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05100092T D� -- il �c E 2 xs�� E F 0 �2 z C U C U CITY OF CUPEWf IN CON BUILDING DIVISION PERMIT BUILDING ADDRESS: CONDITIONED AIR PERMIT NO10 5 10 0 0 9 2 10447 N BLAN OWNERS NAME: PERMIT ISSUE DATE VINOD BALAKRISHNAN 1701 LITTLE ORCHARD ST 10/18/200S RMNE SANITARY NO. CONTROL NO. (408)291-2220 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Scott.. 703(f.f1uhisiton Suffuse Hireirms.rund Profession., C.derand my he... is in fall forcemil.1firm REMOVE AND REPLACE FURNACE LicerseClues Lic. a l(21 6, Dow CO. cWr_ it Z= ARCHITECT'S DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby fifiran to, I ma inwrn,t from to Cmilmoun's License Law far the following motion. (Section 7031.5. Business and Prafrisions Code: Any city or county which ax,flo. . permit to consom" id.,. Ontario, d.rooliah. Or ix,rin an, tiloustare $2300 prior it) its issuance. also bechumms the applicant for such parmil to file a sigired codenorat License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the previsions Of due Contractor's (Chapter b,mantroom, with Section IWO) of Division 3 of the Basin. ad Poificeni ... code) or that he is exempt therefrom and the basus for the alleged exemption. Any violation of —SWF91Td �Or� Occupancy Type Section 7031.5 by any applicant for a Permit subjects the applicant 10 3 CiVil penalty Of .I .. man fiv. hundred do]].. (SSW). C] 1, . owner of the Property. or try employees with .,a aa then subc cmaptneati... Required Inspections will do the work, and me structurc is not intended or offered for sale (See 7W. Business and Professions Code: The Crunrancon's License Law does at apply or a owner of property who builds or improves thereon, and who does sub wrkhim=lfor damnigh his own employee, provided that such improverricrou; arm not intended ortiffeed for aide. If. however. the building or improvement is sold within one cas ofcomplcdon, the owner, builder will have ft burden of proving that he did not build or improve for purpose of saide.). E] 1. as Owner of me property, am exclusively contracting with licensed comemicums 1. compact the project (Sec. 7W, Business and Professions Code:) The Connector's Li come Law does not apply I. .. Owner of property who build. or unFirms thincon. add who contracts for such projects with a contractio(s) ficernind pursuant in the Committees License Law, 0 1 am exempt under Sec. B & P C for this Mason rt:ts Owner Date WORKER S COMPENSATION DECLARATION I hereby affirse unobtr Penalty of perjur, One of ft following declarations: I 0 n I ham and will maintain a Cenifiesm of Consent to self-insum for Worlwit's CcmPxcn- moon. as provided for by Section 37M of the Labor Code, for ft performance of doc w we" ork for which this Permit is issued. 0 1 have and will maintain WmIan'a Croupcinothim firearnmec. as required by Sxfi.n 0 1 37M of One Labor Code, for the Performance of the work for which this permit is issued. "Iffiff My , My Worker's Com,cirsation Insurance carricidp.licy number me. iflicy No.: (199r ,an 76- CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not Ine completed if the permit is for on hundred dollars ($100) or loss.) I ceni(v that in the Performance of the work for which this Permit is issued, I shall not employ any Person in any manncr so w to become subject to the Workors'Compchadion Laws of California. Date A,Hxasa, NOTICE TO APFUCANT. If. after making this Cenificale of Exemption. you should become subject so doo Worker's Compensation previsions of thic Labor Cone. you must forthwith comply with such provisions or this Permit list[ lb, dernind rom1wo. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a conatinsetion lending agency fnr the pirrformance of the work I., which this Permit I, issued (Sec. 3097. Civ, C.) Under's Name Leradir's Address 1 aftify that I haw mad this application and state that due abrom inamandion is Cancer. l3floce to Comply with all city and county ordinances and sure laws relating to building construction. and hereby authorin mpoesurntinims of this city to enter upon the above-mentioned pro,,orty for inspection pinpoints. We) agree in save, indemnify and keep heconlesta One City of Cupertino against liabilities. judgments, costs and expenses which may in any way arcesse, against mid City in consequence of to granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITFI ALL NON-PORFT Issued by: Date E REGUL 411- 0 FL R,-r.ofs Type of Roof ��afifApplicmUCon Date c 0 HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle luminfords material as dcrined by the Cupertino Municipal Code. Chapter 9.12, and the Ficalto and Safety Code. Section 25532(ifil Dy. 951N., All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant am equipment or devicts which I havandous air contaminants as derined by me Bay Area Air Quality Management all new materials for inspection. DeftIM? 0 yo, CKI- I have mail the hazardous materials mquirements under Chapter 6.95 of the Califor ris Health & Safety Code. Sections 25!105.25533 and 25534. 1 modermand that if he building does not currently have a tenant. that it is my responsibility to nottly the cu,.t of the ottlin It h datt,cron,pro.ro, ccmrlcaw 07 Signature of Applicant Date C��2c)5, Z8�� L=— All roof coverings to be Class "B" or better O.hcL,,`6ih.m.d a Date CITY OF CUPERTINO I• 2 of 2 PERMIT RECEIPT OPERATOR: kiersaw COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633111.00 DATE ISSUED.......: 10/18/2005 RECEIPT #.........: 31641 REFERENCE ID # ...: 05100092 SITE ADDRESS .....: 10447 N BLANEY AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: VINOD BALAKRISHNAN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2333 RECEIVED FROM ....: CONDITIONED AIR ASSO CONTRACTOR ........: RICHARD READ LIC # 22334 COMPANY ..........: CONDITIONED AIR ADDRESS ..........: 1701 LITTLE ORCHARD ST CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)291-2220 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BREMFURN NO UNIT 1.00 __ __________ 14.31 _ __ _-___-_-__ 0.00 14.31 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 2,300.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 '0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 __________ 0.00 38.37 0.00 TOTAL PERMIT __________ 164.78 __________ ---------- 0.00 164.78 0.00 METHOD OF PAYMENT AMOUNT NUMBER OTHER 329.56 _________________ VISA TOTAL RECEIPT 329.56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL I 0 E& CITY OF OUPEkTINO is 0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building De artment JOB ADDRESS: ,0 Poe - PERMIT # 0 f'/000 f 2 OWNER'S NAME:{� PHONE # t{0C6) S l,g GENERAL CONTRACTOR: -l/ FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 21 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 v -0--w -ner/ Cofitractor Si,�= CITY OF �UPEkTINO r L CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM C 10 a C-) a - APN # 'J1G-'33-1�1 Date: Ipo IS 0 oS Building Address: BREMFURN o Qv. o . 00pe, Ca 9SolY Owner's Name: Phone #: yCbi V,t 90bL -3515 Contractor: License #: BREMRECEPT 4 L4 516 � - C - �1J Contact: C,;;�-,r\ c Cupertino Bus i ess License #: y Building Permit Info: BUILDING Bldg ❑ Elect 6K Plumb ❑ Mech Job Description: �Cmovo, { Q e MPERMITFEE Rvnccr MECHANICAL Residential. Commercial ❑ Plumbing Permit Issue For Res' ential Installations: BPERMFEE Attic �` floor ❑ 2"d floor ❑ BUILDING Adhere to min set back requirement ❑ Plan Check Fee or Commercial Installations: BUSLIC eplacement same weight_L;J�dditional weight (structural calcs) ❑ BUILDING Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: �, 3oG — Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Re lacementcEa— Qty. if Applicable Fee ID Fee Descrintion Fee Gmun BENERGY Energy BUILDING BREMFURN 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 EPERMITFEE 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