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05120089 (2) CITY OF CUPERTINO ��s,� sn'? Iw� w r �'' • �"- - BUILDING DIVISION PEll1YlIT -"��L\ll. Q �TIVFOTtMATIC/ 1 BUILDING ADDRESS: A PERFECT CLIMATE PERMIT No.05120089 20249 NW SO OWNER'S NAME: PERMIT ISSUE DATE GANESH BALGI 10570 S DEANZA 12/15/2005 NE: SANITARY NO. CONTROL NO. (408) 861-9545 'ARCHITECDENGINEER: ! BUILDING PERMITINF'O ^ . 8400 O ELECT PLUMB MECH ly O u o o LICENSED CONTRACTOR'S DECLARATION Des [100 vd 1 hereby affirm that IN licensed under provisions of Chapter 9(commencing a wish Sextin,700(fol'Divish, Sof the Businetand Professions Code.and my license is J' O Li full force an de gel. REPLACE FURNACE �1,� j n Z Lkcnm CI ss Lic.N ,14 Dale Con , DECLARATION ECL 0 ARCHITECTS DECLARA ON 1 understand my plans shell be used as public records is Licensed Professional OWNER-BUILDER DECLARATION j<i 1 hereby art,.that I em exempt from the Contracmfs License Lew for the COO following won.(Section 703 e.5,Business and Professions Cade:My city or county $ which requires a M mit to cenrtme4 alter.Improve,demaluh.or repair any rtructuro $3199 priorwitsissuance.alsorequi.0c.pplicanl forsuchpermitwfrleasigmdementmi < Meheislicensed pursuant mNcpsAsouofdeConuacwYsUm.Lsw(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or .. that he is exempt muse from end the bae i for the alleged exemption.My ululation of Section 7031.5 by any applicant for a permit anbjews the applicant m a civil penalty of 3APR rUU Occupancy Type mat more dun five hundred dolurs(5500} ❑1.as owner of the property,or my employee with wages as their role compensation, will do me work and the ttrunure is not Intended oroffered for We(Sm.7044,Business Required Inspections and Post'esiov Cade:The Conuacwrt License Law does not apply w e an owner or q p property who builds or improve demon,andwho does such work himself w through his own employees,provided that much Improvements mcaminended oroRered fwsale.If, , however•the building or Improvement taxed within one year of completion,Ne owner. builder will have the burden of proving that he did rot build or improve for purpose of sale.). ❑1.as owner of the property,am exclusively contracting with licensed contractor,In construct the project(Sec.7014.Business and Professions Cade:)The Contractor's U. came Law doe not apply an an owner of properry.who builds or improve Merton,and, who contracts for such projects with a coneww(s)licensed pursuant to the Contnwals License taw. ❑1 am exempt under Sec. .B&P C far this mason Owner Date WORKER'S COMPENSATION DECLARATION I thereby of irrlr under penalty of perjury ane of the following declarations: have and will msinaln•CenfOam ofCoruem to self-iuure fru WorkersCompen- a ided,as provided for by Section 17M of the Leber Code,fru the performance of do for which this permit is Issued. have and will maintain Workers Compensation Insurenm,as required by Section W of the Labor Cade•for de performance of the work for which this permit is issud. My Workers Cam nsatian Insurance artier and Polity num r Carrier. Policy No.: ERTIAf 4(0 PrION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not be completed If the permit tsrarore hundred dollars(fid)) or leas) 1 certify that In the performance of the work for which this permit is Issued.I shall not employ any�ura0In any mannenn u w become subject w tie Workers'Companlotion Lawes of CWro1i Tie. Applicant JlL__Q6 Q^ NOTICE TaAPPLJCAW.ff.after dbaking this Cemi0cate of Exemption,you should become subject w the Worker',Compensation provisions of the labor Code,you mot ,J O forthwith comply with such provisions at this permit shell be damcd pocked..E,r� CONSTRUCTION LENDING AGENCY [. 1 hcmby affirm that Vert is a constructed lending agency for the Performance of DC the wish for which Nu permit Is issued(Sec.3097.Civ.C.) tied Q Lenders Name , Z)Z Landers Adder U0 I certify mut I have read ibis application W vete leu the above information u ' U.F correct.l apes to comply with all city and county colossuses and sate saw reading to O U building construction.and hereby authasise representatives of this city an enter upon the W above-mentioned property for Inspection purposes 6r (We)agree to love,indemnify and keep harmless the City of Cupertino against v.i ti llabilithajudgmenu,cons and expense which may in anyway accrue against said City U Z in eof Me granting of I ANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs fes_ Signature afApplicanUContractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or town building occupant stem or handle hrramlous material as defied by the Cupertino Municipal Cade,Chapter 9.11,and the Hcalth and Safety I'lliked..Seetian zss3z(a)7 / All roofs shall be inspected prior to any roofing material being installed. up ❑Yes Coe Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove - emit haardnu air contaminants a defined by de Bay Arta Air Quality Management all new materials for inspection. District? 0 yea I heves road the hazardous matcrlals requirements under Chapter 6.95 ofine Califw- 2iL nialkailh&SafetyCodc.SeNwuS505.8533and25531.iwnderstmdthe building drelyhana u It u mympuihiiityw mdfy thwupmt of thocawbe d wissuu cemfateafme igna[ureofApplican[ — Date7ryOwer or wthomcd agent ow All roof coverings to be Class"B"or better D Community Development 10300 Torre Avenue i Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 UPEI�TINO Building De artment JOB ADDRESS: PERMIT# ---?— OWNER'S 2OWNER'S NAME: ; PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following , ormation: 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 • Owner/Contractor Signature Date CITY OF CUPERTINO aTYOF FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM ll APN# (G Date: / 7 �oJ Building Address: a,oa'�� or-�iwes� s Owner's Name: vPhone #: Contractor: e� a. rn0.� License #:f 17 a—Sl51 Contact: Cupertino Bi siness License #: U1, Building Permit Info: Bldg ❑ Elect CJ's Plumb L'9' Mec Job Description: Residential vCommercial ❑ For Res' ential Installations: Attic I't floor ❑ 2"d floor❑ Adhere to min set back 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 T e of Construction: ((11 Occupancy group: 1�� Strapped LJ On Platform ❑ Bonded ❑ Sq.Ft. Floor rea: New Location ❑ Replacement Qty. if A licable Fee 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees I BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING