08020141 CITY OF
CUPERTINO ' t»7:. wgdzx,Y:+i+fEa' `�1 .,x ,?` u
BUILDING DIVISION PERMIT � CUI�TTI2AC'IkI2 O�Rl�'TAxiE?1
BUILDING ADDRESS: PERMIT NO,
10265 RICHWOOD DR NATIONAL CONSTRUCTION 08020141
A'S NAME: PERMIT ISSUE DATE
GANESAN & PRABHA SRIRAM 15319 CHATSWORTH ST 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION Job Description
haffi
ereby affirm that 1 sm licensed under pormso mss of Cheaper 9(commencing
' wiLh Mclion7gg))afDividonloflhe uajnmwdProfceium Code.andmylkenseat TEMPORARY POWER POLE-1-100 AMP O/H METER FOR
�� m full rano end 0
DameseClaaa 't7GZa L Coo. CONSTRUCTION. '
ARCHr1EC`S DECLAPOkTION
q33 I understand my plans awl W used a public records
s Civ Licensed Pmfestlonal
3
OWNER-BUILDER DECLARATION
<1 1 hereby arra m that I em escarp,fmrs the Conuanah License law for the
COO following moan.(Seedon 7051.5.Business and Profnsaions Calc:Any city ar county
j g� which lequlma a Permit to cmauum,alter.Waw.demolW,or repair any urmu m
_Zi prior m its issuance.atm requires the applicant for such permit to rile a signed statement
pp < thathcislicetsedpurmantlatheprovisionsattheContranatr'slxenselaw(Chapm9 Sq. Ft. Floor Area Valuation
Y S (cournmeml wide Section 7(00)ofDivishmSofdoBusmassandPmfessiomCode)., $600
Q Nat he la attempt therefrom and the basis for the alleged exemption.Any vlolmma of
Section 70513 by try applicant for a permit subjects the applicant o a civil pend,'ofNumber Occupancy Type
am more Nan few handled dollars(5500). 3 6 9 0 8 04 6 Ae�
0 1,u Owner of the property,or my cnployms with wgu as Weir sok campensNon,
will do the wart.and the sacatre 4 no,inlendedororrared formal.(Sm.7044,Busiws Required Inspections
and Prof.m.Coda:Tin Confiscates License Lav does no,apply at an owner of q p
pmprnywha WIINorimprovumoemon.andwhodoessuN khimwtfwr ulh Ms
own employma.provided thatmeh improvementsam notinundW oroRered for sale.IL
however,the building or Mpm ement I.sold within one fear of completion,the owuer-
builder will have the burden of pmNng most he did not build or improve for purpose of
ask.).
0 1,u sorer of Irk property w eaeluaively cotuactieg With licensed conuamon be
construct th<project(See.7044,Busmom and Professions Cade:)The Coovacton s U.
cew law does not appy in an orc of property who builds or improwm damn,and,
who comncu for such projects with aeanuam or(s)Ikemnd puavant at the Canusetofs
Lim.law.
❑
[am
cpet mve
am ,under S ,B&PC for this an
r Dam
WORKER'S COM1`ENSA71ON DECLARATION
1 hereby alarm under penalty or perjury one of the fallowing decimations:
0 I have and will maintain•CcrtiOcea of Consent mulfdnsum for Work<fsCoarpen-
snion,a provided for by Section 3700 of the Labor Cade,for the performance of the
work for which this permit is issued.
I Ave and will maintain Walkers Compensation Insurance,u remained by Section
37 ofthc UA Code,forthepcdommeofthe forwhich Wupermi,atinad. '
'Werk os Co'mpfemNan buurance carti"and Policy nu berare:
Ceufv/!R.AYL P. No: ' (J�(j k12f/� 'Y, D7
CERT? CCOMPENXTIONI NFRO WORKERS'
COMPENSATION INSURANCE
(This section reed our becernpleted lathe permit is farom hundred dollars_(2100)
or less)
1«nify that in the Wfotmarm of the work for which this permit la issued.I shall nut
employ any Person In any manor u at become mbkCt to the Warken'Cmrommia0an
Laws of Califomla.Dan
Applicant
NOTICE TO APPLICANT.If,eller making this Cenlncek of Eaamption,you should
become monm at the Worker.Comps nNat provisions of the Labor Code.you mus
formwith comply with such Provisions or this Permit mail ba deemed mwkcd.
z M CONSTRUCTION LENDING AGENCY
Ilnmhy anion that there iso romWellnn lendingageeey Tor the pe,famsoccaf
C .� the work for which that Permit Is issued(Sec.3097,Civ.C.)
Dl� Q Leaders Name
Z) z L emice.Add.
U O 1 certify Wu I have mad this application and sum that We above information is
it, COMM 1 agree at comply with all City and county ordinancns and mute laws relating to
Wilding coavru tion.and hereby authonne representatives of this city at emer upon do
W ahove-mentioned property for Inspection Purposes
Py (We)agree at ave,indemnify and keep harmless tin City of CupcItino against
14 Iiabilidc,judgmenu.cmu and espmust which may In any way same against said City
U z in consequence of d loathing of this permit.
(CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
ULATIONS. L /L ��
Re-roofs
gnuurt a(Applicanl/Conuseatr Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tins applicant or future building ocoupantsore or handle haurdous material
dcnred by lie Cupertino Municipal Code.Chapter 9.13,and We Health and Safety
Section 13532(x)7
❑Yns All roofs shall be inspected prior to any roofing material being installed.
Will the applicant future building arsuPanl use cyvipmenl w Ikvkna which If a roof is installed without first obtaining an inspection,I agree to remove
..It Inummous air Conumm nans as dcfmcd1 by the Bay Area All Quality Management all new materials for inspection.
D nets
❑Yu '1� Nu
I have mal dee he mu ma tamquioements unhrChmpnr&95ofthnCalifor-
raHealth&SafetyCade.Sedan 2S305,25553 and 75534.1 understand dutifde building �� / ^ a`
d 'f curren0y haw a I L W I,u my mmpor bili,y m notify the asupant of mon �Y.SPIeJr�a� 0� O�— C)
ts Which on be me rat issuanco ar.Cutilkan ar Occopanq.t Signatureof Applican Date
- Dam All roof coverings to be Class"B"or better
Owner ar authonv<d seem Date'
.a
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36908046 .00
DATE ISSUED. . . . . . . : 02/21/2008
RECEIPT # . . . . . . . . . : BS000004002
REFERENCE ID # . . . : 08020141
SITE ADDRESS . . . . . : 10265 RICHWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GANESAN & PRABHA SRIRAM
ADDRESS . . . . . . . . . . : 10265 RICHWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3360
RECEIVED FROM . . . . : EDWARD GREGORY
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
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
BSEISMICRE VALUATION 200. 00 0 .50 0 . 00 0.50 0. 00
EPERMITFEE 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 M/C
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
i
ZAP
CITY OF CUPERTINO
TEMP POWER
CUPEI'TINO PERMIT APPLICATION FORM p
0
APN# Date:
Building Address:
Owner's Name: Phone #:
Contractor: 1Cvu S�i iU� j�'E., �q�S Phone#:yp,?- Zy42_Z2W
N Fax #: d- 20
Contact:O's owel-ala(q Al 41L Phone#:
Contractor License #: a7-71io
Cupertino Business License #: A.;2J5/
Job Description:
le
Residential Commercial ❑
Valuatio
b )
.
Qty. if
Applicable Fee ID Fee Description Fee Group Permit Type
ERT>1K Res. Temp Power>1K Amps ELECTRIC REAP14
ERT<200 Res. Temp Power<200 ELECTRIC
Amps
ERT2001K Res. Temp Power 200-1K ELECTRIC
Amps
EPERMITFEE Electric Permit Issuance ELECTRIC
ELCPLNCK Electric Plan Check ELECTRIC
/ BSEISMICRE Seismic Residential BUILDING
BSEISMICOM Seismic Commercial BUILDING CEAP14
CITY OF CUPERTINO
1 ' TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
BPWSVCS Water Service PLUMBING CPWS or
RPWS
PPRSEWG Private Sewage Disposal PLUMBING
System
PCESS Cesspool PLUMBING
BPWATER Install/alter Water Pipe PLUMBING
BPFIXTURE Plumbing Fixture PLUMBING
PGASRES Residential Gas Piping PLUMBING
System 1-4 Outlets
BPGAS Gas Piping System 5+ PLUMBING
Outlets
PPERMITFEE Plumbing Permit Fee PLUMBING
Issuance
PLMBLNCK Plumbing Plan Check PLUMBING
PLMBINSP Other Plumbing/gas Insp. PLUMBING
•
TRAVDOC Travel & Documentation Fee BUILDING
BUSLIC Business License BUILDING
•
CITY OF CUPERTINO
TEMP POWER
Ifflot
•CUPEkTINO PERMIT APPLICATION FORM
ECT<200 Commercial Temp Power ELECTRIC
7
<200 Amps
ECT>1K Commercial Temp Power ELECTRIC
>1K Amps
ECT2001K Commercial Temp Power ELECTRIC
100-1KAm s
TRAVDOC Travel &Documentation Fee BUILDING
BUSLIC Business License BUILDING
•
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UP kJINO
Building De artment
JOB ADDRESS-.' PERMIT #
/G'7_
OWNER'S NAME: .,e 9a PHONE # 2 60 2?Od
GENERAL CONTRACTOR: nti 1"L FAX # ! p _ - r
I am not using any subcontractors: 1,ra JL
Signatulq Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical 4 r r ,nom
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
e
Owner/Contractor Sl Date