Group Building Address: tl/ % Res. Temp Power >1K Owner's Name: Phone #: 4�5 Z� Contractor: Phone #: I—oP00-352. 56,33 �o.J/dG CAN%�vC%�,inJ .eC�,aG / 1 ERT<200 Fax #: Contact: Phone #: Contractor License #: ,Cupertino Business License #: Job Description: IERT2001K Res. Temp Power 200-1K Residential Commercial ❑ Valuation (cost of project): S00 Quantity Fee ID . Fee Description Fee Group Permit Type IERT>1K Res. Temp Power >1K E 1REAP14 Amps / 1 ERT<200 Res. Temp Power <200 E Amps IERT2001K Res. Temp Power 200-1K E Amps / 1 EPERMITFE Electric Permit Issuance E lELCPLNCK Electric Plan Check E / 1BSEISMICR Seismic Residential B CITY OF CUPERTINO aTEMP POWER OCUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 IECT<200 Commercial Temp Power <200 Amps E IECT>1K Commercial Temp Power >1KAm s E IECT2001K Commercial Temp Power 100 -IK Am s E 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B i 0 E Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 11119? c��lzL�G� w� - PERMIT # O X636) S-- --- OWNER'S NAME: /?4gn//9G'm2 PHONE # 390 45 z4!5 GENERAL FAX# 5 I I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner frac r Signature 3g6� Date 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 frac r Signature 3g6� Date