050601884
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CQNTRACTORQNFORMATJQN`��
BWLDING ADDRESS:
U
3 041 7 AMqr)T\T A17
CONDITIONED AIR
PERMITND 5 0 6 0 18 8
OWNER'S NAME:
CHANCAL SAHAT
1701 T.TTTT,P. r)RrPART) ST
PERMIT ISSUE DAM
()612SZ2nnr
ONE:
SANITARY NO. CONTROL NO,
(408)291-2220
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDSEs MECH
r__I PLUMB
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Job cri III
with Section 7") of Division Sof ibc Business and Proforations Code. and my licarea, is
born f..O,nd effect.
LicentruClaces C-90 Lb`-*_ L-4 U4 -4 A�a
REPLACE FURNACE & ADDW"!ALED
C
nf-
Dow ("wit(05 croarrolf
ARCHppECT`S DECLARATION
I understand my plans shall he used ar public records
Licensed Prufratimed
OWNER -BUILDER DECLARATION
I hereby affirm 021 1 am exempt from the CortharCIOT'S License Law for the
following reason. (Section 7161.5. Business and professions Code: Any city Or county
B
which icrimme a permit to consumer, ititer, inionative. domeolish. or iriou, any traction,
prior to its issuance. also bruirem, tho applicant for such Permit to file A Signed scirriniOn
that he is licensed purromml. to doo POOVOJOOS Of the COOKOCIOT'S LCrmC LOW (chapter 9
Sq. Ft. Floor Area VaTuation
(commencing with Section 71M) of Division 3 of the Business, and Profirmumis Code) or
that he 0 exempt therefrom and the Wes for dre, alleged exemption. Any violation of
Section 7031.5 by any applicantpermit subjects the applicant tocivil Penalty of
—
3 2W4lMftibcr0 0
6ccupancy -Type
.at dr. door five hundred delta. ($500).
0 1, as mmear of he property. W my craployeaca with wages as their =]a compensation
will do Ne work. and she sonactum is not intended ., offered for a.]. (so. 70,1,1. Bmonis�
and Professions Code: no Commenor's Liescrea Law decd net apply as an Owner of
Required Inspections
property who Wilds or improves thercon, and who ducassuch work himselforitiough his
Own employems, provided thrusuch improvements are not Intended or offered forse le. It,
however, the Wilding or improvement is sold within a= year of completion. the owner.
builder will have the armed of innovin, chat M did ... Wild or Improve to, purainces, of
sarl'.).
C] 1, as owner of the Property. am exclusively connecting wish licensed COnVWLOM 10
consimart the project (Sec. 7044. Business and Professions Cudt,:) The Oarracum's Lt.
course Law d= not apply to an owner of property who Wilds or improves themon, and.
who conounce, for such pmjccm with a comosturr(s) licamard formation to the Cononactor's
License Law.
0 1 .m exempt under Ser. B & P C for Nisreuon
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby itiffinnal under penalty of panpiry noe of the following deriamlimix-
I have and will maintain a Cardfican, of Consent to self-insum for Worker's Comport-
scown, as provided for by Section 3700 of she Labor Code, for she Performance of the
annic for which this permit is issued.
I have and will maintain Worker's Compensation Insurnince. as; molumd by Section
of she Labor Code, for the performance of Ne work for which this Ferran is issued.
My Work rCompensationInsurance cam or and Policy number am:
Cclrin'. Nir�lLI11CPoll, No.: 1 —II 19
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This .,I. dad mAlaxecandi,icd ildhe permit is Were hundred do]]. ($HR)
or Irss.)
I comfy don in the farlionaturce of the work to, which his permit Is issued. I shall rat
employ thyperven in any manner so as at become subject to ft Waflaors'Componsidon
Laws of California. Do.
Applicant
NOTICE TO APPLICANT. If. after making this Certificate of Exemption. you should
amount subject in the Worker's Compensation Provisions of the Labor Code. you mum
forthwith comply With such provisions or this Permit shall be deemed nowillood.
CONSTRUCTION LENDING AGENCY
I hereby AMM that them is a construction lending agency for the Performance of
the work fur which this permit Is issued (Sce, 3097. Co. C.)
Loode"s Name
tondo's Address
I c.ifify car I have mad this application and sue that ffic:have information is
correct. I Fmc to comply iffi all city and county ordinances and .11 laws .[arm& to
building immicurtrotim., and hereby Wiliminm minnermund. of this city to color upon live,
above mendorml propery for inspection purposes.
(We) agree 1. saw, indemnify and keep hamblead the City .( Cilipold.0 gain st
liabiles, judgmarou. cones and expenses which may in any way accom againstacid city
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON -POINT
REGULATI
SOU S..
Issued by: Date 0�_2,p_,f
qE
_,7
Re -roofs
7�/� (2
S(lituituh. of A,licilm/Comorsomir Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will Ne applicant ., furure building occupant iume mh..dlc hiscaundmixoninedid
as defined! by One Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
onle. Socom. 255324)?
0 Y.. C5&
All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future building Occupant use equipment or dcvi= which
lit
If a roof is installed without first obtaining an inspection, I agree to remove
ba,andous; air contaminants ter coffined by ft Bay Area Air Quality Management
all new materials for inspection.
Duariet'
C] yes 0�m
I have mad the hazardous materials requirements under Chapter 6.95 offfic C.1for.
his Health & SafrLYCOKJO. Said. 25505,25533 and 25514. I.Ournmend distaifthe Wilding
does not currently haw . end that it is my mismailbiliky M modify the ciectiparrou Of de61,9eloS
mquirionarchas which4 mo Met poor tu issuance or a condriesse, or borupouncy.
Signature of Applicant Date
xl�
All roof coverings to be Class "B" or better
9 _�iirr or todhonedi,ria uDow
SAP
CITY OF
�UPEI�TINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
o Li I-+ nSo r C
PERMIT #
6o 1$$
OWNER'S NAME:, Ch � S
RAL COTR
GENENACTOR:Co r �
PHONE # og j -O
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Ate'
Owner/Con actor Signature
4 tggiob
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpe
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
Ate'
Owner/Con actor Signature
4 tggiob
Date
h�
CIN of
UPERTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN #
� 6 "too l
Date: G'
2g los
Buildin Add
10%( Address:
Au k- cr`i I.Y, O 64�-
BREMFURN
O's Name:
uncal Saha)
Phone #:
1 -7 D
ontr
ct r: Phoe:
a9r aaa.d
License #:
t
ySf co;t—
/ BREMAIRHAN
aC o
-
Contact: Phone:
Contact,
v> �l 908- aRc -aaa o
Cupertino Business License #:
0
Building Permit Info/
BSEISMICRE
Bldg ❑ Elec Plumb ❑
Mech
Job Description:
Seismic Commercial
Residential Commercial ❑
EPERMTTFEE
3 6- Qrl 7QC
ELECTRICAL
For Residential In t 1 tions:
❑ F1
Mech Permit Issuance
Attic 1" floor 2"d floor
PPERMITFEE
dhere to min set back requirement ❑
PLUMBING
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Bldg Permit Fees
Structural Calculations required for new installation ❑
BPLANCHK
New installation Planning A roval Required ❑
BUILDING
Cos oProject: T e of Construction:
Occupancy group:
�Nao
Stra ped ❑ On Platform ❑ Bonded ❑
Sq.Ft. Floor Area:
New Location ❑ Re lacement
Qty. if
A nnlirahlP
FPP rr)
Fee Description
Fee Group
/^ BENERGY
Energy
BUILDING
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
/ BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMTTFEE
Elec Permit Issuance
ELECTRICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
vt/