06060239 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �N,=CRACTORINFURMATION ,;;
BUILDING ADDRESS: NATIONAL CONSTRUCTION REN rSTNO06060239
7610 HOLLANDERRY PL
OWNER'S NAME: PERMITISUEDATE
RAJEEV PASADS 1355 FILIPE ME 06/28/2006
Eu SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHrMCT/ENGINEER: BUILDING PERMIT INFO
B PLUMB - MECH
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0 0
�8'z LICENSED CONTRACTOR'S DECLARATION "
i 1 hemby affirm that I am hemmed under previsions of Chapter 9(mmmencing Job DCSCCAIpVQ �vs.
with Section 7")of Division 3 of the Beat..atd Professor.Com,and my he.=is �s^
s rp �5.•:e.x
th Lice WC11 MesrrmL R INSTALL TEMPORARY POW\�R- POLE' �0�6
n�Z Data Cl honed
p,p Date — — Conlrenar l
700 ARCHITECTS DECLARATION }lg
I rwon shall nd my piII sed s public rermcn ✓
unde
-G Licenced Professional
vt� Oat I rem cmp(frILDER un the C DECLARATION i
1 Meshy affirm
that I em esempt from the C.vutafs License law for Mm } G
a o fallowing Mason.(Section 7031.3.Business and Profemirnd Cade:My city or county YYY
which requires a permit m convect,tier Improve,mmallsh.or repair any sweture $350
prior to its issuance,also requires the aappplicat for such permit to flit a signed sutemem
�< Nat he la licensed Power,to Me pmvlil is of the C.uamur's limos Law(Chapter 9 Sq.Ft. Floor Area Valuation
3 (commencing with Scotian 7W)of Division]of the Business orb Pmfusiand Cade)ter
that he Is aampl therefrom and Me basis for the alleged eaareption.Any violation of
Seed.7031.3 by arty applicant for a Permit subjects the applicant to s civil smoggy of h u WE Type
not mom due live ha Bred dollars(88004
0 1,as m.of the property,or my employees with wag.as Met,tale mmpe.ation,
will do the work,and the structure u not intended or offered for We(S..70x,Business Re uired Ins ections
and Profession,Code:TM ContmcmYs Liam¢Law dos rem
t apply to an orer of q P
property who buildsorimpmvs Mmrmn,and whadoessuchwarkhlmaelfm through his JULown employ.,provided tMtsumesu
ch irepneveare or
not intended olfernd fm sale ff, 1006
however.Ne building or improvement is said within am your of eamplation.the awrcr• U
builder will have the bunders of proving that M did not build or imprse for purpose of
akJ'
0 1,as mer of the property am exclusively contracting with licensed cnnuamnra to
camsLa IM does
(Sec.in aA,wner of and property
who
Cadei The C.tnnufs LI- '�/CCCIII
eros law does rotchply a an Owner of property who build at improves Mmmms.and
whocontractsLacs for such projeN with a contracurDl licensed punwnl ro the Gnuacnnh
L'ecae law.
❑lore esempt under See .fid PCfm Nis rrss.
Owner Dau
WORKERS COMPENSATION DECLARATION
I Mreby affirm under penalty o(pcqury am of the following declarations:
1 ham and ode for by
echoes 3 u of C e Labor Code,for fmWmaeYa Camp de,
wtion,a provided for by Suction 3700 of the labor Code,far Mm pertermenm of Mm
work for which this permit is issued. ,
0 1 have and will maintain Workces Compensation Insurance,s required by Sachem
3700 of the Labor Cade,for the pertmmance of the work res which situ permit is I"'1
My Wartime.CampemaMon ffIn�,kurenga carior and PoBry number art:
Cartier.��!1C OV tM Policy No.:
CERTIFICA OFEXEMPTIONMOMWORKERS'
COMPENSATION INSURANCE
Cnaisstemion mad solid completed BMan permit is froom hundred dollars($100)
or lea)
I certify thus in the perfoon V of a work r whip Nis permit u Wood.l shall cat
employ any pchum in ay marc u m 'emu the Workeri Compensation
Laws of CallfomlL Dau
Appal m 4449
NOTICE TO APP ,afy making this Cedifrc rte of Exemption,you should
bmome abjml
MOW!
ompendation provisions of the labor Code you most
.J 0 mW forthwith comply with such provisions or this Permit shall be deerevoked.
Z CONSTRUCTION LENDING AGENCY
'f+ Ihereby M.don there u a condensed..lending agency fm Me pesformarce of
a.�. Mm work fm which this permit is issued(Sec.3097.Civ.C.)
W Leadch Name
0 Z lenders Address
V O I gangly that 1 have rod this application and sum the Me above information is
W F CormCL 1 agree to comply with all city and county oNinaacei md,ate laws elating m
0 Ubuildingconswcrion,and hereby authome mpreemutives ofthis city to enter upon hate
W shove-mcmirned property for impaction purposes.
6, (We)agree to arc,indemnify and lamp harmless the City.(Cupertino against
v<fA liabilitkajudgmenu,cmu adespenaes which mayin.ywayamoo againslsid City
U,Z in eo.egucme of the i, do of this permit "
APPLICANT UNDER A D WILL COMPLY WITH ALL N-POINT Issued by: Date
SOURCE REGUfI A NS. , ,Q`
Slgneumof AppI 11iC sacmr `D(ata Ob Re-roofs
( HAZARDOUSMATERIAISDISCLOSURE Type of Roof
Will Ne applicant or future building occupaleam or handle haamos material
as defined by Me Cupertino Municipal Code,Chapter 9.13,and hate Health and Safety
Cam,Sem.y533Z(g7 All roofs shall be inspected prior to any roofing material being installed.
41 0Yes yNo
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applia.t.r fJJwm building Occupant arc eq.ipmesl Of.rims Which '
emit haardnus air c.tuoi.nts s defined by the Bay Area Air Quality Management all new materials for inspection.
District
Oyu u
I have read lid hux metedels mquiromenu unmr Gapter6.93.(the Gli(om
nu Hcelth&Safety Code,$, m7]303.213ll am12533a.l undcmaM dWl(Me building
does not curmnM u L tl t h 6 my rupomibilitY m notify Mm occuPa of M/s
myuirtmcn mhmu c • o issuarccofaCenilkateaf0 ucY of7 Signature of Applicant Date
owner .it ori rad egcnl Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
. j + Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDREy��Srr: PERMIT #
v H `cznc�� Cbt Fj o 6a Z� y
OWNER'S NAME: a Ca4PHONE # ( o Z8'p o
GENERAL CONTRA OR: mng 1 4s Yu FAX #
I am not using any subcontractors: o y�
t tune Date
Please check app licable subcontractor d com"lete 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 Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36229005 . 00
DATE ISSUED. . . . . . . : 06/28/2006
RECEIPT # • • • • • . . . . : 35061
REFERENCE ID # . . . : 06060239
SITE ADDRESS . . . . . : 7610 HOLLANDERRY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RAJEEV PASADS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FANG MING SONG
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------- --- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
--- ------ ---------- ---------- ----------
TOTAL PERMIT 100 .'47 0 . 00 100 .47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 100 . 47 MASTERCARD
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO-1(7�
TMP .POWER
�UPERTINO PERMIT APPLICATION FORINT
APN# �2- '2-9 _ 00D Date: G
Building Address: -7 /o v-y
Owner's Name: RA J 0, FOS f Phone AFD S
Contractor: NcuTi a Not 1 cetis 1 Y td. Phone(/i p8)2 2-7&-vg-p_ �o-v License#:
,: Pv� lT
Contact: .51Phone: Cupertino Business License#:
Building Permit Info:
Elect,
Job Description:
Residential Commercial ❑
Cost of Project: n f
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•