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11120097I : , CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 PHAR LAP DR CONTRACTOR: VALLEY HEATING PERMIT NO: 11120097 & COOLING OWNER'S NAME: KRISH BALA 1171 N 4 TH ST DATE ISSUED: 12/16/2011 OWNER'S PHONE: 4083403957 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 CONTRACTOR'S DECLARATION 17 [; r /+LICE/NSED License Class (_ zt/ Lic.# �C.:J �S"fv BUILDING PERMIT INFO; BLDG ELECT PLUMB , r 1-1 r7 / // t/.- V.-(( JZ t( MECH RESIDENTIAL COMMERCIALr JOB DESCRIPTION: REPLACE FURNACE Contractor a i Date ell 1 hereby affirm that I am license order the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. - I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $3017 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32639051.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the I ^I 1 granting of this permit. Additionally, the applicant understands and will comply Issued by: C/ l J' Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. '7 RE-ROOFS: Signature O/JAr*�( e_/eCr All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 em exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this g p-.� 2f Owner or authorized agent: civ Date) /4 %�� permit is issued. I certify that in the performance of the work forwhich this permit is issued, I shall not employ any person many manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is ' correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 6 ITEMS OF 12 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32639051.00 DATE ISSUED.......: 12/16/2011 RECEIPT #.........: BS000015585 REFERENCE ID # ...: 11120097 SITE ADDRESS .....: 10211 PHAR LAP DR SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: KRISH BALA ADDRESS ..........: 10211 PHAR LAP DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: bethe COPY # : 1 RECEIVED FROM ....: VALLEY HEATING CONTRACTOR .......: ATKINSON, THOMAS LIC # 141 COMPANY ..........: VALLEY HEATING & COOLING ADDRESS ..........:1171 N 4 TH ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)294-6290 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- -ADMIN ------------- HOURS ---------- 1.00 ---------- 41.00 ---------- 0.00 ---------- 41.00 0.00 1BCBSC VALUATION 3,017.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 3,017.00 0.50 0.00 0.50 0.00 1MFR=<100 UNITS 1.00 130.00 0.00 130.00 0.00 1MPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 0.00 ---------- TOTAL PERMIT ---------- 260.50 ---------- 0.00 ---------- 260.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 521.00 --------------- 521.00 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 22976 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING i11)6o9r GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinalcDcupertino.org PLUMBING MECHANICALLECTRICAI- DMISCELLANEOUS MISC PROJECT ADDRESS I0 11 yI �- 1 y APNM '�2// —/ q— DSI OWNER NAME PH NE �r(E-MAIL STREET ADDRESS Ir�� 1 1 (lr., ^. CITY, STATE, ZIP C�f�..l I (,I `I FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑COW"CTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMBi(y �`.•//�1'' LICENSE NUMBER��Ij� oo LICENSE TVPEO � BUS. LICA ,1[�� COMPANY NAME it E -MA FAX STREET ADDRESS li11 CITY, STATE, ZIP ,^ .`bio �I I j, U O- PHONEi 22 Lfq9 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE m DUPLEX ❑ MULTI- FAMILY USE OF .-Do' BUILDMG: COMMERCIAL PROJECTINWILDLAND ❑YES URBAN INTERFACE AREA NO PROJECTOJ ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICMLER HOME? ❑ NO DESCRIPTION OF WORK Toy- Vaa /j TOTAL VALUATION .3Di RP.CBIVED BY`1 By my signature below, I certify to each of the following: application and the information 1 have provided is correct. ordinances and state laws relating tobuildi�g construe' n. Signature of ApplicanNAgent I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local I authon representatives of Cupertino to enter the above -identified property for inspection purposes . Date: SUPPLEMENTAL INFORMATION REQUIRED ' k ; „ G ; OFFICEUSE0NLY ❑ - IfE-COUNTER�' I`~ T' ❑ EXPRESS - ❑ STANDARDS „ . .. Li.y .. I.. �❑ LARCE''i l E ❑ MAJOR . MEPMiscApp_2011.doc revised 06/21/11 ,�� CITY OF CUPERTINO I/ii l FEE ESTIMATOR - BUILDING DIVISION APPLIANCE/EQUIP TYPE ADDRESS: 10211 pharlap dr. DATE: 12/16/2011 APN: BP#: REVIEWED BY: bobs. "VALUATION: 1$3,017 *PERMIT TYPE: Mechanical Permit UNITS PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY &D or Duplex USE: Furnace, Forced -Air PENTAMATION FURNIAC PERMIT TYPE: WORK re alce furnace at same location. # SCOPE P'ci-mit Fee: APPLIANCE/EQUIP TYPE FEE ID IPluu)h, Plan Check QTY UNITS BP FEES Ek°;:. Pe)»r: Foe: Furnace, Forced -Air 1MFR=<100 011ier h7ec. Lirp. ET 1 # $130 P'ci-mit Fee: Supp)/. Insp Fee —77 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Crinstrr)ctiun Tax: Administrative Fee: IADMIN $41.00 Work Without Permit? 0 Yes O No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $130.00 Strong Motion Fee: IBSEISMICR i Mech. Plan Check 0.0 hrs $0.00 IPluu)h, Plan Check Etna I'iau Cf"'fk Mech. Permit Fee: IMPERMIT Plumb. Peindl Fee: Ek°;:. Pe)»r: Foe: Other Mech. Insp. 0.0 hrs $44.00 ()file,), Numb 7)up, 011ier h7ec. Lirp. ET 3,f"ch. Inxp. FYue: Plumb. Imp. lrve. Elec.lm7). Pep'� NOTE: This estimate does not Include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addh7 info FEE ITEMS (Fee Resolution 11-053 Elf 7/1/l/) FEE QTY/FEE MISC ITEMS P&m (;Garb' Face: "'(ppl. PC Pee PME Plan Check: $0.00 P'ci-mit Fee: Supp)/. Insp Fee —77 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Crinstrr)ctiun Tax: Administrative Fee: IADMIN $41.00 Work Without Permit? 0 Yes O No $0.00 Advanced !'/arming? Feel: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0,50 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.50 Revised: 12/04/2011 Nj CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 0211 4rlk&PERMIT # OWNER'S NAME: 96 Kr, PHONE # -3 — 345 GENERAL CONTRACTOR: ✓u 626LOBUSINESS LICENSE # 11Y ADDRESS: !V q4A $ CITY/ZIPCODE: S1,c Tse QS!/ *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork. Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date