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07020119 CITI OF CUPERTINO BUILaiNG DIVISION PERMIT +C� t' 'ItAt� I�i }RMT��N: PERMIT NO. BUILDING ADDRESS: 10088 RIDGEWAY DR ELITE I.EATING & AIR 07020119 PERMIT ISSUE DATE OWNER'S NAME: CUNDIT DN' VAYANT JAIN 5565 RL'SSO DR SANITARY NO. CONTROL NO. jNE: (408) 7: 6-1618 BUILDING PERMrr INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ,p p LICENSED CONTRACTOR'S DECLARATION Job Description 3r(= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is FURNACE; C HANG E OUT/ADD AIR CONDITIONING I y in full force and eff MA';7fo Z License Class �� LM•# t-m.a Date clor ARCHITECTS FD LARATION w-,Cl 1 understand m plans public records ,a U.F- Licensed Pro esstonal O< OWNER-BUILDER DECLARATION N I hereby affirm that I am exempt from the Contractors License Law for the p o following mason.(Section 703 1.5,Business and Professions Code:Any city or county < Pi which requires a permit to construct alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area j t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5300 i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of t�}cD�7#�Tt Number Occupancy Type not more than five hundred dollars(5500). 3 4 2 41 0 2.8 . V V ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is notintended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. gJ'I have and will maintain Worker's Compensation Insurance,as required by Section 700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier.fV X A# C M& Policy No.:W� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Workers'Compcnsation Laws of California.Date Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY (~-d C/) I hereby affirm that there is a construction lending agency for the performance of pt,> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name 2 Lender's Address U 0 1 certify that I have read this application and state that the above information is LI. " corconstruction,t.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date /V �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. 2/Z L D 7 Re-roof; Signature of Applicant/Contractor Dam T of Roof HAZARDOUS MATERIALS DISCLOSURE y> Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof3 shall be inspected prior to any roofing material being installed. ❑Yes ej'N° Will the applicant or future building occupant use equipment or devices which If a root is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? C]Yes XNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occcup Cy. Signatul e of Applicant Date I r All roof coverings to be Class"B" or better Owner or authorrrcd agent Date .' Community Development M 10300 Torre Avenue 41, Cupertino CA 95014 Telephone(408)777-3228 C11Y OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE # ( Z 4�, - (6(Q GENERAL CONTRALTO FAX # ( Z& - (, 7T or I am not using any subcontractors: 2/-?31G7 5 ignature Date Please check applicable subcontractors and cont lete 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 Tile Owner/Contractor Signature Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34241018. 00 DATE ISSUED. . . . . . . : 02/26/2007 RECEIPT #. . . . . . . . . : BS000000529 REFERENCE ID # . . . : 07020119 SITE ADDRESS . . . . . : 10088 RIDGEWAY DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VAYANT JAIN ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2659 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : RALPH B ALCARAZ LIC # 28438 COMPANY ELITE HEATING & AIR CONDITION ADDRESS 5565 RUSSO DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE (408) 726-1618 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34 . 86 0.00 34 .86 0.00 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 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0. 00 BSEISMICRE VALUATION 5, 300 .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 PPERMITFEE 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 REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 176.34 149 --------------- TOTAL RECEIPT 176 .34 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO 0o7v Iq k `U N. CE/AC CUPEkTINO PERMIT APPLICATION FORM APN# 7� u/ (� / Date: 2 2 b 7 Building Address: Owner's Name: Phon #: Contractor:. i Phone: 40,b 716' '&106 g License A6+3 Conta t: Phone: Cupertino Business License#: z e:r—V-t Building Permit Info: Bldg ❑ Elect Plumb E Mech Job Description: �v�� G h vii t- � � ADP ON) Residential Commercial ❑ For Res ential Installations: Attic L,,d 1 st floor ❑ 2nd floor❑ Adhere to min set back requiremen For Commercial Installations: _eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform Bonded Cfi— Sq.Ft. Floor Area: �7vdffi New Location ❑ Replacement P✓ f i Qty.ty. Applicable le Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN furnace MECHANICAL BREMACOVER E�/C Unit> 10,000 efin MECHANICAL BREMAIRHAN f�/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT ltec tl, Switch & Outlets ELECTRICAL BSEISMICRE ;)'eismic Fee Res BUILDING BSEISMICOM ;)'eismic Commercial BUILIDNG EPERMITFEE l:lec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Jas Piping System Fee PLUMBING BUSLIC ;3usiness License BUILDING