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08070119 (2) CITY OF CUPERTINO �. BUILDING DIVISION PERMIT aCNTRACT��ORIN1�f1RMAtTI(3N ,.. n' :;+ice-' eWiFaae.. PERMIT NO. Buagl�C�.Yo3TILKINSON AVE TBD — TO BE DETERMINED 08070119 OW NER's NAME: PERMIT ISSUE DATE PANKAJ NANAVATI 07/16/2008 NE: SANITARY NO. CONTROL NO. ARCHIIECffENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 I� 300 LICENSED CONTRACTOR'S DECLARATION Job Description u C I hereby affirm Nat I w licensed under provisions of Chapter 9(commencing U with Section 7M)ofDivhion3af0eBuaimswWProfessions Coda,andmylicense is RPLC EXTNG FURNC & NEW A/C SYS. LORD & SONS N inrnllfodeaMercncn O Lag z License Clan HEATING AND AIR CONDITIONING PD FOR BUS LIC Dam Commclor o 17-C- n xcHECrS DECLARATION 7/16/2008 �y [understand my plans shall be wed sopublic¢cords pyU g LL y LICCNetl PNre3LOnaI 570 5 Oat I am exempt( DECLARATION i e C 1 hcroby affirm that 1 1. exempt from pr .Camnnoh License c taw for Oc O O following matin.(section Ronstr Businns and wn,da oll Code:Any city or county which nits ism n permit re sires the plan improve dcmoluh.ri mpur any structure _zr primtoiLLcensed e.purmais ncquims Novisiosofthe Commuoitto Rk ae Law(ned uemcm £ Q (not,hecommencingddpueruamto0mprovisiawoftheConmcmr'mLiceormed. Clapmr9 Sq.F[. Floor Area $8200 Valuation e5R man he immngwiNSootior]000)MDivmaformtheBed ancondce.Any Cade)of _ Natio u campy anyeGmo and the per (m me subjects the edmant to Any Notation of .1. 7031.5 by any led duct for permit dbjecs Ne applicant •civil penury of Number � Occupancy Type ml roam than fiw handled dollus(gN101 35613025 .E P Y YP 1,u owner of Ne property.a my employe¢wird wages u Heir die wmpeweHon, will Professions r Ncwmk,ands: he Commences W In Owners and lanywh bo Code:TM Conuactam,and Law uch nay apply to,n awmr is Required Inspections propertywho b.Idsarireprove himp,and whodoesstirwart himdl(wthrough his own wr.me building Nor over inti mid wit tie not eacMN mpleued fm We It. however,Ne building or impromnent u mold a did one year or compmdon.One owver- aide). will Nw the uudea of proving Nat k did Out ddltl or improve(or puryc¢of sam.I. ❑1.as awncs of the popeny,me asclwiwit,conussting wird licensed contractors to ceramics the project(Soo.7064.Business;and Professional Code:)The Camrnmi s U. who claw docs nor apply a an owner or progeny wan used poor fmproma Nemoe,and, who contracts for such projects wird a anwnor(s)licewed pwsuam m Ne Contrxtor's Gemco law. ❑lam uernpt undo See ,08PCfor Nip recon Owner -oil - WORKERS DaWORKERS COMPENSATION DECLARATION tII hereby a firm under pewlty of perjury ane of tis following declarations: Mw arM will mainuin aeenifiamaf Condnt to self-irs.forworkefscompen- smon,Is provided for by Section 3700 or Ne lebm Cade,for Ne Performance of dm work,fm which this permit is idued. ❑1 have and will maintain Worlser's Compensation Insurance,as required by Section 3700 of Ne labor Cade.for the performance of the work for which this permit is isued. My Worker's Compensation Insurance artier and Policy number ad: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu xctim red Out w romplemA if the permit is fm cm hu bed conan(s100) or loss.) I artily,Net in Ne performance of the wart far which this Permit is issued,I"I not Zremploy an TINY manpelI n�D Ne Wwken'Compenurlan Armrp of ifo d Applian NOTICE To APPLICANT:If.afmr ^tg Nu Cenifcase of Exemption,you Mould me becosubject he NWorker's e Com codon provisions of Ne labor Cron.you mutt .J O Eforthwith comply with such provisiow or Nu peonit shut M doomed mated. E " CONSTRUCTION LENDING AGENCY .5+ 1herehya(nrm NU Nem u acrosunctinn lending agency far the perfmman¢uf Ba work for which this Permit u iuucd(Soo.3097,Civ.C.) aA lender's Name Z) Z Lander,Mdneu U Q 1 certify Nat 1 have read this application and mum Nm the above information is !' cmwcn I epee m comply wird At city and county ordin•~••and sera laws muting m .O Wilding conumcdon,and hmebyauNmise mpmaentstiws of Nis city in.=.pro use r4 show-mentioned property for inspection pulp=& (We)agree to sive.indcmufY and kveP harmless the City Fo(Cupcmno"i'm' T liabilides,judgments,carte and expends which may in any way scene,agaiwt did City U Z in consequence of the granting of Nu Farah. APPLICANT UNDERSTANgy1ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOy GUL ORS ` ! Laf,t 6/o Re-roofs Su 'fgnu o(Appli HAZARDOUS AISDISCLASURE Dam Type of Roof WIB dm appliant w fumm building arupdtatom or lundlc hevutlow mamrial as dc0md by the Cupenina Municipal Code.Chi 9.11 and rhe HcaiN and Safety eade.Section25532(a)7 Cy. conk.- All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or farad Wilding Occupant use equipment or devices which Pe g Oil haardnw air ci numiwu s u defined by Ne Bay Arca Air Quality Management all new materials for inspection. D suicR ❑sen tC} I have mad dm hvaNausmatoriais mquimmenLL ummr Cbmic,6.95 of dm Cuifoa .is W.1"Sa1myCode,Sootima ZM5.25533 and 25534.1 undcrsLLM dutlfNc building daet rot emmml It Y my responsibility to acti(y Ne occupant Of me m naw hon a met r to hauamooft Ceruficamafucupanry. C__ C & Signature of Applicant Date Owner Or auNomad agent Dem All roof coverings to be Class'W'or better CITY OF CUPERTINO • 7ITEMS OF 7 PERMIT RECEIPT OPERATOR: pdtg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35613025 . 00 DATE ISSUED. . . . . . . : 07/16/2008 RECEIPT # . . . . . . . . . : BS000005488 REFERENCE ID # . . . : 08070119 SITE ADDRESS . . . . . : 10893 WILKINSON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PANKAJ NANAVATI ADDRESS . . . . . . . . . . : 10893 WILKINSON AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4733 RECEIVED FROM . . . . : DAVID DIAZ CONTRACTOR TBD = TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . . TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 8, 200 . 00 0 . 90 0 . 00 0 . 90 0 . 00 1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 IEPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1MRSUSHTR UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00 1PPERMITFE 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 335 . 25 0 . 00 335 . 25 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 335 . 25 MC --------------- TOTAL RECEIPT 335 . 25 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • v90-7o119 CITY OF CUPERTINO • FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # o / 3 U ,� , i Date: T l�l 2op�j Building Address: J C, 3 q zJ I ✓i SGyI 1'Tv� _ (� �O C ��O Owner's Name: PO � iA� n , /t N 1q V✓t_� `Phone#:�Lt o�\ c�� —3 o-Z L Contractor: L-0z / 'e"So JS N Imkf A'Jo I4 � Phone#: Q31J 2 ! 21 -� y Fax#: g 3( - Z Contractor License#: Cupertino Business License#: !I't 152Z Contact: Phone#: 3 I 5-3S 9 6 4 Co Fax#: '0 CoCP 3 Building Permit Info: Elect PlumbEl Mech Residential IVI Commercial LJ • Job Description: lecf�-1gccs 6 X r511ws FWkJAcr; e NCW AA 5 y For Residential Installations: Attic ❑ Is' fl o [v� 2"d floor ❑ Adhere to minimum setback 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 Project_ Type of Construction (I)sage Class): Strapped On Platform El Bonded New Location Replacement ' Project Size: Express Standard ❑ Large ❑ Ma or❑ Valuation, --6 Z4f S ;2-0O . 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. • CITY OF CUPERTINO d' FURNACE/AC • CUPEkTINO FEE SCHEDULE Quantity Fee 1D Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-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. I 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. IMCSUSHTR Commercial Install/Relocateea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P IA outlets 1 BPGAS For each gas piping system of 5 or P more er outlet. I MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance rmit. IBSEISMICO Commercial Seismic B I MRRAA 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. IMRSUSHTR Residential Install/Relocateea M suspended heater,recessed wall htr, or floor mounted unit heater. IMRAPPVNf Residential for the install/relocate/or M • replacement ofea appliance vent install &not incl in an a I permit. Quantity Fee ID Fee Description Fee Permit Type CITY OF CUPERTINO ��D. FURNACE/AC CUPER,TINO FEE SCHEDULE Group FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P I-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M I MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type fumace/burner, incl ducts/vents attached to such appliance up to and • include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B j 1BUSLIC Business License B • uautit Fee ID Fee Description Fee I Permit Type CITY OF CUPERTINO ' FURNACE/AC • CUPEkTINO FEE SCHEDULE Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units<= 10k CFM B IMCRAA Commercial Mech Repair/alt/add M I BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets I 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 I BREMAIRHAN Residential A/C units<= 10k CFM B 1MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B • IEPERMITFEE Electric Permit E IMPERMITFEE Mechanical Permit M IPPERMITFEE Plumbing Permit P ITRAVDOC Travel Documentation B IBUSLIC Business License B R Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 4fUPERTINO Building De artment JOB ADDRESS: PERMIT # 100 Ax-16- - 080.7 f OWNER'SNAME: I<A--J- /JFF fh/R PHONE GENERAL CONTRACTOR: Lpi¢� 'so.✓f (�t/� e FAX # I am not using any subcontractors OI t co / 05 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