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07030300 CITY OF CUPERTINO BUILDING DIVISION PERMIT I TE R II QRI �ITIf�N PERMIT NO. BUILD,(N 9Dpp ESS: 141 N BLANEY AV A B S HEAT'-NG & AIR COND 07030300 - PERMIT ISSUE DATE OWNER'S NAME: SURESH BABU CHANNALATH 334 SHAMROCK DR 03/27/2007 SANITARY NO. CONTROL NO. .INE: (408) 238-7:L78 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH i 00 LICENSED CONTRACTOR'S DECLARATION Job Description I I- I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z,w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE FU NAC E, DUCTING & ADD A/C t y in full force and effect. lg License Class. Lic.# i- Date Comtaetor A CHITECTS DECLARA i a< 1 understand my plans shall be used as public records >yU U.In Licensed Professional O a OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 0 which requires a permit to construct,alter,improve,demolish,or repair any structure ti prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation -?< that he is licensed pursuant to the provisions o(the Contractor's License Law(Chapter 9 Sq.P.Floor Area 1 O O O 0 F (commencing with Scction 7000)of Division 3 of the Business and Professions Code)or 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 AR s�Number Occupancy Type not more than eve hundred dollars($500). 31633114 V J ❑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 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. ❑1 am exempt under Sec. B&P C for this reason 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 Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker' Compensad twtance artier and Policy number arc:_ Carrier. Policy No.: R 1 CATE C MPTION FROM (5RKERS' COMPENSATION INSURANCE (This section need not he 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 Califomia.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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of - (Y > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is ►-' correct.1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorise representatives of this city to enter upon the aabove-mentiuned property for inspection purposes. (\\ (We)agree to save,indemnify and keep harmless the City of Cupertino against F" Cn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence oC a grantin this permit. Date ►" APPLICANT U ErR AlAND W L COMPLY WITH A L NON- OINT Issued by: S( so U , GU Re-roofs Sign%U,Wf Apjlhicaradomactor Dam Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof 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 materil lls for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Godc,Sections 25505,25533 and 25534.1 understand that if the building d Ll ve a tena t it is my sponsihility to notify the occupant of the ui en w t 'ora' ofaCcrtift atc of Occupricy. Signature of Applicant Date or au hori-rcd a rat Da All roof coverings to be Class"B"or better CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31633114 . 00 DATE ISSUED. . . . . . . : 03/27/2007 RECEIPT #. . . . . . • • . : BS000000806 REFERENCE ID # . . . : 07030300 SITE ADDRESS . . . . . : 10415 N BLANEY AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER. . . . . . . . . . . . : SURESP BABU CHANNALATH ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2333 RECEIVED FROM . . . . : RECEIFT INTERFACE CONTRACTOR . . . . . . . : ROBERT HALL LIC # 22481 COMPANY . . . . . . . . . . : A B S HEATING & AIR COND ADDRESS . . . . . . . . . . : 334 SEAMROCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 238-7178 FEE ID UNIT QUANTITY AMOtNT 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 BSEISMICRE VALUATION 10, 000 . 00 1. 00 0 .00 1. 00 0 . 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0 .00 38 .37 0 . 00 MPERMFEE SQUARE FEET 1, 400 . 00 112 . 00 0 . 00 112 . 00 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 X87 .54 0 .00 287 .54 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 287.54 10896-A B S HEATING --------------- TOTAL RECEIPT 287.54 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CU.PERTINO = FURNACEAC Cin of CUPEF�TINO PERMIT APPLICATION FORM APN # Date: :j //V -7 A2 . Building Address- 624 !S�_ 6>V' e9 V�12E Owner's Name: Phone#: Cont to Phone: License#: 3 * 717 Ctact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: EVA 4- Resid &tial �[i]'" C mmercial ❑ ForRes'dential Installations: Attic 1 st floor ❑ 2nd floor❑ Adhere to min set back requirement 0 For Commercial Installations: _eplacement same weight ❑ Additional weight(structuralEl cales) Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of Construction Occupancy group: kn D00 3 Strapped ❑ On Platform Ei' Bonded Sq.Ft. Floor Area: New Location El- Replacements d� Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energ, BUILDING / BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL tl BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seism:c Fee Res BUILDING BSEISMICOM Seism:c Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL f MPERMITFEE Mech:?ermit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ':UPEkTINO Buil din 7PFIUMn artment JOB ADDRESS: # OWNER'S NAME: PHONE# LO - L GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signat-ire Date Please check applicable subcontractors and complete the followin 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 I ::, -,-, AV Owner Contractor Signature Date