06060256 CITY OF CUPERTINO > / °�' 77—
BUILDING
`BUILDING DIVISION PERMITC�NTRAGTORINFORMATION
BUILDING ADDRESS: CONDITIONED AIR PERMITN0.06060256
1198 S STELLING RD
OWNER'S NAME: PERMIT ISSUE DATE
RAVI SHARMA 1701 LITTLE ORCHARD
ONE:
SANITARY NO. CONTROL NO.
(408) 291-2220
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ioo LICENSED CONTRACTOR'S DECLARATION - Job Description
1 Withy affirm Nat I am licensed anter provisions of Chapter 9(commencing
?Z with
L Section 701g))of DivivonJof the Bnsinea and Profustiou Code.and my licenxal
3lgz ;«Ice°cls:d`f�` �j tic.a 4t i 51�` R & R FURNACE AND ADD ON A/C
Dam e,(.o'er Contractor
a
ARCHITECTS DECLARATION
l m< I understand my plans shall h used as public records
paU
cGy LvcnxJ Pmfeuional
1 OWNER-BUILDER mDECLARATION
COC I hereby alum Nat 1 1. exempt from the Contractor's License Law for the
O O following mason.(section 703 1.5,Business and vs.demolish.
Code:Any city Of coumy
<m which requires a permit m c.nsW.L alcor,impmm,dcmoliN,nr repair my structure
$5400
�¢r prior to iu issuance.also requires the applicant(or such permit to file a signed salement
< thathc isliceracd pursuantm the pmvfslons ofthe Contractor'slJcenx Law(Chmtcr9 Sq.Ft. Floor Area Valuation
it- (commencing with Scetion70W)ofDivision Sof Ne Businmsnd Professions Code)or
Y — that hal eacmpt therefrom and the basal for the alleged euempuon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ET Occupancy Type
not mart than five hundred dollars(SM.
❑ I.uownerof Nepmpvry,mmywployemwiNwa uNcirmlccompewuon,
will do the work,and the swcum is not uncritical or offered forsak(Sec.7044,Business
and property.1W
Wilds Code:The ma a scteYs Licuuc law docs rot apply lf an owner is $wired IhS�eG
ownenywycemprom;mgso such han,andwho doasucnwmk himself.through his
owneer.theuilding or Nm such;mpmrcmcnuin..ear isftleroffcrW rorsale.n-
V `
huilder .NebuRdingmimpmmmvin,On,hesold didn tone y<vofcompletion,the puowner-
huildm will ham dm burden of proving Nat he did rot xiw or improve for purpose of
sale.).
❑L as cramre p of project
property,.Business s and convening with licensed cert eters m 6
c ue La des not(Sec.o in wrofand property
whoWilds
Code:)pr Convenor's e
whotaw dace not apply je an owner of property who builds or improv Ihmton,ors.
whto conuacu for such projects with a conmaof(s)licensed pursuant m th Contractors
Lk:enm Law.
❑lam uempt undo See .BkPCfer dtis won
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aufrrre under para ty of perjury nae of th following decimations:
1 have and will mainuin a Cenifiam of Consent in self-imare for Worker's Compen-
,on,u provided for by Section 3700 of the labor Code,for the performance of Ih
work for which this pcmit is issued.
1 have and will mainum Workers Compensation habitants,as required by Section
37W of the labor Code,for the Kdombance of the work for which Nal permit is issued.
My Worleces Compensation Insummi,carrier aM Policy number art:
Carrier.of 0001 US-OG 1 Policy No.: MIiT'yYgfvfei
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Otis scaien need not be completed if the permit is furone hundred dollars(SIM)
or less.)
1 certify On,in the perform....Of the work for which Ns permit is issued.1 aball not
employ any person in any mammrso u Of become subject to Ibe Workers Compensation
Laws of California.Dam
Appliam
NOTICE TO APPLICANT:If.After making this Certificate of Exemption,you should
become subject us the Workers Compensation provisions of she taper Code you mux
0 z forthwith comply with such provision or Our permit shall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
h-- I hereby affirm that there is a Construction lending agency for the,perfamarce of
Cft work XVI.which Nis permit is issued(Sec. I,Civ.C.)
QLender's Name
7 z lender's Address
V 0 1 cen;fy that 1 have head this application and site Nat the above information u
U. F-' correct.I agree to comply with all city and county ordinances and sum laws relining to
OO building construction,and hereby authoriao rtprtxnutives Of this city to enter upon the
ah°vcmernwed proper for in'co..purposes.
(Wm agree to save,indemnify and keep harmless the City of Cup( against
rtinto
fn liabilida•judgments.Cosa and expenses which may in any way
&a=againslnid C;ty
C)z A consequence of the UNDERSTANDS
of AND WILL
Issued by: Date
^ APPLICANT UNDERSTANDS AND W ILL COMPLY WITH ALL NON-POINT
SOU REGUL TIONS. e
��']]�1A..Lyf C
sign, App tonmxlor G a0_0 Re-roofs
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of future Wilding occvpamvtore or lundk hammous nommad
al
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25572(a)?
p Ycs �° All roofs shall be inspected prior to any roofing material being installed.
Will ft applicant orfuture buildinyompant uxcyvipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
it haraNnus air conami,unu as defined by the Bay Area Air Quality Management all new materials for inspection.
Wits?
[3 Yes �U
I have read the harardVcussmmaterials requirtmcnss under Chapter6.95 of NeCi lifor-
niaHalth At SafctyCode,Scctions25505.25533 and 25574.1 understand Nmif do building
dura not mancndy ham a roman.Nat it al my responsibility to notify the occupant of No
rtyuirtmcpywhich must xmetprimrtolad.Or.cmalfi orOcapaney. Signature of Applicant Date
Ownet l� -W -Od All roof coverings to be Class "B"or better
r or e�ihoriecd agent Date'
CITY OF CUPERTINO
�em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36225018 . 00
DATE ISSUED. . . . . . . : 06/30/2006
RECEIPT # . . . . . . . . . : 35081
REFERENCE ID # . . . : 06060256
SITE ADDRESS . . . . . : 1198 S STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RAVI SHARMA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CONDITIONED AIR
CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334
COMPANY . . . . . . . . . . : CONDITIONED AIR
ADDRESS 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 291-2220
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 6, 000 . 00 0 . 60 0 . 00 0 . 60 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 . 34 0 . 00 176 . 34 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 176 . 34 VISA
TOTAL RECEIPT 176 . 34
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
r, Community Development
r A�i 10300 Torre Avenue
` Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRES : PERMIT #
/41 e S Stc l-L , O 6O z-VG
OWNER'S NAME: F1-V I S PHONE #
GENERAL CONTRACTOR: M FAX # g- -
I am not using any subcontractors:
Signature D
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS CENSE #
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 Roc
Tile
Owner/C ntractor Signature Date
CITY OF CUPERTINO 0(00tjorcOw
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
0Co
Building Address:
1 � 9S-fe( li FZc�
Owner's Name- s/L Phone #:
RA-v a v mcr 40g - Sa8 - y.Zss
Contractor: _ Phone: License#:
LID? a 4 t-aaa t1 4 S I to z
Contact: P one: Cupertino Business License#:
Tw
Ik G � - ani-aaao
Building Permit Info:
Bldg ❑ Elect J9— Plumb Ef-' Mech CR'-,
Job Description: 4,16
Residential Commercial ❑
For Residential Ins llations:
Attic El 1 s` floor 2nd floor❑
Adhere to min set back requirement 0�
Fr Commercial Installations:
Vo
eplacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project:3— _ Type of Construction: Occupancy group:
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location R lacement E
Qty. if
ApplicableFee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN 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
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