13020149I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1228 WEYMOTH DR CONTRACTOR: MISSION A/C & PERMIT NO: 13020149
FURNACE
OWNER'S NAME: SASHMALA OBILISETTY & MAHESH 12485 AUTUMNVALE DR I DATE ISSUED: 02272013 . I
OWNER'S PHONE; 4082550842 SAN ]OSE, CA 95131 PHONE NO: (408) 554-2878
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lie.#�
Conttacm,22,,5r Ri ver -late �%' 2 a13
I hereby affirm that I am licensed udder the provisions of Chapter 9
(commencing with Section 7000) ofDivision.3 of the Business & Professions
Code and that my license is in full force and effect.
I here by affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
Icertify that I have read this application'snd state that the above information is
correct. I 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 above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may ac against said City in consequence of the
granting of this Additionally, e applicant understands and will I
with all non -p m so ce reg do per the Cupertino Municipal Code, Section
9.18. 117 1 /
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
I, as owner of the property; am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of pedury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the labor Code, for the performance of the work for which this
pennit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read. this application and state that the above information is
correct. I agree to comply with all city andcounty ordinances and state laws relating
to building convection, and hereby authorize representatives of this city to enter
upon the above mentioned property focinspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and.expenses which.may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
ADD NEW AC UNIT TO REAR YARD Sr REPLACE (E)
FURNACE
IN SAME LOCATION (INSIDE HALLWAY CLOSET)
Sq. Ft Floor Area: I Valuation: 54800
APN Number: 36210035.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAY RMIT ISSUANCE OR
180 DA M LASTeiLLED INSPECTION.
nate:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all. new materials for
inspection.
Signature of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534: 1 will -
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality. Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, SectAns,;5505425531, and 25534.
Owner or authorized
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of ,
work's for which this permit is issued (Sec. 3097, Civ C) -
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
2 GENERAL PERMIT APPLICATION � Irl E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
.10300TORREAVENUE •CUPERTINO,CA95014-3255 Q /'�
CUPERTFhtO (408) 777-32288 - FAX (408) 777-3333 • buildinQQcuoertino.orG ` ■V
F-1 PLUMBING 6mcHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
AIN: J / `r O „
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OWNER NAME R
�E
STREETADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
E-MAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT X
CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAI,T
CONTRACTOR NAME
LI SE NUMBERLICENSE
TYPE
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BUS. LIC#
COMPANY NAME
E-MAIL
FAX
STP DRESS
CTTYZIP SI Z
P 091 I
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC A
COMPANY NAME
E-MAIL,
FAX
STREETADDRESS
CITY, STATE, ZIP
PHONE
USE OF ElfFD m DUPLEX ❑ MULTI -FAMILY
BUDING: []COMMERCIAL
IL
PROJECT IN WILDL4ND I] YES
URBAN INTERFACE AREA NO
PROJECT IN ElYES
FLOOD ZONE ❑NO
IS THE BLDG AN ❑ YES
EICHLERHOMET ❑NO
DESCRIPTION OF WORK
Z
LCJ i
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TOTALVALUATION: Q�
RE ED
By my signature below, I certify to each of the following: I
application and the information III ave rovided is correct. I
ordinances and state lavas relating to i ons ction.
Signature of ApplicanVAgent
the property owner or authorized agent to act on rop owner's all. ave read this
ve read the Description of Work and verify it is accurate. I agree to with all applicable local
authorize repreS natives of Cupertino to enter the aboev�e-id ttified propel,for einspection purposes.
Date: f-+ G ? 12—o1 �
SUPPLEMENAL INFORMATION REQUIRED
OFFICE USE ONLY
ma—VER-THE-COUNTER
El EXPRESS
U
U
STANDARD
LARGE
El MAJOR
MBPLfacApp_2011.doc revised 06/2]/]]
CITY OF CUPERTINO
mrws � mAil D7T77 TiN!'_ TITVTCT(TN
APPLIANCE / EQUIP TYPE
FEE ID
.•••- -• -
QTY/FEE
QTY
1228 WEYMOTH DR DATE: 02/27/2013
REVIEWED BY: MELISSA
ILIADDRESS:
A/C Units (<=I OK cfm)
VALUATION: $4,800
Permit Fee:
APN: 362 10 035 BP#:
#
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PENTAMATION FURN/AC
PRIMARY SFD Or Duplex PERMIT TYPE:
USE:
AC UNIT TO REAR YARD & REPLACE E FURNACE IN SAME LOCATION INSIDE,
WORK ADD NEW
SCOPE HALLWAY CLOSET)
APPLIANCE / EQUIP TYPE
FEE ID
.•••- -• -
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=I OK cfm)
1BREMAIR
Permit Fee:
1
#
$67
Furnace, Forced -Air.
1MFR=<100
PME Unit Fee:
1
#
$133
Construction Tax:
Administrative Fee: IADWN
$42.00
TOTALS:
$0.00
Advanced Planning Fees:
f g.
'Ft . r
$200.00
ti
Mech. Plan Check 0.0 hrs
Mech. Permit Fee:
Other Mech. Insp. 0.0 - . hrs
;tlech. Insp. Fe<c:
Nt)TF. This estimate does not i
$0.00 Plumb. Plan Checd'
RnM7T P(umG. Permit Few
$45.00 Other Plumb Insp.
Plumb. brsp. Fee:
de fees due to other Depart
Elec. Plan Check
Elec. Permit Fee:
Other Elec. Insp. LJ
Elco. Insp. For:
irks, Fire, Sanitary Sewer District, School
District, etc.). Thesefees are basea on the PreUMUPFUIT
FEE ITEMS (Fee Resolution 11-053 Eff 711112)
:rs urm -- uv....,....�
FEE
.•••- -• -
QTY/FEE
-••• --------- -
MISC ITEMS
Plan Check Pee:
Setppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. ]nsp Fee
PME Unit Fee:
$200.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADWN
$42.00
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC
$45.00
Strong Motion 'Fee: 1BSEISMICR
$0.50
Select an Administrative Itecri .
Bldg Stds Commission Fee: 1BCBSC
$1.00
$333.5r0
_.,,,I
$0.00 OLA]E
$333.50
-J. n.ln�/fll1'i
22 g vie� `fir
DEVELOPMENT DEPARTMENT
3 DIVISION - CUPERTINO
s set of plans and specificatio s fv1 T be kept at the
site during construction. �iATawful to make any
chances or alterations on same, or to deviate
erefrom, without approval from the Building Official.
stamping of this plan and specifications SHALL NOT
held to permit o an approval of the violation
any pr y nance or State Law.
2 -
NO. NO.
2�1 �
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I -
OIFICE COPY
FEB 2 7 2013