06060055 CITY OF CUPERTINO
BUILDI4lG DIVISION PERMIao INI+'ORMAT7QN
BUILDING ADDRESS: AIR QUALITY HEATING & AIR 5.HT"..06060055
22423 RAMONA CT
OWNERS NAME: PERMITIsSUEDATE
� KULDEEP KARLCUT 714 NORTHRUPSANITARY No. conIe No.
E. (408) 293-7138
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG EI.ECr PLUMB MECH
o 0 LICENSED CONTRACTORS DECLARATION
WF T hereby grim that 1 am licensed under provislou of Chapter 9(commencing Job Description
;Zey wish Section 7")of Division 3 of the Butlncss and Professiuu Code,arW my Became is
"oma inten lnmaandc REPLACE FURNACE AND. ADD AC UNIT
Lkemm clas o
a-p Dace Conmcer s y
ARCHRECTS DECLARATION
i I urdemand my plans small be used m public memos
taU
G y Licensed Professional
3 OWNER-BUILDER m the Comment's
o men
f ION
1 Wmhy.(idem on 11. eaempt from Nc Cesimet is l.iemsc Law for the
:O o following mason.(Section]031.5,Business and Pmfdemoli h.or pa city or county
structure
wM1ich equina a permit m cnnswn,elmq Wpmvc,demolish,m¢Pair any swcwm 1 QQ
�zi pnwnis issuance.also mquimssM applicant forsmh permit t.tilt asigncd summcnt
thatlsaulicenxJpursuamloNepsovisionsofNeConuacmrit.icenxlaw(CTap¢r9 Sq.Ft.Floor AreaVk6ation
2 r o (commendng with Suction 7")of Division 3 of sad Businus arW Pmfeaiom Codc)ur (�
$
that be is wimpt thaefrom and the basis fur de alleged a mapuo t.My violation of
Seem.]031.5 by airyapplicant fora permit subjects the applicant W.civil penalty of P U U ancy Type
not mare Nan five hundred dollars(5500).
I,as owner afthe property,or my employe with wages as their sok compensadon,
will Pr Neurons arta Nemuaont u mors Lnded w offend s and a(Sec. owner
of
and anywhions Code:The C.nsetoand License Law de ort apply ff an owner of Required Inspections
den erty who Wiprovid mprory thereon.ormenc M d rs nothhwa a himself wthrough his
awnemploye,providedmatsuchem 1.Sold i. .yean of ffebel
for ale.,.
however.Ne building a improvement la sold within arc year of i.p.fo.Ute use of
builder will bare tad burden.f proving Nn W did tet Wild m improre(w purpose of e
sale.).
D 1,as owner of the property.am exclusively combining with licensed cmnbsters is
construct the project(See.74)44.Business and Profusions Code:)The Caovaer's U.
ecce law dots not apply to an curter of property who Wilds or impmru thereon.and
who co umets for such p njems with a can rac er(s)licensed pursuant ro the:Contractors
License Lan
D I am exempt under See .B k P C for Nis msson
Owner Data
P1WORKER'S COMPENSATION DECLARATION
I Wmby affirm ender Prosily of perjury oro of the following arslamimu: .
ham and will maintain a Cerufreate of Covent to self-iu e,forWorkersCompcn-
sauon.as provided fur by Secum 3700 of the labor Code.for LW Md...of the
were for which this permit is issued.
D I hire head will maim se,Workers Compcnadon I....u hump d by Section
3]00.1 the Labs Cade,far the perfarmence of the wwk for which this Permit is issued. '
Mywortr sCom"pe'winTa Bsunnce cartiye�r y(ewd olli/cypn mher
Carrier. {(�g�d,ylK 1 _�v"Po slryu�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ibis scxvm need not W completed Buss permit israone,hundred dollars($100)
or less.)
1 cmd!y Nat in the Perform.of the work for which this permit IS issued,l shall ma
employ any person in any manner m as as bceomc subject he LW Worked Compensation
Laws of Calif.ml,Data
Applicant
NOTICE TO APPLICANT:If.ager making this Ontifrcae of Exemption,yon ahould
become Subject an the Workers Compensation Mormons of the Lahr Code,you mute
O foMwich comply with Such provisions w Nu permit shiln
shill Ise deemed aked.
Z CONSTRUCTION LENDING AGENCY
N? IWrewh Wfithi Nis Vert isaedtSeeu 097,Crag agenry far Ne pedmmance of
L
the wort for which Nu permit is kssueW(Sx.J091,Civ.CJ
a0 lender's Name
�z Lemdera Address;
U Q 1 certify that L have mad Lids application and sate and the aWm information is
Ir.I-' correct.1 agme to comply with all city and county o th.and sate laws Lelaumg to
QU building construction.and hereby suhmive rcpresenatims of this city to cner upon to
.1xwe mentioned property for hufactwo purposes-
F-, We)agree to save,indemnify and keep harmless Ne City of Cupertino against
N Iiabilidu.juigmcna,Casts and expo.which may in any way amueagaiaisaid City
U Z inconsequence of the granting of this .it r
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:REGU
SO Date
CE TIONS.
&/7 p
Sigmmam or ppmData.Contractor Re-roofs
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will t e applicant w forum Wilding decupncLanna Or handle transactions material
U dtfined by Ne Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Core.Section 25532(a)t All roofs shall be inspected prior to an roofing material beim
El Y. Lp0w P P Y g g installed.
Wits Nan applicant fTumm Wilding occur nt us,equipment If a roof is installed without first obtainingan inspection,I agree to remove
Ton e w s Pmcmt.t Management
P
_Suis horaNnus air conamiunu ns JCOnaO by Ne Bay Area Air Quality Managcmcnt all new materials for inspection.
DiNrictt
Dy. WNe
I have mad the hiondo smhmnalarcquimnems unit,Couper 695 of the Caldor.
.in Hcal"SaretyCodc,Sectiwts 15505,25533 and 25534.1 unJcmuW the ifthe Wilding
does not cumandy ban a b:nanl Nu it u my responsibility to mufy de a<opmt of de
r:quimmenuwhic utb,: tpnormiukutecofaCatiOca,eofQccu cy. Signature of Applicant Date
O nmmMthonred semDate 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 . . . . . . . . : 35701090 . 00
DATE ISSUED. . . . . . . : 06/07/2006
RECEIPT # . . . . . . . . . : 34725
REFERENCE ID # . . . : 06060055
SITE ADDRESS . . . . . : 22423 RAMONA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KULDEEP KARLCUT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : AIR QUALITY HEAT
CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791
COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON
ADDRESS . . . . . . . . . . : 714 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 293-7138
qEE 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 10, 000 . 00 1 . 00 0 . 00 1 . 00 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 . 74 0 . 00 176 . 74 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 176 . 74 52353
TOTAL RECEIPT 176 . 74
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
swu
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
g�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # 14 o$ - — 17J 3g
GENERAL CONTRACTOR: . tr FAX # cf OB _ ag(
I am not using any subcontractors: / (3
S*gnature Date
Please check applicable subcontractors and complete the followinginformation:
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
caner/Contra for Signature Date
L- CITY OF CU PIE]L TIINO WWW ,9 j
•CUPER,TINO PERMIT APPLICATION FORM
APN # 3�5-1 –O' _ C)9D —1571e: 61(,16
ate: 61(,16(o
Building s:Addre
aa 3 e,- C -L."no 0,0 So l
Owner's Name: Phone#:
a 53 -3cw
Contractor: License #:
rtn �' (0
Contact: Cupertino Business License #:
aa7y �
Building Permit Info:
Bldg ❑ Elect .lam Plumb .al— Mech
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor ❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required El
Cost of Pro,6ct: Type of Construction: Occupancy group:
{/ 0 Ch9 ` to_- r 3
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm 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
BPF,RMFEE Bldg Permit Fees BUILDING
BPLANCHIC Plan Check Fee BUILDING
BUSLIC Business License BUILDING