05060082 CITY OF CUPERTINO �* .amd
BUILDING DIVISION PERMIT 't CONKS, TRACTORINFORMATION x
Irt, q:&� �'. ., %1�§ :....0 moo,,.
BUILDING ADDRESS: WEST HOME AIR PERMIT N005060082
10498 GLENCOE DR
OWNER'S NAME: FERMITISSUEDATE
RAJESH JHA & ASHIMA GARG 5801 SANTA TERESA 2005
NE: SANITARY NO. CONTROL NO.
(408) 202-9693
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
_oo LICENSED CONTRACT'OR'S DECLARATION
s u wi
G I ion, affirm Wt I am lianud under provis ans of Chap¢r 9(commencing Job D2SCfIpCIOn
tomth Sation70f1U)of Division]of NC Bu4msa and Professinnx Code.and mylicens is
in full form and effect. INSTALL 2 OUTDOOR A/C UNITS &
iq?
nF•� Class
Dow Contractor
ontr
COILS & CONNECT
ARCHITECTSDECLARATION
?W U 1 understand my plain atoll he used u public¢cords
A.
Licensed Pmfcssional
6 OWNER BUILDER DECLARATION
a1 hcmby ul(rm thin 1 I.S.exempt from the Contractor's rs :Any c Law for the 1�,g f� fl 41 T�•'1 17
pan followingmason.Permit
IID LBusiness and Profcssium Code:erm city or county
which squire a permit to cam;th L alter.Improsu h permit
t or repay any comment y¢i priormits issnse dpu santto the provisions for mchpermiuo Rkasigned summcm
sollutheincingxdpSectio7Mthe Abofvivisionf ffic ofthenusiessndProfLaw(Chapter
ade)or Sq.Ft. Floor Area Zf/��p^pGp Valva[ 17Q
x� (commencing with Section?0001 of Division3 of the Business and Professions Cade)or
3
i Nal he u exempt therefrom and de basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Front SUbjecu the applicant to a civil penally of APN Numberane- 06`eu Type
not mos than five hundred dollars(S5f10). P Y YP
❑Las owner of the pmpen,,or my employees with wages M their sok compctwtion, 32630164 . 00 7
will do the work.and dm swclum is not immndcdmo(Toed fonale(Sec.1044,Businix. - - -
and Professions Code:The Contractor's License Law docs not apply to an Owner of Required Inspections
property who builds orimproves thereon,and who doeasuch work himself orthrough his
own employes,provided thin such improvements art oat intended aro0ered fantasia If.
however,the building or improvement is sold within one year of compktlon.Ne owner.
builder will have de burden of proving that he did rot build of improse far purpose of
sak.).
r of the property,am exclusively contracting with licensed convectors 10
consumer the project(Sec.70 ,Business and Professions Cotler)The Contuctar's Li
Conti law dors not apply in an owner of property who builds or improves teteon,and
who contracts for such projects with a conusctor(s)lieerued pursuant to the Convectors
License La .
❑1 am rte pt undo[Se B k P C or s moon
Owner \ Dare 6 f �
WO KERS COMPENSATION DECLARATION
1 hereby aRnrt under penalty of perjury ane of the following declantians:
1 kava and will maintain a Certificate of Consent to self-insure far WorkcdCumpcn-
setion,m provided(or by Section 37W of the Labor Codc,for the perfmman¢of the
work for which Nis permit is issued.
❑1 have and will maintain Workers Compensation Insurance,As occurred by Sccuon
37W of the labor Code.far the pedarmancc of the work forwhich Nis person is issued.
My Workers Compensation Insurance Cartier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU section need not Mcompleted if the Permit is for one hundred dollars(SIM)
or less.)
1 century that in the performance of the work for which this Permit is issued.I shell not
employ any ninany laannerany tp lhcco�cfuwbjecuo the Workers'Compensation
hws of Califo�t�ata.�Da�C 1 b I
Applicam t `aA-yam I s
NOTICE TD AP�:If,after making this Cenibaa to of Exemption,you should
become Subject to the Worker's Compemtnllan provisions of the labor Cwk,you must
.,O forthwith comply with such provisions or this Permit shall M deemed revoked.
Z CONSTRUCTION LENDING AGENCY .
'f•� Ihereby Affair that them is o comvtrctinn lending agency,far the reffurmaeac of
a the work Can which this permit is issued(Sea 7091,Civ.C.)
W Q Lender's Name
Lender's Address
az
U 0 1 certify shat I have read this application and sate that Oc above information is
W f-' cancer-1 agree m comply with all city and county ordinances and sure laws palating m
DU building construction.and hereby audamim repmrn
suuses of this city to cnmr upon the
>4 above-mentioned property for inspection purposes
G (we)agree to now,indemnify and keep harmless iM City of Cupenino against
F' fn
Liabilities,judgments,costs and expenses which may in any way accrue against said City
Uz in consquence or the granting of this permit.
'-' Al LICANT UNNDD({g1RSTAN�D�S AND WILL COm1/PLY WITH ALL NPN-POINT Issued by: Date
J E�aDVI�NS.,V VV YA 1�5 � 'i3lof
A� Re-roofs
Signawmof pIiCNDe
HAZARDOUS
m
US MATERIALS DISCLOSURE Type of Roof
Will rhe applicant or future Wilding occupant store or handle havartfous
and Safety
Ank dcfi;:,.,.Y.
c0 by tM Cupertino Municipal Cade.Chapter 9.11.Sud the Health and Salcey
.Section 25532(x)?
fly. All roofs shall be inspected prior to any roofing material being installed.
13th¢
Will mea applicant or future building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
pp g p equipment rut or devices which g
it hazardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
7d'�
strict? t"
❑Yes eNu
1 have real dtc W.rdaus mmerials requirementsunder Chapmr 6.95of the Calif a.
Health 6 Safety Code Sccdons 25505.25533 and 25534.1 undthavid our if the building
not cumCall,have a tenant,that it is my reefomibility m nnuly the cup of thewhihmxet etpdoftai n ceniEcate0ro�au�y. 0 Signature of Applicant Date
wner ar a horind agent` (a Date All roof coverings to be Class"B"or better
.r Community Development
'v. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
{04 l%- GLtpj(ME p ,5-b6'ao&-'Z
OWNER'SNAME: Q.AJTS)N K• Z+A %t A5)i,mA GAQy PHONE #
GENERAL CONTRACTOR rJC3'1 not AIR FAX #r q
I am not using any subcontractors: L 1 1 An"
ignature Dat
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
numbing- P C Ur\,T- W C7(.7 1*vrA C' Almg 0 �a--7
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
13 OL,
Own r/Contractor Signature ate
CITY OF CUPERTINO U G
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN 3 2 6 - 3 CI - 16 Date: 13 Z00,�
BuildinAddress:
10 { 9Sj GLF91CVE aR�VF CVPtYYTIND CA �►Solt�
Owner's fl,jT-50eK . MAA '1;v- ASOIIMA 6AG Phone #: � �� - � 4-6-3733
Contractor: License#:Contact: Cupertino Business License#:
SPyf,os `IADGRR 40� - 661-7a4 7
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
IN57f�LL o0loo , A- G UNITS TbJD COILS d- Co,JA)FCT'_?D
Residential ❑ Commercial ❑ u?.
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost Ir":7-0
nD— Type of Construction: Occupancy group:
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
'Z 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