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07080183
CITY OF CUPERTINO0. BUILDING DIVISION PERMIT ® ' ' ► Ta� ATI©N. PERMIT NO. BUILDr�rr D KESS: b�JCLIFFORD DR A PERFECT CLIMATE 07080183 PERMIT ISSUE DATE OWNER'S NAME: RAVIK JAGANNATHAN 8375 BRENTWOOD BLVD STE B 8/20/2007 SANITARY NO. CONTROL NO. NE: (408) 861 9545 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB ?AECH 0 z LICENSED CONTRACTOR'S DECLARATION - o Job Description U3 I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Scction 70(10)of Division 3 of the Business and Professions Code,and my license is MOVE/REPLACE AIR CONDITIONING UNI T y in full force and effec ? License Class Lre•# p Date J - Contractor RATION ARCHITECTS DECLA 11 a I understand my plans shall be used as public records yU u.ti Licensed Professional a OWNER-BUILDER DECLARATION a 1 hereby affirm that I am exempt from the Contractors License Law for the :n O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Area Valuation Ft.Floor that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. $3526 t=$ (commencing with Section 7100)of Division 3 of the Business and Professions Cade)or . that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �1 Number not more than five hundred dollars($500). 3 6 9 2 70 1 5 qv ❑I,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 docs 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 contractors)licensed pursuant to the contractofs License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: L]I hsve and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. V:Tbavc and will maintain Workces Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor EC._ Insurance carrier and Policy numb;T arc: Cartier: w._ .2 LW 1't odic.Nn 16, 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,I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date 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 I hereby affirm that there is a construction lending agency for the performance of x > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lcnder s Address U Q I certify that I have read this application and state that the above information is W . correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. O. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA 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 9 ., APPLICA DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bv SOURCE RLGLIATIONS. Re-roofs Signature of Applicant/Contractor Dare Type of Roof MATERIALS DISCLOSURE yP 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes PX 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 ..mit hazardous air contaminants as dcfned by the Bay Arca Air Quality Management all new I materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building does not rr fly have a tenant,that it is my responsibility to notify the occupant of the rcquirem ich must be met prior to i c of a Ccrtificatc of Occu aney. Signatur' of Applicant Date All roof coverings to be Class"B"or better Owner®raothorize�agcnt Date - - CITY OF CL"PERTINO 6 ITEMS OF 28 PERMIT F.ECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 3692; 015. 00 DATE ISSUED. . . . . . . : 08/2C /2007 RECEIPT #. . . . . . . . . : BSO00002431 REFERENCE ID # . . . : 0708C183 SITE ADDRESS . . . . . : 6776 CLIFFORD DR SUBDIVISION . . . . . . . CITY CUPEP TINO IMPACT AREA . . . . . . . OWNER RAVIK JAGANNATHAN ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPEP TING, CA 95014 RECEIVED FROM . . . . : EDWARD GREGORY CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS 8375 BRENTWOOD BLVD STE B CITY/STATE/ZIP . . . : BREN-WOOD, CA 94513 TELEPHONE . . . . . . . . : (408) 861 9545 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 BSEISMICRE VALUATION 3, 526 . 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 160. 73 0 . 00 160.73 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------------- CREDIT CARD 675.24 TIC --------------- TOTAL RECEIPT 675.24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OFCUPERTINO FURNACE/AC CUPEIZTINO PERMIT APPLICATION FORM 070a0183 APN# Date: Building Address: / ----�� r Owner's Name: Phone#: Contractor: �p, �c;4- l` Phone: gb�, License#: 7 Z 3 1,S--8 Contact: Phone: Cupertino Business License#: ` o 'i (ire �!�- IN Building Permit Info: Bldg ❑ Elect ®� Plumb Mech L Job Description: Residential 7 Commercial ❑ For Residential Inaallations: Attic ❑ 1 S`floor P 2°d floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weighs (structural Elctural calcs) Structural Calculations required for new installatiai New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupy gro p: Strapped ❑ On Platform M Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of 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 BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 �CITY Of Fax(408)777-3333 7UPEkTIN0 Buildi:n De artment JOB ADDRESS: PERMIT # in OWNER'S NAME: PHONE GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Si;;nature 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 'Do- o,;:> Owner/Contractor Signa Date