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07050222 CITE'OF CUPERTINO C�1'�TRAGTC�R I�tEt}RMTIN� BUiLDI 46 DIVISiC:!1 ERWT PERMIT No. BUILDING ADDRESS: DR AAA FURNACE & AIR 07050222 18345 PERMIT ISSUE DATE OWNER'S NAME: 05/22 2007 KUMAR, ATUL 1712_ STD AVE aWUARYNO. CONTROL NO. NE: (408) 293-4717BUILDING PERMITiNFO ARCHITECT/ENGINEER: ELECT PLUMB MECH (� O Z LICENSED CONTRACTOR'S DECLARATION Job Description v1 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 ADD A/C UNIT "'o- in full force and fe v�Z License Class Lc' p Date Contractor t U) A CHI iECTS DEC A a< I understand my plans shall be used as public records 14 V u.In Licensed Professional O< OWNER-BUILDER DECLARATION reason. 3 a i It afr,rm that I am exempt from the Contractors License Law for the p O following (Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation "m prior to its issuance,also requires the applicant for such permit to rile a signed statement S Ft Floor Area $4]$2 a that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 fl r E✓ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L drat rte is exempt therefrom and the basis for the alleged exemption.Any violation of �p1 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37522108 . C77 t not more than five hundred dollars($500). O i,as owner of the property,or my employees with wages as their sole compensation, Required Inspections 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 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 sate.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.). 0 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. ❑1 am exempt under SeB&P C for this mason Sec. Date Owner WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: LJ 1 have and will maintain a Certificate of Consent to self-insure forworkees 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's Compensation Insurance carrier and Policy number are: Carrier.r4 4 N.• �✓ Policy No.: E T A O EMMON FRO ERS' 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 ,'Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY (�Cn 1 hereby affirm that there is a construction lending agency for the performance of (�7 the work for which this permit is issued(Sec.3097,Civ.C.) ;4 IM Lender's Name 0. Lender's Address I certify that i have read this application and state that the above information is Ocorrect.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspecuon purposes. nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against tF" liabilities,judgments,costs and expenses which may in any way accrue against said City Date ... 22-1— U Zin consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SAUE REGULATIONS. Re-roofs so pp tcaoUCo rector Date 'I Of Roof HAZ 'or MATERIALS DISCLOSURE Type 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 roofs shall be inspected prior to any roofing material being installed. 0 Yes o If a roof is in:;talled without first obtaining an inspection,I agree to remove Will the applicant or store building occupant use equipment or devi devices all new mates salts for inspection. emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Q Yes No I have read the haza nos 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 -- Date requircmejis which must be met prior to issuance of a Certificate of Occupancy. Signature of��ppl icant All roof coverings to be Class"B"or better Own r or aut frized agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lct: APN 375221C8 . 00 DATE ISSUED. . . . . . . : 05/22/2007 RECEIPT 4 . . . . . . . . - : BSOOOOC1425 REFERENCE ID # . . . : 07050222 04l_Lbw'cD SITE ADDRESS . . . . . : 18345 C'IiL-EMS70= DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KUMAR, ATUL ADDRESS 18345 CHELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JIM RANDO CONTRACTOR RANDO, JIM LIC # 8050 COMPANY AAA FUPNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (408) 25,3-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ ---- ---------- ---------- ---------- BENERGY PERMIT FEE 1 .00 :,4 . 86 0 .00 34 . 86 0.00 BREMAIRHAN NO.UNITS 1.00 =.0.26 0 .00 10 .26 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0 .00 1 .20 0 .00 BSEISMICRE VALUATION 4, 782 . 00 0.50 0 .00 0 . 50 0.00 EPERMITFEE FLAT RATE 1 . 00 _.8 .37 0 .00 38 .37 0. 00 MPERMITFEE FLAT RATE 1 .00 _;8 .37 0 . 00 38 .37 0 . 00 PPERMITFEE FLAT RATE 1.00 ;;8 .37 0 .00 38 .37 0. 00 ------ ---- ---------- ---------- ---------- TOTAL PERMIT 161 . 93 0 .00 161 . 93 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------------- CREDIT CARD 161. 93 VISA --------------- TOTAL RECEIPT 161 . 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL 070—oz22? CITY OF CUPERTINO FURNACEAC CUPEI�TINO PERMIT APPLIC2LTION FORM APN# 3 7� &) Date: Building Address: Owner's Name: Phone#: A14-V if• baY- S"/os Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: G - o :4 3- s Building Permit Info: Bldg El Elect Plumb Mech Job Description: e T�,&,) Residential �L Commercial ❑ For Residential Inst Rations: Attic ❑ 1" floor 2"a floor❑ Adhere to min set back requiremenvQ- For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy oup: Strapped ❑ On Platform 0 Bonded E5- Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfrn MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL / BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec P,;rmit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumb:ng Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan C,4eck Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Businc ss License BUILDING X, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r.UPEkTINO Building Department JOB ADDRESS: PERMIT # /f 3 .i G4 fce v, C7 05CW'R OWNER'S NAME: 4,4,1w PHONE # ya S-i o GENERAL CONTRACTOR FAX # I am not using any subcontractors: els-- 2 a -p Si ;iture Date Please check applicable subcontractors and complete 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