08040182 CITY OF CUPERTINO .x s,. ,qY„tag, +".v'Miiu.-5"'
BUILDING DIVISION PERMITeCRACTQR T1�tF�UItMATIf4,N
Bu11O1N0 AD00.FSS: PERMIT NO.
20398 CLAY ST GOSAL HEATING AND AIR COND 08040182
OWNER'S NAME: PERMIT ISSUE DATE
KHAN, NISHAT 2679 CHERRY BLOSSOM WAY 04/25/2008
E: SANITARY NO, CONTROL NO.
(510) 441-2318
ARCHITECTITINGINEER: BUILDING PERMIT INFO
O O PLO MECH
'I G G LICENSED CONTRACTOR'S DECLARATION
ZF�( I hereby affirm that 1 Am Ikansed under provisions of Chepur 9(commencing lob Description
n<S with$ection 7")of Division 3 often Business and Professiutu Code.and my license is REPLACE FURNACE
InfwlmmcendeG '_a� reg 6i p4(
Lkenm Clw
Dam Cauacer
S ARCHITECTS DECLARATION
y I understand my plans smil he used As public records .
c 7 Luxessed Professional
y OWNER-BUILDER
exempt
DE CLARATION
COO
hereby.(Ben o n 1 em exempt Truro the Canlncmfa :Anse city
o for the
y O o following wan.(section 7031.5.wcaro Busks end Profess mil Cod,:Any city i county
9 e.' whish mqulma•Portrait re comwct alter,improve,mmNitt of a apoul,.1g od auuctum
priortois immdco,sou rt In the Pevision or for Cmumne Permit cleaagkdnatemcnt
�m< warmencinmndpmctionwwcofDisonen(of Camrncwr'atxcmmesuo Chapter9 Sq.Ft.Floor Area Valuation
(commencing withsection
And
of D asisfr ofthe Business and PmfAny iCom)w $2600
9 Nn io w exempt 0ercfmm and me per for the skge, pplica on,Any l penalty
of
.. was five
any Applicant ears"emit surjecu the appikent w•dull pemlq of N Number Occupancy Type
nm mom then five bundrtd dollars(5300). 36938025 .�.
0 I,As awkc of the property,a my employees with vnges As their sole compensation,
will m the wart,and me sruchm,Is not mounted or arrested for oak(Sen.]044,Business
and Profeaaam Code:The C,nmckrY License Law does let apply w sin awkr of Required Inspections
Property who bui Ids a im proves thereon,and who does such wort himself or through his
comemploycn.Provided well such improvements art not intended maRemd for s>k.R.
Imwewr,the building on,improvement is sold within am Isar of complemn,the owncr-
builder will haus the burden of proving that he did rot bald or improv for purpose of
ark.)
0 1,as cam of the property.am exclusively contracting with Bawad conuAman to
cummet the pmjert(See.7044,Business send Prefentloss Cade:)The Cmmcmr's U. .
cenm law does not apply to An owner of property who bolds or improver demon,and,
who contacts for such projects wW a conumenor(s)Incensed personal to me Contnewr's
License law.
O lamesempturdersec. ,Bit PCforw[s. -
0. Dam
WORKERS COMPENSAT]ONDECI RATION
I henry AM.under penalty of perjury one of tiro following declarations:
raw and will msostn•Canifinm or Convent to elf-ImamfaWorkeYaCompea-
aarion,As provided for by Socei 3700 or m labor Code,for wen s rforwanm Of we
work for which this permit is issued.
0 I have And will mantsin Wartefa Compensation I..As required by S.W.
3700 of the LAlm,Codd.for the performance of the wart forwhlch this permit is Wood. '
My Warteh Cam wtio ITn,,w,r,1 Am court and Policy number are:
Carrier, ="Zen "`^ Polley No.: M 35 d'
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
CrIlaminn ked ktlx comPle ed If the permit la two=hundred dollars($101)
Of leu)
1 unify that in the performance of the wart for which this permit I wand,I shall nm
employ any peram in any mannerw As In become subject to the Workers'Campensadm
Laws of CafiforolL Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certifimw of Exemption,you should
become .bj=w the w tefs c mpemtd.pmvw m of the Luba Cade you mm
.J Q faMwith comply with such p.W..ar this permit shall k mend rcwked.
zy CONSTRUCTION LENDING AGENCY
[—� I hereby aMmu dent mem I..comtmmrnn lending aRncy far we pefformaraccof
C ti the wart for which this permit is issued(Sue.309],Civ.e.)
WR A Lendefs Name
z lander.Addw
U O 1 cutil mat I lavenand this applicadon And saw son the above Information ii '
It, Cavett 1 agree w comply withall city and county ardnances and sew Is"rcWing to
.O building construction,and hereby ambona reprtsenawws of this city to enwr upon we
.term-mentioned property for impccwon Purposes.
(Wel agree w ave,indemnify and tkp harmless the City of Cupertino alga as
t„s on IiabilideL Judgments,costs m
And cape ,s which may in any way...Against sad City
(„)7 in consequence of the granting of this PemIL
n7 APPLICA NDERSfAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date
souRce u s.(9 , "00?
sgnarrrc or ApplkAenuCa -r-tom. "4 Date Re-roofs /
NA2IARDOU3 MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building a trupmtsmm or Iarblc hazardous materia
As deRkd by th,Cupertino Municipal Cade.Chapter 9.12,and the sheath and Safety
Code.Se z525532m)?❑y. �No
All roofs shall be inspected prior to any roofing material being installed.
Yes
Will do applicant or future building aacupant use equipment a datcm which If a roof is installed without first obtaining an inspection,I agree to remove
harardom air conamimnu As m0kd by me Bay Ama Air Quality Management all new materials for inspection.
a7
0Yo (6Nu
I here read the hsardausmaasalaetryvementsumkr Clupter S93 ofthe
Swd=UM5,2Ss33 W 25534.1 undcnund son Rgc building
dos let corm y haw a tenant mat it' y mpomlhilitY w notify NC ancupent of the
rcquirtmenu ichmy bemetpriart ,nmtkanCawftnmofa,rwc. Signature of Applicant Date
lam/ tis/�
2!.rL6, tho,ired aCem DOW All roof coverings to be Class'W'or better
Community Development
10300 Torre Avenue
I' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
6UPEkTINO
Building Department
JOB ADDRESS: a � C IGS Ot PERMIT #
OWNER'S NAME: PHO
GENERAL CONTRACTOR: FAX# 5(D GSI —1 lG
I am not using any subcontractors: `' a'
gnature Date
Please check applicable subcontractors and complete the following information:
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
Ile
er/Contractor Signature Date
• CITY OF CUPERTINO
5 ITEMS- OF 6 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36938025. 01
DATE ISSUED. . . . . . . : 04/25/2008
RECEIPT 4. . . . . . . . . : BS000004582
REFERENCE ID # . . . : 08040182
SITE ADDRESS . . . . . : 20398 CLAY ST
SUBDIVISION . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KHAN, NISHAT
ADDRESS . . . . . . . . . . : 20398 CLAY ST
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : GOSAL HEATING
CONTRACTOR . . . . . . . : SINGH, KESAR LIC # 21350
COMPANY . . . . . . . . . . : GOSAL HEATING AND AIR COND
ADDRESS . . . . . . . . . . : 2679 CHERRY BLOSSOM WAY
CITY/STATE/ZIP . . . : UNION CITY, CA 94587
TELEPHONE. . . . . . . . . (510)441-2318
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------— ---------- ---------- ----------
1BSEISMICR VALUATION 2, 600 . 00 0.50 0. 00 0.50 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1MFR=<100 UNITS 1 . 00 122. 38 0. 00 122 .38 0. 00
1MPERMITFE FLAT RATE 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 245.25 0 . 00 245 .25 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------—------------- -------- ----------------------------
505
--------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
CITY OF CUPERTINO
(�D FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN # 369 , Date:
Building Address: � C I4 l
r
Owner's Name: Phone#: _a S 5—77-S/7
kNAry , �15�F�T
Contractor: Phone#:
Fax#: X10—�`II -IIgS
Contractor License#: r �11 Cupertino Business License#:
x1350
Contact: Phone#: Sim 37 -31 I
J
Fax #:
Building Permit Info:
Elect Plumb Mech
Residential Commercial LJ
Job Description:
For Residential Installations:
Attic ❑ I" floor 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
a�013
Strapped H On Platform Bonded New Location Replacement
Valuation: a
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
1
-� CITY OF CUPERTINO
�` FURNACE/AC
TY 0
CUPERTINO FEE SCHEDULE
tion Fee Permit Type
Fee Description Quantity Fee ID p
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ca heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code. •
1MCSUSHTR Commercial Install/Relocateea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1 MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed.wall htr, or
floor mounted unit heater.
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install & not incl in an appl permit.
G
CITY OF CUPERTINO.
FURNACE/AC
• CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit.Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each. gas piping system of 5 or P
more per outlet.
l 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permit Fee E
1
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
CITY OF CUPERTINO
FURNACE/AC
ITY 0
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units<= l Ok CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= lOk CFM B
1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•