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09070117E n t:P �le X96 % U. F �0 n�- �pC Km� y�> f�C i - 0� Z � �Q W�04 UC wE F.t C t-r G U; CITY OF CUPERTINO PERMIT BUILDING DIVISION .MIf�k�t* x BUILDING ADDRESS: PERMIT NO. 21947 LINDY LN NATIONAL CONSTRUCTION ^WNER'S NAME: T-IT T173 'A RENTALS PERMIT ISSUE DATE 2UN PHO -�� S A CONTROL NO. (818)221 -6057 ARCHMCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 a 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is TEMP PO AVER in full force and effect License Class Lic. M Date Contractor ARCHrMCT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure 5q. Ft. Floor Area Valuation prior to its issuance, also requires the applicant ror such permit to rile a signed statement Law 9 that he is licensed pursuant to the provisions of the Contractor's License (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 415 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 35625029.00 ❑ I, as owner of the property, or my employers with wages as they sole compensation, Required Inspections q P will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Conuactoes License Law does not apply to an 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 offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder have the burden of proving that he did not build or improve for purpose of saleJ. ss owner of the property. am exclusively conuacting with licensed contractors to X;Qt Professions Code:) The Contractor's Li- the project (Sec. 7044, Business and cause Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors License Law. ❑ I am a ;crept and B& P C f tthis ason her C Le ORKER' O PENSATION DECLARATION I he t under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMFnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less) I certify that in the performa a of the work for which this permit is issued. I shall not employ any person in an r so as to become subject to the Workers' Com lion Laws of Cali rni a l Applicant NOTICE' 0 P f, a m ng is Certificate of Exempti n, yo sho d - become subject to the orkcr s o nsuition provisions of the Labor Cade you must ' forthwith comply with h prov' ' ns or this permit shall be deemed revoked. " CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of y the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to " building construction, and hereby authorize representatives of this city to enter upon the above- mcndoned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. (1 " APPLICANT UND STANDS AND WILL COMPLY WITH ALL N- INT Issued by: Date SO CE REG ONS. Re -roofs Type of Roof Sign ure canVC for Date HAZARDOUS MATERIALS DISCLOSURE Will aAapplicant or future building occupant store or handle hazardous material as defined by the Cupertino Murricip Code. Chapter 9.12. and the Health and Safety 'ode. Section 25532(a)? All roofs :;hall be inspected prior to any roofing material being installed. C] Yes o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new in iterials for inspection. District? ❑Yes qlbllr I have read the hazardous materials requirements under Chapter 6.95 of thc Califor- nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building not currently ant that it is my tespo 'bility to notify the occupant of the req ire which met prior to iss once ficate ofOccu Signature of Applicant Date ' Suth All roof coverings to be Class 'j`' or better Owner o 'aced agent Dare r. CITY OF CUPE�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: LA-N L1 LI N� L C � >�Y'� h� w PERMIT # J <D �?� t OWNER'S NAME: PHONE # qo8 2-k GENERAL CONTRACTOR: L- E=L q N FAX # L t� �n�� M M�►4t��6 I am not using any subcontractors: Si E,nature Date Please check atnlicable subcontractors and corn-Aete the following information: 1 Owner/ ontractor Signature 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 TN 1 Owner/ ontractor Signature Date 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: BlP:: Lot: APN ........: 35E25029.00 DATE ISSUED.......: 07/14/2009 RECEIPT # ......... BSC00008190 REFERENCE ID # ...: 09(70117 SITE ADDRESS .....: 21S,47 LINDY LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER SHESHA KRISHNAPURA ADDRESS 201. ORCHARD GLEN CT CITY /STATE /ZIP ...: MOUNTAIN VIEW, CA 94043 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... OPERATOR: SylviaM COPY # : 1 SHESHA KRISHNAPURA NA -IONAL CONSTRUCTION RENTALS LIC # 22537 NA -IONAL CONSTRUCTION RENTALS 15_19 CHATSWORTH ST MISSION HILLS, CA 91345 (8-.8)221-6057 FEE ID UNIT QUANTITY ILMOUNT PD -TO -DT THIS REC ---- - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- 1BCBSC ------- - - - - -- VALUATION ---- - - - - -- 415.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 1.00 0.00 1BSEISMICR VALUATION 415.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1ERT <200 UNITS 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 -- 42.00 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ----- - - - - -- 127.50 ---- - - - - 0.00 127.50 0.00 METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 127.50 --------------- 127.50 REFERENCE NUMBER -------------------- american express VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- -- - - - - -- ---------------------- - - - - -- 402 TEMPORARY POWER 1-19 CITY OF CUPERTINO CITY OF CUPERTINO TEMP POWER PERMIT APPLICATION FORM N ?0 &7 APN # �S•-6 2 Sr cy Fee ID Date: Fee Group Building Address: 2-i9Lfl- LNG -LAVE E lIrJ0 I ERT> 1 K Owner's Name: SNFsrb,�-- E Phone #: /to t Contractor: Res. Temp Power <200 Amps Phone #: 5 i c7.-- S67 3 —LY do 0 1J l 1-1 o w 6 L N S t�lCj�p 12 i zS 1 ERT2001 K Res. Temp Power 200 -1 K Amps 3p° – `�4 S Fax #: 1 EPERMITFE Contact: J SS 1 Cwt Phone #: �- q o r- , - C{ 29 2j Contractor License #: g q-1 6d 1 ELCPLNCK Electric Plan Check Cupertino Business License #: 225" 3 / Job Description: Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Commercial El 1 TRAVDOC Travel & Documentation Fee Valuation (cost of project): 1 r Type of Construction: N/A Quantity Fee ID Fee Description Fee Group Permit Type I ERT> 1 K Res. Temp Power > 1 K Amps E 1REAP14 IERT <200 Res. Temp Power <200 Amps E 1 ERT2001 K Res. Temp Power 200 -1 K Amps E j ( 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E / 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Documentation Fee B Revised 01 /07/09