06040156 CITY OF CUPERTINO
BmLDLrvculvlsloN PERMIT GO1�fTRAG, INP'YORMATION a
BUILDING ADDRESS: CANAAN INVESTMENT INC PERAAR No 06040156
18861 PENDERGAST AVE
OWNER'S NAME: PERMIT MUE DATE
SUDHARSHAN KADARYI 20902 FARGO DR 04/25/2006
ONE: SANITARY NO. CONTROL NO.
(408) 873-7575
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIEC( PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION
WF 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Deseri to
;Z9 wiNSeclion]gK1)af Division lofted Busnruand Rofcssiam Code.aed my licenxb
a<m, in full force and affect. 73 6 S INSTALL TEMPORARY POWER
L;eemx 1 3 Lie.« FNt MAY
Date canDECL l3 2006
ARCHITECTS DECLARATIONG �ug■■p
j z I understand my glom shall he used as Public records V��
Y L U �� fff��,
-or
p� Licensed Professil
�ona �
OWNER-BUILDER DECLARATION
y I herebyaRrm Nm I am czempt(tete dm DaOtrmlara IJccnx law far One
p O following ration.(Section 703 L5,Business and Professions Calc:Any city or county
<$�+ which rectums;a permit m construct.alter,imp on,dcmal"tsh,m regal,my structure - 1 O 00
Z¢i prior to its issuanc,ibo roquiaa the applicant for such perm;Oo file a signed sutemens
that he 4 licensed pursuant to the provisions of ane Connectors Li¢n¢Low(Charter 9 Sq.Ft. Floor Area Valuation
[1— (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
that he is eaempt therefrom and the basis fm the alleged eumpuon.Any violation of
Section 7031.5 by my apYlicaot fm a permit subjccu the applicant m a civil penally of er Occupancy Type
not more Nan fin nandma collar i(MW).
❑1,u owner of site progeny,m my employcu with wages u their sole compensadon,
will do the wort and the stmeame b notimendea oronered formic(Sec.TO M,Business
and Professions Cade:The Conuxmfs License Required Inspections
Law docs teme
t apply N an comer of q P
propvty who Wilds orimpraw dmmWn,and whodmssmh wort himfelforNrough hu
awnemployes,proHdcd prsuchimprowmmssammtieufcmli she oven.
however.We have
las
r Improvement I,mid within am yeti ofi mprove for
the ar mf
Wilder will rove Ne When of proving WI he ilia nm Wile m improv rte puryox of
ule.l. - -
❑1.u owner of the Property,am exclusively crowning with demand contractors W
consumer gas pmjen IS".70".Business and Professions Cmic:)The Conummrs L;-
cc=law does not apply m an owner of property who Wilds or impulses dbmmu,and,
who convects for such pmjecu with a contractor(a)licensed punuam W the Conu utor's
Luenm Law.
El 1 am exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under persatY of perjury one of da following dmbmdons:
❑Imam and will mainuinaCenificeteef COmemmxlf-insurtlmWOM1ersCompen-
sm.a.as provided far by Section 3700 of Ne labour Code,fm the No...of the
wants for which this permit is issued.
Q 1 haw and will maintain Worhers Compensation Insurance,u rammed by Section
3700 of Nc labor Code,for the performance of the work for which this permit is issueQ
My Workers Compensation Nsmance earner and Policy number am:
Carrier. TLh'<w, Polity No.: _
CERTIFTCA�EMP IONFROM WORKERS'
COMPENSATION INSURANCE
(This securo mod mlbeeompleted from permit b froom hundred dollars($100) r
loss.)
I ceNfy that in Inc perfomrsme of the work for which this permit is issued,I shall not
employ any person in my mmmerJ4Wbcco esub c Waft.,Campenudon
Ls of CalifomiL x 0WL,' .a h j
Applicant O Ce
NOTICE TO APPLICANT:If,after maball this CcolBesm of Exemption,you shrew
memac subjem to Ne Worker's Compensation provisions of Ne Labor Code.you muss
.J O forthwith comply with such provisions m Nu permit shall be deemed revoked.
Z o-' CONSTRUCTION LENDING AGENCY
ti
E~ hereby Whah thi Nemrciased(Sec.307.Ch.C.) for the Performance of t
the work rte which Nb permit b issued(Sec.3097,cif.C.)
ALeaders Nana
�z Leaders Address
U 0 1 mnify that 1 haw read this application and sate Nat the aWn in(orrmiun b
It, E' cowct-I agree to comply with all city and county ordioames and state laws relating W
0 Wilding consuunion,and hereby auNome mpmmntativ or this city to enter upon the
ahovcmcmioned property for cx,c ms which ms �/"��/�[Js/
F 0. (We)agree m An,indemnify and keep haran1e33 NC City of Capaltlao dgainsl
in comespue demons,cam and mpcnses which may in any way attrue gainsssaid City
U Zong Of this parmit.
APPLIICCANTeUN Uof da,NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EREGULATIONS.
Ili O }S 6 Re-roofs
Sigtwum of Applian✓Conuanor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuuue Wilding aavpantstme m handk haaardoms material
as&A ad by the Cupema.Municipal Code.Chapter 9,13,and Ne Health and Salary
code. 0Yes 255324)? )gNo
All roofs shall be inspected prior to any roofing material being installed.
Yes
Will Ne applicant or future building Occupant use eyumenr or devices which If a roof is installed without first obtaining P an inspection,I agree to remove
ip
emit havudms air canumu claimed efied by the Bay Arca Air Quality Management all new materials for inspection.
Mama?
❑yea ') Nu
I ban read the husammus m aerialsrequiremenu under Ch rmer6.95 of um CaRfao
nu Health&SafclYCada,Seeumu 35505,25533 mad iib.Itmhrsana Natribes Wilding
does tet cumen ly ban a mane Nat it is an,capem,hilily w noury Nes.,,upas or the
myui Is whim amt W met prior Wind.aril cemrteam of aro ay. Signature of Applicant Date
Ct /� 75 1A ����/61 All roof covering s to be Class"B"or better
Owner or mNoriud agent 'Date'
CITY OF CUPERTINO
lam 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37533026.. 00
DATE ISSUED. . . . . . . : 04/25/2006
RECEIPT # . . . . . . . . . : 34136
REFERENCE ID # . . . : 06040156
SITE ADDRESS . . . . . : 18861 PENDERGAST AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SUDHARSHAN KADARYI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ROSE
CONTRACTOR . . . . . . . : ROSE KER-DI MA LIC # 27800
COMPANY . . . . . . . . . . : CANAAN INVESTMENT INC
ADDRESS . . . . . . . . . . : 20902 FARGO DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 873-7575
*FEE 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
----------------- ------------ ------------------
CHECK 100 .47 2636
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
0 Torre Avenue
I sm
Cupertino CA 95014
m. Telephone(408)777-3228
CITY OF Fax(408) 777-3333
WUPEkTINO
Building Department
JOB ADDRESS:
PERMIT # 60
OWNER'S NAME: PHONE # K�,'- F 7 3 r
GENERAL CONTRACTOR:Ctc)LacL>t J7L L,19 -f/Ne,tf 21(, FAX # Sion- 3 /cF 2-
I
I am not using any subcontractors:
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 Signature bate
CI'T'Y OF CUPERTINO OWD4(� 15Cp
-7���
TEYiP POWER
SUPERTINO PERMIT APPLICA'T'ION FORINT
APN # Dater 1� o
Building Address:
oLet CuJ e. , e r�irw, C/-1 1'0
Owner's ame: L Phone #:
.�s�Tf Su
Conti tor: Phone: License #:
Contact: Phone: Cupertino Business Licen e#:
,s
Building Permit Info: ..L/7j— mu —tom , P np L, e V—
Elect [3-
f
Job Description:
Residential Commercial ❑
Cost of Project:
• X00 O c��- '
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•