06060098 CITY OF CUPERTINORoo
• BUILDING DIVISION PERMIT -.CC)N 'Re�i.��x XN�'URMt�.TIQ I y
7 'b •4.eniye�oa4L,
BUILDING ADDRESS: , FURNACE & ,AIR CONDITI R#1Mto'06060098
10976 LINDA VISTA DR
R'S NAME: PERMIT 16511E DATE
ARINA TIWARI 1712 STONE AVE 06/13/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITELTXNGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION Job DBSCrIpIlOn
V 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Busim a and!Pmrcasiuw Code.and my hleense b
m y in fulCan s t ADD A/C 3 . 5 TON
Licemc Chafe _ Lk.N� 010&
Dam Contractor
arts 091ARCHrE=it as public
AT10N h4�iV�'!!�4
3 U 1 uMenunJ my Plass shall be wed u public recnrth y
6
tp
iiLicensed Professional
cy5 OWNER-BUILDER DECLARATION
I I hereby affirm that 1 am tacmpt from the Conaactoh License Law for the
a o fallowing reason.(Smdon IID 1.5,Business and Pmrrssions Cade:My city our county
which requires a permit m cowtmc4 ahmr.hnprow,demoltsh,or repair any Correction $3800
�Z'n prim an is issuance.also mqui,es the applicant forsuch Permit to nhC a signal aocumnu
E G that heislianmdpurnere uaNcprovisions Ofthe Camrmmr'sU mL..(Chapttt9 Sq. Ft. Floor Area Valuation
(commencing with Section 700)ofDivision 3 of the Burimaand Profusions Cade)or
9 that he is eaempt dmmfmen and the basis for the alleged exemption.Any violation of
Benda.703U by any applicant par.permit subjects the applicant On a civil pewhy of r Occupancy Type
Mt come time Ove hundred dellaaa($701
0 I,ssowmfafl pmpmy,mmytmployeeswiNwaauNebsoleeompenadon,
winds the work,and the swarm a rstimanded"offend formic(Sec.7044,Bushum Required Inspections
and Professions Cole:The Cantncmfa Lhanse Law does oro apply a an awoer of q P
property who Wildtorimproves thneem.and who doessuch work himseirm NmuN his
ownemploynes.provided that ash improvements am eat amended oreffereG forma B.
however,Ne building our improvement is said within oro year of Completion.do awm-
Wildex will law the budrn of proving that he did amt bund m Impmm for purpose of 4/ ^ /
ai l✓/j
co 1.as awmr of the property,.B eacem and Contracting with:)The
conpaemn U.
7
camuuct the es project(Sec.n th.w e r of and property
who ui cadet Tim Comremors of 3
.he Law dmforoapply manowoerofproperty whobuildsmhnn Mt he C mumerod.
who conuacu for such projects with aConuxtoNs)licensed Puraam m lice Conuanors n
Licence law.
❑1 w exempt entice Sec. .B 8 P C for the mason Cal
Data
WORKERS COMPENSA71ON DECLARATION
I threby affect under pewlty of pexjury can of the following decluaUans
Ihaw and by
Section
37M atLmmCod Imamut Wmema Cmnpem
radon.r providedhLid(m by Ss bon 770 of the Tabor Code.for the perfonvaox of the
work far which Nis permit u bound.
❑1 have and will maintain Winters Compensation Insurance,as required by Section
370 of the labor Coln,for the performance often vert fm which Nis Permit IS iawed.
My Workers C of aunoa lwm ce wrier and Poli numher
Carrier. Policy No: OS
E0.17FlCA OF
COMPENSATION
NFRO WORKERS'
COMPENSATION INSURANCE '
nbu mice need rot M Completed if ft permit Is f a.hundred dollma($10)
or moa)
1 car ify that in the performance of the work for which this permit is issued.I Nall not
employ any penton in any manner an u to berome subject in Lis Worlma'Compenwion
Laws of California.Dae
ApPlianI
NOTICE TO APPUCANT:If,after making Nu Cmiricam of Exemption,you should
become subject in the Winters Compensation providau of the labor Code.you muss
Oforthwith Comply with inch provisions or this permit Mall W decmcd remtrd.
5; CONSTRUCTION LENDING AGENCY
[—r 1 Corney afTrm that Vert b Nagcm
a eorimunn lending y fordm Performance of
fYv•7 Ne wort far which Lida permit is issued(Sec.7097.Civ.C)
Iii Q LendersName
D z Lenders Add, ,
U0 I cenify that 1 have mad this application and tum Na the above infonnadun V
if+P Correct.1 agree of Comply with all city and county ominaraes and sue laws rtladng In
DU building construction,and hereby authorin representatives of this city to enter open the
W aWvc-mcntiuncd property for impaction purpose&
(We)agree m ave,indemnify and trop harness the City of Cupertino against
it,4 limilims.judgmena,case and expenses which may in any way aceme against aid City
U Z in consequence of the gntndng of this Permit
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUaCE REGULATIONS.
-f!(»_ NS _!/lc P41�k4� Re-roofs
Gi6nmure of AppnwnUCantncmr Div '�,Py Of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building mmpammure or handle humdow material
Fned by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes (No
Will ft applicant(,/Insim building Occupant um equipment or deal=which If a roof is installed without first obtaining an inspection,I agree to remove
emit handouts air rontsmiwnts as dcnnsd by the Bay Ara Air Quality Management all new materials for inspection.
Disuic0
❑Yu []Nu
I have read the huamsan mMriab requirements under Chapter 6.95 oftheCalifar-
nuHcalN&Safely Cede,Secdm27505.25533&WI5534.1uner dthniftim building
damn not currently have a event that It u my impowihility to notify the occupant of the
nequiremc which mea be met prior m arsumcc oft Outhicaa of Occupancy. Signature Of Applicant Date
0 cr or authoriacdagent Dem'
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
A✓' Cupertino CA 95014
Telephone(408) 777-3228
IUPCITY OF
EPTIN� Fax(408)777-3333
rC I�1 Building Department
JOB ADDRESS: PERMIT #
1,0q1; 6 G,' ,r �� ddD �-
OWNER'S NAME: Ao�jow/4 PHONE #
GENERAL CONTRACTOR.,e -1 FAX #
I am not using any subcontractors: J��•-- _ Olo/J :��
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical p
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
Item 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35614040 . 00
DATE ISSUED. . . . . . . : 06/13/2006
RECEIPT # . . . . . . . . . : 34823
REFERENCE ID # . . . : 06060098
SITE ADDRESS . . . . . : 10976 LINDA VISTA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ARINA TIWARI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
• TELEPHONE . . . . . . . . : (408) 293-4717
FEE ID UNIT QUANTITY AMOUNT , PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----=----- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 3 , 800 . 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 161 . 93 0 . 00 161 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 333 . 22 VISA
TOTAL RECEIPT 333 . 22
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
______________--------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
CITY OF CUPERTINO
'- FURNACE/AC
�UPEf�TIN0 PERMIT APPLICATION FORM
APN# Date:
Ste-14- D,, oma
Building Address:
l ' r *,rl t-
Owner's Name: Phone #:
7- z
Contractor: Phone: License#:
W
Contact: Phone: Cupertino Business License#:
2 -11�
uilding Permit Info:
Bldg ❑ Elect Plumb L Mech 0
Job Description:
J
Residential Commercial ❑
For Re idential InAallations:
ttic 1s` floor LJ 2nd floor❑
dhere to min set back re uireme
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: Occupancy grrRp:
��.
Strapped EO On Platform El Bonded LLJ Sq.Ft. Floor Area:
New Location El Re lacement El
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
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
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING