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08040182 (2) CITY OF CUPERTINO .x s,. ,qY„tag, +".v'Miiu.-5"' BUILDING DIVISION PERMITeCRACTQR T1�tF�UItMATIf4,N Bu11O1N0 AD00.FSS: PERMIT NO. 20398 CLAY ST GOSAL HEATING AND AIR COND 08040182 OWNER'S NAME: PERMIT ISSUE DATE KHAN, NISHAT 2679 CHERRY BLOSSOM WAY 04/25/2008 E: SANITARY NO, CONTROL NO. (510) 441-2318 ARCHITECTITINGINEER: BUILDING PERMIT INFO O O PLO MECH 'I G G LICENSED CONTRACTOR'S DECLARATION ZF�( I hereby affirm that 1 Am Ikansed under provisions of Chepur 9(commencing lob Description n<S with$ection 7")of Division 3 often Business and Professiutu Code.and my license is REPLACE FURNACE InfwlmmcendeG '_a� reg 6i p4( Lkenm Clw Dam Cauacer S ARCHITECTS DECLARATION y I understand my plans smil he used As public records . c 7 Luxessed Professional y OWNER-BUILDER exempt DE CLARATION COO hereby.(Ben o n 1 em exempt Truro the Canlncmfa :Anse city o for the y O o following wan.(section 7031.5.wcaro Busks end Profess mil Cod,:Any city i county 9 e.' whish mqulma•Portrait re comwct alter,improve,mmNitt of a apoul,.1g od auuctum priortois immdco,sou rt In the Pevision or for Cmumne Permit cleaagkdnatemcnt �m< warmencinmndpmctionwwcofDisonen(of Camrncwr'atxcmmesuo Chapter9 Sq.Ft.Floor Area Valuation (commencing withsection And of D asisfr ofthe Business and PmfAny iCom)w $2600 9 Nn io w exempt 0ercfmm and me per for the skge, pplica on,Any l penalty of .. was five any Applicant ears"emit surjecu the appikent w•dull pemlq of N Number Occupancy Type nm mom then five bundrtd dollars(5300). 36938025 .�. 0 I,As awkc of the property,a my employees with vnges As their sole compensation, will m the wart,and me sruchm,Is not mounted or arrested for oak(Sen.]044,Business and Profeaaam Code:The C,nmckrY License Law does let apply w sin awkr of Required Inspections Property who bui Ids a im proves thereon,and who does such wort himself or through his comemploycn.Provided well such improvements art not intended maRemd for s>k.R. Imwewr,the building on,improvement is sold within am Isar of complemn,the owncr- builder will haus the burden of proving that he did rot bald or improv for purpose of ark.) 0 1,as cam of the property.am exclusively contracting with Bawad conuAman to cummet the pmjert(See.7044,Business send Prefentloss Cade:)The Cmmcmr's U. . cenm law does not apply to An owner of property who bolds or improver demon,and, who contacts for such projects wW a conumenor(s)Incensed personal to me Contnewr's License law. O lamesempturdersec. ,Bit PCforw[s. - 0. Dam WORKERS COMPENSAT]ONDECI RATION I henry AM.under penalty of perjury one of tiro following declarations: raw and will msostn•Canifinm or Convent to elf-ImamfaWorkeYaCompea- aarion,As provided for by Socei 3700 or m labor Code,for wen s rforwanm Of we work for which this permit is issued. 0 I have And will mantsin Wartefa Compensation I..As required by S.W. 3700 of the LAlm,Codd.for the performance of the wart forwhlch this permit is Wood. ' My Warteh Cam wtio ITn,,w,r,1 Am court and Policy number are: Carrier, ="Zen "`^ Polley No.: M 35 d' CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE CrIlaminn ked ktlx comPle ed If the permit la two=hundred dollars($101) Of leu) 1 unify that in the performance of the wart for which this permit I wand,I shall nm employ any peram in any mannerw As In become subject to the Workers'Campensadm Laws of CafiforolL Dam Applicant NOTICE TO APPLICANT.If,after making this Certifimw of Exemption,you should become .bj=w the w tefs c mpemtd.pmvw m of the Luba Cade you mm .J Q faMwith comply with such p.W..ar this permit shall k mend rcwked. zy CONSTRUCTION LENDING AGENCY [—� I hereby aMmu dent mem I..comtmmrnn lending aRncy far we pefformaraccof C ti the wart for which this permit is issued(Sue.309],Civ.e.) WR A Lendefs Name z lander.Addw U O 1 cutil mat I lavenand this applicadon And saw son the above Information ii ' It, Cavett 1 agree w comply withall city and county ardnances and sew Is"rcWing to .O building construction,and hereby ambona reprtsenawws of this city to enwr upon we .term-mentioned property for impccwon Purposes. (Wel agree w ave,indemnify and tkp harmless the City of Cupertino alga as t„s on IiabilideL Judgments,costs m And cape ,s which may in any way...Against sad City („)7 in consequence of the granting of this PemIL n7 APPLICA NDERSfAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date souRce u s.(9 , "00? sgnarrrc or ApplkAenuCa -r-tom. "4 Date Re-roofs / NA2IARDOU3 MATERIALS DISCLOSURE Type of Roof Will the applicant or future building a trupmtsmm or Iarblc hazardous materia As deRkd by th,Cupertino Municipal Cade.Chapter 9.12,and the sheath and Safety Code.Se z525532m)?❑y. �No All roofs shall be inspected prior to any roofing material being installed. Yes Will do applicant or future building aacupant use equipment a datcm which If a roof is installed without first obtaining an inspection,I agree to remove harardom air conamimnu As m0kd by me Bay Ama Air Quality Management all new materials for inspection. a7 0Yo (6Nu I here read the hsardausmaasalaetryvementsumkr Clupter S93 ofthe Swd=UM5,2Ss33 W 25534.1 undcnund son Rgc building dos let corm y haw a tenant mat it' y mpomlhilitY w notify NC ancupent of the rcquirtmenu ichmy bemetpriart ,nmtkanCawftnmofa,rwc. Signature of Applicant Date lam/ tis/� 2!.rL6, tho,ired aCem DOW All roof coverings to be Class'W'or better Community Development 10300 Torre Avenue I' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 6UPEkTINO Building Department JOB ADDRESS: a � C IGS Ot PERMIT # OWNER'S NAME: PHO GENERAL CONTRACTOR: FAX# 5(D GSI —1 lG I am not using any subcontractors: `' a' gnature 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 Ile er/Contractor Signature Date • CITY OF CUPERTINO 5 ITEMS- OF 6 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36938025. 01 DATE ISSUED. . . . . . . : 04/25/2008 RECEIPT 4. . . . . . . . . : BS000004582 REFERENCE ID # . . . : 08040182 SITE ADDRESS . . . . . : 20398 CLAY ST SUBDIVISION . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KHAN, NISHAT ADDRESS . . . . . . . . . . : 20398 CLAY ST CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GOSAL HEATING CONTRACTOR . . . . . . . : SINGH, KESAR LIC # 21350 COMPANY . . . . . . . . . . : GOSAL HEATING AND AIR COND ADDRESS . . . . . . . . . . : 2679 CHERRY BLOSSOM WAY CITY/STATE/ZIP . . . : UNION CITY, CA 94587 TELEPHONE. . . . . . . . . (510)441-2318 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- --------— ---------- ---------- ---------- 1BSEISMICR VALUATION 2, 600 . 00 0.50 0. 00 0.50 0. 00 1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 1MFR=<100 UNITS 1 . 00 122. 38 0. 00 122 .38 0. 00 1MPERMITFE FLAT RATE 1 . 00 40.79 0 . 00 40 .79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40. 79 0. 00 40.79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 245.25 0 . 00 245 .25 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------—------------- -------- ---------------------------- 505 -------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO (�D FURNACE/AC •CUPEkTINO PERMIT APPLICATION FORM APN # 369 , Date: Building Address: � C I4 l r Owner's Name: Phone#: _a S 5—77-S/7 kNAry , �15�F�T Contractor: Phone#: Fax#: X10—�`II -IIgS Contractor License#: r �11 Cupertino Business License#: x1350 Contact: Phone#: Sim 37 -31 I J Fax #: Building Permit Info: Elect Plumb Mech Residential Commercial LJ Job Description: For Residential Installations: Attic ❑ I" floor 2nd floor ❑ Adhere to minimum setback 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: Type of Construction (Usage Class): a�013 Strapped H On Platform Bonded New Location Replacement Valuation: a Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. 1 -� CITY OF CUPERTINO �` FURNACE/AC TY 0 CUPERTINO FEE SCHEDULE tion Fee Permit Type Fee Description Quantity Fee ID p Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ca heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. • 1MCSUSHTR Commercial Install/Relocateea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed.wall htr, or floor mounted unit heater. 1 MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. G CITY OF CUPERTINO. FURNACE/AC • CUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit.Type Group FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each. gas piping system of 5 or P more per outlet. l 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type fumace/bumer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type fumace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • CITY OF CUPERTINO FURNACE/AC ITY 0 CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BREMAIRHAN Residential A/C units <= lOk CFM B 1MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B • 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B •