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06050185 CITY OF CUPERTINO BUILDING DIVISION PERMIT ,',� �1T• R4•,("'' 'Q.. , ,, TZd BUILDING ADDRESS: E & I CENTRAL HEATING & AI ft6RMl7NO.06050185 10120 IMPERIAL AVE OWNER'S NAME: PERMIT ISSUE DATE - RAJA MANI 372 RIVERCREST LN 05/22/2006 Eo SANITARY NO, CONTROL NO. (510) 377-4352 ` ARCHITECT(ENGINEER: BUILDING PERMIT INFO 'BLDG 0 PLUMB MECH O yap mus[ILICENSED CONIRACIDB'S DECLARATION kion; fChap lob Des [tQjl !x 1 hereby70(affirm Net I am If ensedtho Bu umss and Proons of,Code. 9(commencing '�w`gft®(�sow xti iNllforcn]Dl1))af Divisiaa3of Nc Butinestaed Profuskns Code.and mylkensou �� ,< Li one CLUS a ln. ADD A/C j n Z License Clara - — - Q Lk.g s t- Dam Cr.r ' TS DEur E 1�4g As shat b use Ds publlRATION µ,. f!'a.e. U I understood my plans Nall he used u public recnrN .IUIV :cep Licensed Pmressiadl I r (t OWNER.BUILDER DECLARATION I therebyeR hy from that I am.Copt Ism the ConuanoN License Law for the �� /yk� p o following reason.(Section 7W IS,Business and Profusions Cmk:Any city or County '(`lig $ which mqulce a parmil m CortsWc4 Wur.hormone.demur W.or repair any sualum F 4 (]Q _Zr prior to its issuance,also requires the applicant for such permitro Ilk a signed statement F G Nat he is licensed pursuant to the provisioneofNeConnectorbUmnmLaw(Chapter 9 Sq.Ft.Floor Area deal 3�$ (commencing with Section 7000)of Division 3 of use Surrounded Profession,Code)of e — that W u dump,therefrom and the bails far the all aemPdm Any vkWion of Section 7031.3 by any applicant for a permit subjects the applicant in a civil penalty of 3 MMMe—r U U Occupancy Type not more than In hundred dollars($SW). ❑I.ndwnarafteFopmy,mmyaropWycewbh"twuftirmlc=pe don, will do the work,and theandernm Is notimerAcl orartered forsale(Sm.7044.Busiau ree Raired Inspections and Professions Cade:The Communes License Law dime,set apply u so owner of q p propeny who buildsorlmgonts thereon,and whoddem uch wakMmse3furthrough his own employees,pro wide l that inch ImPraaa mom art not intended aartarad rorsale.U. however,the Wildingor Impmwmenl is sold within one year of Completion.the own". builder will Isw the burden of poring Nat he did ad build m Impmow far purpose of ate.). ❑1,u Owner of the property,em uelualwly conducting with licensed mntracou m cautmct the project(Sec.70/4.Bnsinm and Profusions Cade)The Contracufs U. causes law does oat apply to an owner of property who Wilds a improve thereun.and. who coned for such projects with aContrsosrtU licensed purstant to tee Comosele is Lice.A law. ❑I not memp,under Set .B A P C for Lids muco Owner Dam WORKER'S COMPENSATION DECLARATION I barony same abler penalty of perjury one of ties following 4eelarNamc 1 bad and will malnWn.Cerdfl mofConsent la Alf-hommfor Waher'sCompen- union,as provided for by Section 37W of the Labor Cade,for the performanee of Lie work for which this permit is iauee. ❑1 haw and will maintain Worker's Compemadon Imu tAce,as mquimd by Senior 37W afthe labor Coin.fa the performance often work for which this permit or traded ' My Worker's Compensation luuruta carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE r (This section Mad not be Completed If the permit is for duct hundred infam($1001 LICA) I anifY test in the performance of dire wok fat which this Permit is Laced,l WWI no, emplayanypermn(nanymannermumbecnmembjecUathe Wo Compensation Iowa Of Cslifom(p�am L Pit I NOTICE TO APPLICANT:If.after making this CeniOdm of aremp,ion,you should become subject m the Worker's Comperm dam provision,of rite lobo Code,you mud Q forthwith comply with such proNns m this pumil iMed ll an deemrawbct. „zm CONSTRUCTION LENDING AGENCY [ti I homey affmn thin them ka Coulrodmi Indo) tagency for the perrurmanmor Ir'> the wok fa which this Permit Is Wood(Sm.3W .Civ.C.) Q Lender's Nune ] Lender's Add. U0 1 cenify that I haw tad this application and sum that Lie thew information k IT f-m com"CL 1 agree m comply with all city and county aNnan icu and sink laws relatin{m pU building construction,and hereby mthorira rephaeumivuerr this city to Omer upon the Ill shove-mcnduncd propeny for inspection puryaea 4 (We)agree in an.indemnify and keep harmless the City or Cupertino cgtins, nr y liabilities.judgments,costs and expenses which may In any way mane against said City UZ in conmiumou of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date "CEREGULATIO s. � �Q 02h7-16 Re-roofs /vim Signature Of nppramt/Cantaanor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will In applicant or fade building OCCOPALnoc oreat dle ha'numi material as in lned by de Cupertino Municipal Code.Chapter 9.IL and Lie Health Ad Safety Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. Oyu �J`No 41 Will the Applicant or room:Wilding occupant um equipment or device which If a roof is installed without first obtaining an inspection,I agree t0 remove eml,haatdau,air Conumlnsms a dcrincd by the Bay Area Air Quality Management all new materials for inspection. Dlmicty Cl Yes ON. I haw mad the Imutdcusmateriak requimmenu under Chapu ti.95 ofthe Califor. me HcWNM.S fc,y Dain,Sominm25505,25533 md25534.1 umknund thal(de Wilding dao net c ntty haw•acrook than It u my responsibility to madly the aaupanl of tee require te hkh manhe tpri vAce arerr Cenilkeu or OccupA Signature of Applicant Date Owara uthamad, G Lem Dow All roof coverings to be Class"B"or better au CITY OF CUPERTINO •m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35722036 . 00 DATE ISSUED. . . . . . . : 05/22/2006 RECEIPT # . . . . . . . . . : 34502 REFERENCE ID # . . . : 06050185 SITE ADDRESS . . . . . : 10120 IMPERIAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RAJA MANI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : PASCUAL FLORES CONTRACTOR . . . . . . . : MAXIMINO R FLORES LIC # 27533 COMPANY . . . . . . . . . . : E & I CENTRAL HEATING & AIR ADDRESS . . . . . . . . . . : 372 RIVERCREST LN CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 377-4352 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 4 , 000 . 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 160 . 73 0 . 00 160 . 73 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 160 . 73 VISA TOTAL RECEIPT 160 . 73 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---- -------- ------------------------ 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building Department JOB ADDRESS: PERMIT # v C- ' OWNER'S NAME: Z A ,' la. PHONE # S =Y5r?— GENERAL CONTRACTOR.*VASt-,.j�e( Pfarec FAX # I am not using any subcontractors: Zz . 64 Signature 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 Tile • Owner/Contractor Signature Date CITY OF CUPERTINO 0(4501 fay `W FURNACE/AC OUPEIZTINO PERMIT APPLICATION FORM APN# /�� • ��V� IX Da 2? to Building Address: • ve Owner's N e: Phone#: Contractor: Phone: License#: / � T a it G 37 tact: Phone: Cupertino Business License#: Gve Building Permit Info: Bldg ❑ Elect B -� Plumb"B� Mech Job Description: Residential � Comm tial E] For Residential Ins allations: Attic ❑ IS` floor lJ 2nd floor Adhere to min set back requirement E] or Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Q G Type of Construction: OccuZ-/'L— Strapped ancy group: _'L Strapped LJ On Platform t& Bonded LJ Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group Ir BENERGY Energy I BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cf n MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Re t1, Switch &Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL Ai PPERMITFEE Plumbing Permit Issue PLUMBING IMF BPERMFEE ME Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING