The URL can be used to link to this page

08070167 CITY OF CUPERTINO PERMIT BUILDING DIVISION ,. PERMIT ACONTRACTOR�INF'OILMATION�"=. BUILDING ADDRESS: PERMIT NO. 18760 TILSON AVE NATIONAL CONSTRUCTION 08070167 OWNER'S NAME: PERMIT ISSUE DATE J:EVAN KHOSLA & SAMIR KHOSLA 15319 CHATSWORTH ST 07/23/2008 NE: SANITARY NO. CONTROL NO. (818) 221-6057 ARCHITECTIENGINEFR: BUILDING Pill INFO BLDG ELECT PLUMB MECH u o o LICENSED CONTRAC DR'S DECLARATION O O O O mI bereby.Ran that 1 an li¢mW under pnevisions ofcbapu9(commencing Job Description ^ with Scourn Ta)B)ofDiviarn 3 ofthe Busirwsv and Prornacom Cwd.aed my fieeme W TEMP POWER POLE In full fommand effect Z License Class Lie.0 F p Dam Contractor q 7W ARCHITECT'S DECLARATION W Vr 1 undimmed my plum Nall Ise used as public recoNs 1,Q Licensed Professional OWNER-BUILDER DECLARATION i F I hereby affirm that 1 am ucmpt from the Contramors L.kense Law for IK D O following moon.(Section 7031 1,Business coal Prepossess Cods:My city or county ZOO o which requires• ormi,m conaroeL alcor.improve,elemala.or mp,k any structure prior to its issuance.also requires theapplium for such permit to file a signed sutenen, C that he W licensed pursoeni to the provisions of the Conux,ms Liccme Law(Chapter 9 Sq.Ft.Floor Area Valuation �$ (commencing with Section 7000)of Division 3 of the Business and Pmfendons Cork)or $350 - that he I,exempt therefrom and the buff fee the alleged exemption.Any violation of Sectlon 7031.5 by mr,applicant for a permit subjew the applicant to a civil penalty ofNumber Oceu not mom than five hundred dollar ISM). 3 7 517 0 4 0 .-tom, Pane Y Type ❑I,weowrcr of Use NOPc+tY,ncmy wplaym with wagnuNe'v sok comPewtion, MR do We week and thea tmekcot intended or offered for weld(Sm.7044.Bananas ad Pm[..I.u Cad,Tan Cembanor.Lima Law dues not appy to a owner of Required Inspections property mo bui lde c r improves down,sew who doc z arch work himvlf tar lluough his own employees.provided that such itepmvemenu an not intended oeoffered for sale,ff. however.the building or unProvemal]Saw within off year of compkdon.the owcor- Wilder will have the WNca of poring that M did not Wild or improve for purpose of sale.). C111.u.of the property.as exclusively contracting with Earned emnvaton in constmct the project(Sec 7044.Business and Professions Cade:)line Cmtrcmrs U- cove Law does not apply to an owoes of property who builds or improve thereon.ad who contracts for such projects with a contramor(s)licensed puuun,to the Conuac,ors Lkeme Law. ❑Imensmptundes See� � ,Bk PCfor Nisreuoo G*- A.A V/ Dam 11 'S COMPENSATION DECLULATION 1 hereby alfuen under poiro pointy of perjury oof tic following dccluWona I law AM will maintain aCauOom of Consent u self-imam for Wahers Compo- .lion.as povided fee by Session 3700 of the Labor Cede,for the Peolorm.of the work for which this pamit is issued. ❑1 have ave will enaimam Workers Compensation Instar .as required by Section 3700 of the Later Code.for floc performance of Ne work for which this petit is iuued My Worker's Compensation Wer.cagier ad Policy number am: Cards: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This soman rcN atW completed ifft parent,uformm hundred radial($100) oekst) I wufy that in Ne perfomac of tie work for which this permit W issued,I shall not employ any person in ay �JLIIntYPecme subject to tho Workers'Compensation Laws of California.Dam mama Appellant Irk— NOTICE TO APPLICANT:If,after making this Cmifiute M Exemption,you should became subject ch the Workers Compensation provisions of the Mbar Code.you most .J z forthwith comply with such Provisions or this petit shall W:dcomed muted. ` zy CONSTRUCTION LENDING AGENCY E+ I hereby aRm that fm Is.com,recunn lemi ng agency Tor the perfermaau of C' dm work for which this Permit W issuced(Sec.3197.Civ.G) Qlsadcrs Name D z lattices Address U O 1 cordfY that I have read this apFicumm sew main thu the above womauon W (y coral I agree to amply with all 61,ad county orfinanxs ave sum law,mlaung to Wilding convection,ave hereby autbodre representatives of this city to enter upon Ne ,r, above-enaudgm property for imPe Impaction y (We)agree to saw,indemnify ad keep hemleu the City of CuPeruno against res in consequence coati and espenreawhich mryin aY waysucomagalnn weiO City U z Aconsequence of IW grating of this petit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA N�S`.-pty`,(Y�(_� `]/ Signature of Appl tr.cytir �^r�� Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tins applic at m future Wilding occupant nom or handle h.attlons much l as defined by IK Cupertino Municipal Cade.Chapter 9.13.ad the Health ad Safety Code.Session 25532(.)? ❑Yon ❑Ne All roofs shall be inspected prior to any roofing material being installed. Will ft applicant or future Wilding 0ecupn,ata equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .t hrrardons air conueninanu u defined by the Bay Area Air Quality Maagemem all new materials for inspection. Diana? ❑Yes ONO I have mad the lis ardwsursom al,rtquimmum w4r Chmscrd.95 of he Califor. aW Hralth9SLIMYCok Smiass25505.25533 aw25534.lunMraaw Nat ifthe bolding doe cot cwremly have a tenant that it is my requmibiliry to notify Nc occupant of Ne requirements v�bch^uv_kke mit prior m issuance nn cerude,m or�cvpmcy Signature of Applicant Date (hrNa O J�-7-}��p,� owra or a, sent Dba" All roof coverings to be Class'n"or better -7 cD CITY OF CUPERTINO TEMP POWER • CUPERTINO PERMIT APPLICATION FORM APN # Date: %376-17v �� U, c� v 07/a2)o06 Building Address: 1,816 o —f I c Ave . Owner's Name: Phone #: bra 813 4i 1 I 6so 7tq� (,�t-TO Contractor: Phone #: Fax #: Contact: Phone #: ern�a �tnosla iso gy3 y211 Contractor License #: Cupertino Business License #: Job Description: Residential L2' Commercial ❑ Valuation (cost of project): da�—� Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power>IK —, E 1REAP14 Amps 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps I EPERMITFE Electric Permit Issuance E IELCPLNCK Electric Plan Check E 1BSEISMICR Seismic Residential B IITRAVDOC Travel & Documentation B Fee CITY OF CUPERTINO 'EM TEMP POWER CUPEkT1NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 1 ECT<200 Commercial Temp Power E <200 Amps 1 ECT>1 K Commercial Temp Power E >lK Amps IECT2001K Commercial Temp Power E 100-1K Amps 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B • . Community Development 0 Torre Avenue V Cupertino CA 95014 iR . Telephone(408)777-3228 Cl OF Fax(408) 777-3333 4UPEkTINO Building De artment JOB ADDRESS: PERMIT # rY'nv 01 7Ol OWNER'S NAME: sly SDvn it 1,qosk PHONE # 600 823 1f GENERAL CONTRACTOR: P carr�y�h FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 66 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 nn • �Vm��r. to-7 22-)06 Owner/Contractor Signature Date CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37517040 . 00 DATE ISSUED. . . . . . . : 07/23/2008 RECEIPT # . . . . . . . . . : BS000005560 REFERENCE ID # . . . : 08070167 SITE ADDRESS . . . . . : 18760 TILSON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : JIVAN KHOSLA & SAMIR KHOSLA ADDRESS . . . . . . . . . . : 18760 TILSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MONICA KHOSLA 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 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00 lEPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IERT<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 AMEX --------------- TOTAL RECEIPT 122 . 87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER •