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09050163 orf Z � PERMrr NO. rINO 1r�1 CITY VF CU1 Eli PEP-NUT BUI'.JANG DrYIS1oN BUILDING ADDRESS: KRISHNA K I�BI �IuaTISSUE DATE 7 811 LILAC CT SCONTROL NO. A ' OWNER'S NAME: KRISHNA KILAM BUILDING PERMIT INFO MECH ELECT PLUMB IE: BLDGj� ARCHITEC IENGINEEW job Description RSDECLARATION WITH A 4 TON COIL & 4 TON CONDENSER LICENSED CONTRACfO rov,sions of Chapter 9(commencing v o o I hereby afrirm that(am licensed under pr and Processions Code,and my license is IN STL AIC J at Z m with section 7000)or Division 3 of tta Busirtesa .G. in full force and effect- Lic- j M Z License Class-------�Contractor LARATION p Date ARCHSO ltTbc used as public records a< I understand my Plans sbal ul URATION i°'F Licensed Professional w for the r O< pWNER-BUILpER DELLA ors License La Valuation t from the Conte An city or county n`A.t 1 hereby affirm that 1 am Bel��and Professions Cade: Y suucture alter,improve•demolish.or repair any Sq.Ft.Floor Area 2 8 O 0 cc following reason.(Section 7()3l'S' alter. nt for such Permit'o file a signed statement >o which requites a Permit to construct P uires the applicant tar's Lie Law(Chapter 9 Occupancy Ty y^w prior to its issuance,also req rovisions of the Contrac i that he is licensed Pursuant to the p exemption-Any violation of APN Number on 7000 of Division 3 n[the Business and Professions Cade or basis for the alleged penalty of 2%0 H G (commencing with�and the cu the apPlicant to a civil pe Y 3590302.6 . 0 1. that he is 31.5 applicant for a petal subje Section 7031.5 iv arty aFP Required Inspections ces with wages as their sole compenytions not more than five hundred dollars( jp44 Business 0 1,as owner of the property,or my employ work and the structure is ars Lntc�eosa raw�not PP y to an owner through his will do the ons Code:The Conlrac and Profess` sea thereon,and who does such work hooffered for sale-U• property who builds or imps rovements are not inter Co wmPletion,the owner- own employ provided that such imp for purpose of however,the building or improvement is sold within one Year builder will have the burden of proving that he did not build or Improve saleJ- exclusively contracting with licensed contractors to rty'air+ processions Code.)The Contractors Li- ®I as owner of the prope neon,and. �onstnrct the project(Sec.7044•Business aad who builds or`reit to�Contractor's cense Law docs not apply to an owner of PtO t,s licensed purses who contracts for such projects with a contra r<) B do P C for this mason License Law• %I am exempt under rY Data O `Lti owner WORKERS SATION DECLARATION COMPEN affirm under penalty of perjury one of the following declarations: I hereby rsCompan- Section 3700 mf the Labor Code.far the perforntartx of the J 1 hs+e and will maintain a Certificate of Consent to self-insure[tu Wm cation,as provided for by work for which this permit is issued' required by Section Compensation Insurance.u tW permit is issued. I have and will maintain Won ees performance of the work for which this 3700 of the Labor Code. In Insurance carrier and Policy number am: My Warkees Compensation policy No.: Carrier. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INS�'tt it s oronehundreddollars($100) (This section need not be completed if the pc or IessJ rrttft is issCompe shall not Warkr�•Compensation I certify that in the performance of tic work whit,thwlhe person in any m r so as employamYmia L - Laws of mption,you sh uld Applicant if,atter making ibis Ccniftcate of You must NICE Tp APPLICANT: ompeasetion provisions of the I abort Code, Y become subject to the Workers visions or this pernil shall be deemed rev° z with comply with such pro C) CONSTRUCTION LENDING AGENCY l' or the performance of to I hereby affirm that there is a constroctic lending C`.C.) r-. permit is issued(Sec.3097. a> the work for which this pe Lenders Name 0Wn A Lenders Address application and state that the above information is "7 OI terrify ttat 1 have read tids app ordinances and state laws relating to correct I agree to comply with all city and counretscntadvcs of this city to enter atom Zg E-t building construction,and hereby authorise rep 0 rt for inspection purposes. Cupertino against Date V above-mentioned PMPe Y , and y�cp harmless the City at Caanst said City y+W (Wc)agree to save.indemnify which may in any waY accrue B f i p liabilities,jadgmcnts.costsand expe rmit ALL NON-POINT Is:,ued by: `~ in consequence o[the granting of this pc V rz-t APPLICANT UNDERSTANDS AND WILL COMPLY W© ^ R-,-roofs SOURCEREGULAT►ONS �� ale a of Roof T 1p installed. Signature of Appli�tucontractor ALs DISCLOSURE ossa mater`s► roofing material b HAZARDOUSMAT�cupantstoreorhandlehazard inspected prior to any I agree Will the applicant or future building to 9-12,and the Health and Safety x,11 roofs shall be insp p an ins ection, as defined by the Cuperono Municipal Code. Chap without first obtaining p Code,Section 25532(a)? tANo IF a roof is installed 0Yes which materials for inspection. Mg occupant use equipment or deM�gemcnt i.11 new Will the applicant or future aildil fined the Bay Area Air Quality ,mit hazardous air contaminants as District? ONO j]Ycs ifor- ter 6.95 of the Cal' Date bus materials requirements under Chap understand if the building 1 have mad Co��. the occupant of the licant rt "or better niaHcalth8rsarety a°1,that itisS53 d n �ySignature of App to be Class does not currently have a tenant.pr or W issuance of a CcAiGcate oo �,\ All roof coverings � re Its whi ust be mel psi Date Owner of authorized agent CITY OF CUPERTINO (40 FURVACE/AC CUPEi�TINO PERMIT APPLICATION FORM APN # 2,P• pC5 Date: Building Address: LILAC C-�-T Ct-) pGl:- U CA Ci Owner's Name: Phone#: l S t< I to 409 9�,� Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect Er Plumb ❑ Mech Er Residential P11, Commercial Job Description: I � ,� Q , ` w i t �( L- For Residential Installations: Attic ❑ 1st floor 14 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): (� Strapped I On Platform Bonded New Locatio Replaceme Project Size: Express Standard ❑ Lar e ❑ Major❑ _ Valuatio� Green Buildin Please com Tete relevant orti)n of the Green Building Checklist & attach it to the g� P P application or if applicable, include in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC COf CUPETkINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type -qL0-UjL AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= 1 Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ca gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas pi ping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= I Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standa-ds Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1EPERMITFEE Electric Permit E ` 1 MPERMITFEE Mechanical Permit M / 1PPERMITFEE Plumbing Permit P - 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1"OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: /v 7- f J¢ (/.r-&- PERMIT # (-)9 r-> OWNER'S NAME: e,..� WAIArj PHONE # 4'f/Z-4 GENERAL CONTRACTOR: A.- ,. FAX # i I am not using any subcontractors: Signature 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 �• /Z 0 wne Intractor Signature Date