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07050272 CITE'OF CUPERTINO *� BUILDING DIVISION PERMIT � 11, BUIL[ yQ ¢D9ES BLANEY AVE PERMIT NO. ((JJJ AAA FURNACE & AIR 07050272 OWNER'S NAME: PERMIT ISSUE DALE PRASAD LAKAMSANI 1712 STONE AVE 05/29/2007 HONE: (408) 29?-1717 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0Z U00 LICENSED CONTRACTOR'S DECLARATION Job Description E- I hereby affirm that I am licensed under provisions of Chapter 9(commencing z Ed with Section 70(X))of Division 3 of the Business and Professions Code,and my license is in full force an REPLACE FURNACE E 70r000 BTU, ADD A/(' 3 TON ? ?,24 Licensc Clas �' y^l/ Lic.# F Date #4 7,4 Contractor g Ogg RCHITECI'S DEC 10 w U I understand my plans shall be used as public records ,a rn Licensed Professional OWNER-BUILDER DECLARATION j<X I hereby affirm that I am exempt from the Contractor's License Law for the - 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter•improve,demolish,or repair any structure Z In prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S I I Floor Area :=o P P ( P q. Valuation R F$ (commencing with Section 70(X1)of Division 3 of the Business and Professions Codc)or $7635 L .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty oft Number not more than eve humored dollars($500). 3 6 9110 5 4 Occupancy Type ❑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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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.IL 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.). ❑I,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 reason Owner - Date WORKER'S COMPENSATION DECLARATION 1 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. ❑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 Work mpensa'on I urance carrier and Polity number are: 1 Carrier. Policy No..- !!26 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 Workers'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 .J z forthwith 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 �i the work for which this permit is issued(Sec.3097,Civ.C.) Q Lender's Name a z Lender's Address J C) I certify that 1 have read this application and state that the above information is Ucorrect.1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ..t f/I liabilities,judgments,costs and expenses which may in any way accrue against said City J z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:, - by:SOU REGU TONS. Date ik� � Re-roofs S4gnaturc o�App�canUCon�ctor �. Date HAZARDOUS MATERIALS DISCLOSURE 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 Code,alien zss32(a)? All roofs shall b,;inspected prior to any roofing material being installed. Yes f�No (/` If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which P g emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new material: for inspection. District? ❑Yes Nu I have read the hazardr s m Sections requirements under Chapter 6.95 of the Califor- nia Health&Safety Code, 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 Arcquic,m,,crus hieh must be met prior to issuance ofa certificate of Ocanty. Signature ofApplieant Date r authorized ag t Dare All roof coverings to be Class"B"or better CITY OF CU?ERTINO 8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: -jot: APN 36911)54 . 00 DATE ISSUED. . . . . . . : 05/29/2007 RECEIPT # . . . . . . . . . BS000)01486 REFERENCE ID # . . . : 07050272 SITE ADDRESS . . . . . : 10358 S BLANEY AVE SUBDIVISION . . . . . . CITY CUPER,rINO IMPACT AREA . . . . . . OWNER PRASAD LAKAMSANI ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERPINO CA, 95014-3121 RECEIVED FROM . . . . : JIM RONDO CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY AAA FJRNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JDSE, CA 95125 TELEPHONE (408) 293-4717 FEE ID UNIT QUANTITY AMOJNT 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 7, 635 .00 0.80 0 . 00 0 .80 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 .54 0 .00 176 .54 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUP ERTINO FURNAC "VAC iITY F CUPEkTINO PERMIT APPLICATION FORM APN# ;3 01 // ) --// - Date: ,5 Building Address: l C•' `a 11 1 ve u Phone#: Owner's Name: - ---- —--_-- — License 4: Contractor: Phone: Contact: Phone: Cupertino Business License#: 6AAGz Olin Building Permit Info: Bldg ❑ Elect Plum i ❑ Mech Job Description. , c Qc 1 d 3 Residential [K Commercia ❑ For Rsidential Insttions: Attic r 1St floor E 2nd floor❑ Adhere to min set back requirement EY For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Proje t- « Type ofConstruction: Occupancy group: 7 -� Strapped/❑ On Platform Bonded Sq.Ft. Floor Area: New Location Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furna 3e MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Llnits<= 10, 000 cfin MECHANICAL BREMRECEPT RecplI, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE Plum ging Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Cleck Fee BUILDING BPGAS Gas Pipi System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �CffY OF Fax(408)777-3333 CUPEkTINO Buildin ; De artment OB ADDRESS: PERMIT# OWNER'S NAME: P,V,4 X,oL ,o PHONE# S"a GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /d -de Si ature Date Please check applicable subcontractors and com 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