06080264 CITY OF CUPERTINO ''`��a� ' 4
BUILDING DIVISION PERMIT CO ?TRA-CTOit TNT'( RMATT�N �'
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BUILDING ADDRESS: AB OLING & HEATING PERMIT 140.06080264
10377 LAS ONDAS WY
OWNER'S NAME: PERMIT ISSUE DATE
SATISH MENON 31845 HAYMAN ST. 08/31/2006
E: SANITARY NO. CONTROL NO.
(510) 471-8181
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BIS I� PLUMB
� 0
o0 LICENSED CONTRACTOR'S DECLARATION Job Description
u� I booby a(prm N°t 1 am Valued unhr prevision of Chapter 9(commencing
with Section 7IXI0)of Division 3o(thc Bueine and ProfeuinaC and mylkeneb
, N mfulifmceandc612-* gj REPLACE EXISTING FURNACE 110K ADD ON A/C 4 TON
Lima.am,
YN SIDEYARD.
DamesARCH SDECLARATION
I < I understand my pins shall W used u public teends
i Ur
i0 Licensed PMfessianel
Oat I mo sUIIDER DECLARATION
1 hereby.(Trm Intl 11, enmpt s an Ne CanlractCo Ethane taw(err the
,D O following moon.Permit
a 711713,Business and Rder o i Cade:My ally Of caumy .
;20 which mqussu a permit re cores t,spec raincoat.hmdW,ri capairsig any strucwm
3;0 prim W its issuance.alumcar require the applicant toe such permit W Tile a Law statement Valuat (1 3 3 2
;r< NtlWblieendpuasunttoMeofDagon3Ne eButucetadennlaw(CWpter9 Sq.Ft.Floor Area
O (cmnmcneing with Section 7000)af Diviatanlaf the Budneasud Pofeulana Cade)or
3
that W b asampt Nerefrem and she baste fm the a oicd agmMPuom My N0lallon of
Section 70713 by say applicant fm a permit subjects the appr=L W a cavil penalty of ,k ry7s7 14N77 tD{1�ter Occupancy Type
not mom Wan pm hundred dallus(5500). 391.'1' A`�mj v; 0 0
1,as owner of Me property.m my employees with wages u their sale compensation.
O 7 L 77 OG
will do dm work.sad Ne aWetYR Y nal intended or offend for sale(Sm.]BM.Business Required Inspections
and Pofeuiom Code:The Canuacures Llan n ne
Law data apply m an owner of q P
property who buildsorimpmwe thereon,and whodoes sm1twork himselfrothrough his
awn employees,provided thatanh improvements are amt intended oraRemad for sale IL
however.the building or impmvcment is sold within ane year of completion.the owner.
builder will bar,de human of Moving that W did an,mild or impmm for purpose of
ask.).
0 I,as owner of the property,am asclusimlY contracting with licensed enntrelOn la
construct Ne prefea(Sec.7014,Business and profeasmna Code:)The CooumWrs U-
con law does not apply W an owner of property who Wilds or impoms theman,and,
who contracts for such projects with aeanracter(s)Ilmna d Normal W the CantractoYe
Lim.law.
O l am aemptunder Ser. ,B&P C for Nb moon
OwnerData
WORKERS COMPENSATION DECLARATION
1 hereby aRkm under Mondry of perjury ane of the following hcluaMona:
0 1 ham and will maintain a CeniOau of Conant W elf-insure for Wortela Compmo-
soon,u porulded for by Section 77M of the labor Code.fm M e Md...of Ne
work for which this permit is issued.
I have and will..few.Workefs Compensation Inumna,as myvilad by Section
700 of the Labm Cade,for the Malmmanceof the werk for which this permit is lasued.
My Wgc�e.Campena n Insu a atria and Policy numbu am:
Carier��, let
POIky Na.C2�6o'�y3to1
ERTIFICATE OP EXEMMUN FROM WORKERS'
COMPENSATION INSURANCE
rob section need name completed If Me permit is forane hundred dollen($100)
or less.)
I certify that In the performance of the work for which this Permit b issued.I shall net
employ any person In any manner an as W become abject W We Wmkun'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this CoNpcam of Eemption,you should
beton subject W the Worker's Competition provisions of the Labor Code,you mug
.,O (onhwith comply with such pmvialon or this permit hall he tlecmed mmkud.
ZN CONSTRUCTION LENDING AGENCY
F+ 1 hembya111na Nal Nem is a eonsuna nolending agency fm Me MIlemnca of
Ci> Ne work fur which Nis permit is issmA(Sec 3097.Civ.C.) `
W Q Lance's Namc
z lanhfs Add"
U O I certify Nat I have read this application and sum dm Mte above information it
DL F conch.I agree to comply with all city and county on inners and sum laws Misting W
C U building construction,and hereby sudsodre repneenutiara of this city to enter upon the
W aWvc-mentiuncd MWMeny for inspection purposes.
0. (We)agree to save,indemnify and keep harmless the City of Cupertino against
,.y� liebilitia,Judgmenu.costs and saps which may in nay way accrue agalnslasid City
0 inconsequent Ne grnli a( rmiL
APPLICA ND , W L 1 A N -POINT Issued by: Date _ 1
Re-roofs
Signature of ApplicnUConuntor Doma of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will Ne applicant or fumru building mcup of state rehandle havudous material
az def nad by the Cupertino Municipal Code.Chapter 9.12,and Mro Health and Safety
cah,scedan 2s 57:a)7 _ All roofs shall be inspected prior to any roofing material being installed.
0 Ya
Will the applicant or mon Wilding=opal n equipment or devices which If a roof is installed without first obtaining an inspection,l agree to remove
..it hvamon air conuminsnu as depend by Ne Bay Area Air Quality Management all new materials for inspection.
Dig,kt7
0Ya
1 have mad Ne ha'rard.maerials requirements mcer Chapter 6.95 of the C°li(on
ria Hcalth&Sofa Cah,Sms.2550 25777and 53q.lmdereuna Nn ifdu Wilding
does not curre tum a len my iniliy M ratify Ne asyp�t r Ne
requiemen mbm i fOca /// Signature of Applicant Date
Owner or antbadacd agent p Date ` All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36929038 . 00
DATE ISSUED. . . . . . . : 08/31/2006
RECEIPT # . . . . . . . . . : 35862
REFERENCE ID # . . . : 06080264
SITE ADDRESS . . . . . : 10377 LAS ONDAS WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SATISH MENON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : GERALD UNRUH LIC # 24643
COMPANY . . . . . . . . . . : ABC COOLING & HEATING
ADDRESS . . . . . . . . . . : 31845 HAYMAN ST.
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510) 471-8181
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
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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 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 176 . 54 0 . 00 176 . 54 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ------------ ------------------
OTHER 176 . 54 MC
TOTAL RECEIPT 176 . 54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
___________-----------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCOF Fax(408)777-3333
4FUPEkTINO
Building De artment
JOB ADDRESS: 103 77J 0'"d«.o PERMIT #
OWNER'S NAME: 3 Lam PHONE #, 7--9;Li 9 0
GENERAL CONTRACTOR Ll 9 C f FAX #
I am not using any subcontractors:C?XC 1"
4 - $� 3 o
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
�6
Owner/ContractdSignature Date
CITY OF CUPERTINO O (a U12JY`�
FURNACE/AC
Cm of
CUPEkTINO PERMIT APPLICATION FORM
APN # „ry^ ! Date:
Building Address:
!03 7 7
Owner's Name:^ Phone#:
v Li-5 21 7 Q
Contractor:0 0 C y Shona: /o 4 �1• r-!8 License x,23 Ff3
Contact: Phone: Cupertino y �e�3ense#:
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description:4&/, . ,4
..d�
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ® 2"d floor❑
Adhere to min set back requirement®
ForCommercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Ap roval Required ❑
Cost of Project: Type of Construction: Occupancy group:
'7.33 2-
Strapped
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
I BENERGY Energy BUILDING
I BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL
I BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
I EPERMITFEE Elec Permit Issuance ELECTRICAL
I MPERMITFEE Mech Permit Issuance MECHANICAL
I PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS as Pi in S stem Fee PLUMBING
BUSLIC Business License BUILDING