07010096 77777777
CITE'OF CUPERTINO nn
-BUILDING DIVISION � � �
PERMIT
PERMIT NO.
BUILDING ADDRESS:
6776 CLIFFORD DR A PERFECT CL
PERMIT ISSUE DATE
OWNER'S NAME:
RAVIK JAGANNATHAN 10570 S DEANZA BLVD 01/17/2007
SANITARY NO. CONTROL NO.
,ONE: (408) 861L19545
BUILDING PERMIT INFO
ARCHITEC IENGiNEER:
BLDG ELECr PLO ME�CN
o p LICENSED CONTRACTOR'S DECLARATION Job Description
m I herebyaffirm that I am licensed under provisions of Chapter
ha ter 9(commencing
env P p REPLACE FURNACE
_Z� with Section 70(10)of Division 3 of the Business and Professions Ctrelc and my license is
H in full force and e
Z License Class Lk.i
Date Cprruactor
�qC
S DECLARATION
?m U 1 understand my plans aha 1 be used as public records
n,
LO y Licensed Professional
< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
1:0 O following mason.(Section 703 1.5,Business and Professions Code:Any city or county
.40 r. which requires a permit to construct,alter,improve,demolish,or repair any a cutre
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft. Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $4785
Yt= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y 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 3692701 3 .W Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(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 docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a cont actors)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this Macon
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-insure 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.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the workfor which this permit is issued.
p
My Workees Comnation Inwra ce carrier-ltd Policy nu� aM:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKER '
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,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dat—
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(�tom. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
� z Lenders Address
V Q 1 certify that I have mad this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hemby authorize representatives or this city to enter upon the
above-mentioned property for inspection purposes.
>'a (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
►+ APPLICANT UNDERSTANDS AND Wl L COMPLY WITH ALL NON-POINT Issued b`r:
SOURCE REGULATIONS. .,�^
Re-roofs
Signature ofAppliezrt aclor HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
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
Cede,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
❑Yes v'
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dcfh d by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
1 have mad 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 PM to issuance oQ&Certificate of OV upancy. Signatur.,of Applicant Date
Owner or authorized age Date _ All roof coverings to be Class"B"or better
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT' RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36927015 . 00
DATE ISSUED. . . . . . . : 01/17/2007
RECEIPT #. . . . . . . . . : BS000000241
REFERENCE ID # . . . : 07010096
SITE ADDRESS . . . . . : 6776 CLIFFORD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAVIK JAGANNATHAN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : SFITH, BYRON E LIC # 21144
COMPANY A PERFECT CLIMATE
ADDRESS 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE (408) 86119545
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
BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00
BSEISMICRE VALUATION 4, 785. 00 0.50 0. 00 0 .50 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 164 .78 0. 00 164 .78 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 164 .78 030452
---------------
TOTAL RECEIPT 164 .78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------ ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF CUPERTINO
FU NACEACD1 00q (PI'CIF
CUPEkTINO PERMIT APPL [CATION FORM
APN # "-- 7--0115 Date: � 7-10
Building Address:
Owner's Name: Phone#:
Contractor: Phone: License#:
Cupertino Business License#:
Contact: Phone:
Building Permit Info:
Bldg
Elect Plumb Mech
El Elect LVA
Job Description:. .
CAI f-
Residential Commercial ❑
For Residential Inst ations:
Attic ❑ 1" floor 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
_eplacement same weight ❑ Additional weight(structural calcs)❑
Structural Calculations required for new installation 1
New installation Planning Approval Required ❑
Cost of Project: �i Type of Construction: Occupancy group:
1S
Strapped ❑ On Platform ❑ Bonded C Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN F imace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT R ec 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 Cras Piping System Fee PLUMBING
BUSLIC Busipess License BUILDING