05100075 CITY OF CUPERTINO n ss a} i< $ +�'""'+'�" om � r,
BUR.DING DIVISION PERMIT ;CONTRr� URINFORMATIOV
BUILDINOADDRESS: FOREMOST HEATING PERM1TNO05100075
829 LILY AV
_OWNER'S NAME: PERMIT ISSUE DATE
PUNIT & MEGHANA JAIN 770 CHESTNUT ST 10/14/2005
NE: - SANITARY NO. CONTROL NO.
(408) 287-9234
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION Job Description
0 1 herby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Satian70(g))of Division 3 of the Business and Professions Code.and my license is
I.full mrceandeffat FURNACE REPLACEMENT
Z Llcenm Clue
Dau Contractor
Oi- ARCHITECTSSDECLARATION
111 I understand my Plem atoll bo used u public records
g0 Licensed Pntfessional
u, OWNER-BUILDER DECLARATION
.�0 9 I naso .(firm that I 1 exempt from tins Contractor's CoLicense: c Law for the
0 o following reason.Permit
170313. t.0teas and R.darn li Code:Any oily or county
$ which its is a•Permit m c fires th L eller.improve,demallah,m repair ed mumure T $950
prior m its issuance,also requires the applicant far ouch permit te He a signed smemem
FF< mornmeningwis pursuantto )orovlsioa ofthethe SarmrklJcense UosC(Charm e)or Sq.Ft. Floor Area cation
5D (eat he I,exempt
pt t Serefon70ndth basis for
the alleged
euand
on.AnyACa an or
$ that he 4 exempt Iertftvm and see buts fa six alleged eumptim.Any violNon of
Schon 7031.5 by any APPllesen for a Permit subjects the applicant te a civil penalty of 3 WRIAW90-rur- Cupancy Type
not mom thea five hundred dollars(M).
❑1,as waver of the Property,or my employ=with wages as than,elecompeaathm.
will do the work.and thestrucame is not Intended reoffered forsak(Sme.7044,Residents - q Re lured Inspections
6
And Fruitage.Code:The Cmarutorna a LiaLaw does not apply he an owner of p
property who bui lds or im pmvu thereon,and who daeauch wor!himself or Ouwugh his
own employees,provided that such improvements are not installed monad foruls.IL a
however,the building or improvement is sold within arc year of impletion,the owner.
builder will have the human of proving that he did not build or improve far purine of
Ask.).
❑1,a owner of the property,am exclusively contracting with licensed intrsemn m
construct site project(Sec.7044.Business and Praksalau Cade:)The Commuter's LI-
ccme Law does not apply m an owner of propeny.who boils or improves thereon,and,
who contracts for such pmjits with a eontrume(s)licensed pursuant m the Contrumr's
License Law
❑lam ase funder Sao. ,BAPCfa this recon
Ownerlig�Dau I C
KER' OMPENSATION DECLARATION
1 hereby&from under penalty of perjury ono of the following schardimur
❑I ham and will maintain a Cmunrnu of Consent to self-ineum for Worker's Camper. -
sales.a provided For by Section 3700 of the labor Cade,for the Performance of du
work far which this permit is iaucd. -
❑I ban and will maintain Worker's Compensation Insurance,a required by Section
3700 of the Labor Code,fm the padmarance of the work forwhkh this permit Is issued.
My Worker's CamPensuion Insurance cannot and Policy number am:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
orbs section need not he completed If the permit is for one hundred dollen(Sip)
mIna)
I certify that In the performance of Oe work for which this permit is issued.I shall not
employ any eon in any mmncrsoawbecptpe mbleGmtM Wormers'CompensaRon
Laws of Cal ami Dam ,t T d D"1
Applicant 1 4�
NOTICE TO APPLICANT.by
If.after making this Coul of Exemption,you Mould
became subject in the Worker's Compensation provisions of the labs Code.You muse
,J O foMem
with comply with such provisions or this permit shall M deed revoked.
tiCONSTRUCTION LENDING AGENCY
C~ Ihereby affirm that there is a contraction lending agency for the Performance of
ai the work for which this Permit Is Issued(Sex.3097.Clv.C.)'
Qh Q Lawara Name
iti. z Under's Address .
V Q 1 certify that 1 ban mad this application and sum that the above information is
ly!" correct I agree to comply with all city and county ordinances and sure laws relating to
Q rV' Wilding construction,and hereby authorise repaunutiw of this city to enter upon the
Lid shove-a m Toned property,for inspection purposes.
gy (We)agree to an.indemnify and kap harmka the City of Cupertino spirt
y Ilabiliva,judgments,costs and expenses which may In my way arra against said City
V 7 In canuquena Doth. rating of Ni.permit, y
F7 APPL ANT UNDE ANDS AND WILL COMPLY WITH All NON-POINT Issued b s4to� . Date 7
SOUR REGUL�10 S
t AAW Re-roofs
Signuurca ppli
AcanbCom O Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willt applicant or furore Wilding occupant owe a Media haudoa material
a sfined by by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Cade,Section 75532(4)7 All roofs shall be inspected prior to any roofing material being installed.
[:I Y" ❑No
Will the applicant or future building axuP.nt use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
sit haardnus air contaminants u do red by the Bay Area Air Quality Management all new materials for inspection.
District]
❑Yes ❑Nu
I have mad the m ardousmaterials requirements undm Clupur6.95 of the Califor.
ni&Heslth&SefetyCade,S.d.25505.25533 and 35534.1 untkruand thmif the Wilding
not currently h a unan4 Nu it u my rtainsihility m ramify site oceupeat of the
re remcnuwh' hm t metpdormlavanceofaCcnifiesuolo upanc Dom• Signature of Applicant Date
11 r� All roof coverings to be Class"B better
Owner m authorised agent Dam
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35903007.00
DATE ISSUED. . . . . . . : 10/14/2005
RECEIPT #. . . . . . . . . : 31616
REFERENCE ID # . . . : 05100075
SITE ADDRESS . . . . . : 829 LILY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PUNIT & MEGHANA JAIN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : PUNIT JAIN
CONTRACTOR . . . . . . . : CHAPMAN, ROBERT LIC # 18537
COMPANY . . . . . . . . . . : FOREMOST HEATING
ADDRESS . . . . . . . . : . : 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408)287-9234
QE 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 950.00 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
__ __________________
CHECK 164.78 681
TOTAL RECEIPT 164.78
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
3 to Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OJPEI�TINO
Building De artment
JOB Aa s: Ll L y fv .. Cu f EFr,f j 0 9� t y PERMIT #
7
OWNER'S NAME: FV NiT c HGANA 11V PHONE # 40V 718 186-1
GENERAL CONTRACTORo f-EMDU 146 -ria FAX #
D 17` CONLyTIo^iwa
I am not using any subcontractors: M;- !0
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
05 1 ot-AD'75
CITY OF CUPERTINO
FURNACE/AC
• CUPERTINO PERMIT APPLICATION FORM
APN # 359- 03—Oc��- Date:
Building Address:Y -2 ? L( L �/
Avg,v u E CvPEf-n4 o cyi- 9 ,�-v �y
Owner's Name: Phone #:
PUry d— h66; HAn(a 1A IN � 0g "7/B /162
Contractor: License#:
rt4-E HD ST I &A7-,N J}ND At4 CO3vzgr,&w a. ?3 `'( -(.9—
Contact: Cupertino Business License #:
rviv1 � A n(
Building Permit Info: U fZ w AC 6 (L E f LkC E NEN 7
Bldg ❑ Elect Plumb Mech
Job Description:
Residential ja Commercial ❑
For Residential Installations:
Attic ❑ 1" floor 9 2nd 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 of Project: Q Type of Construction: Occupancy group:
N
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement T
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin 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