13040027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10384 MELISSA CT CONTRACTOR:ONE HOUR HEATING PERMIT NO:13040027
AND AIR
OWNER'S NAME: BHAVEN AVALANI 1400 PETALUMA HILL RD DATE ISSUED:04/03/2013
OWNER'S PHONE: 4089309960 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIALE]
C l o l G1A 2a REPLACE(E)FURNACE IN GARAGE AREA&REPLACE
License Class Lic.# /
(E)
Contractor Date A/C UNIT IN SIDE YARD
Nl�I hereby affirm that I am li ensed under the provisions of apter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby 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. Sq.Ft Floor Area: Valuation:$9100
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 APN Number:34245022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITfIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the !f/3� r
granting of this permit. Additionally,the applicant understands and will comply Is te'
with all non-point source r a ns per the Cupertino Municipal Code,Section
9.18.
�-ROOFS
l _ )
Signature Date `7 / 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.
❑ OWNER-ALDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property;am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 , 5 3 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: D
permit 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 CONSTRUCTION ING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION MEP .
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ` �oo
.10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ,
C!f PEE3TFNO (408)777-3228-FAX(408)777-3333• buildino cDcuperiino.org o MISC
❑PLUMBING. MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �� t c ` AIN n 2 ^ ^ too
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OWNERNA1,1E (� /► � L A' / 1J O , "HON +�Q307 G0 E-MAII,
STREET ADDRESS, F V lr CITY, STATE,ZIP _` FAX
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CONTACT NAME F 1 Z;D11 jO :] _ � E-MAIL
STREET ADDRESS � CITY TE,ZIP �9 C 4 F.4X'a�"�'1� ��1Q J
❑ OWNER ❑ OWNER-BUILDER 10%`NERAGENT ❑ CONTRACTORONTRACTORAGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER El
CONTRACTOR NAME 2 LICENSE NUMBER 2t�D�CSRTPI
S BUS.LIC#C2o c, '"1
COMPANY NAMEO \ A E-MAIL' 1�+ O 1Dv�AFAX
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STREET ADDRESS OV `�•/ STATEY IT
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILY 7R01CT IN=LAND ❑ YES PROJECT Al ❑YES IS THE BLDG AN ❑YES
BUILDING ❑COMMERCIAL N INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: ►�T V
By my signature below,I Artify to each of the following: I am the property owner or authorized ag to act on the p<bperty o«• ' ehalf. I have read this
application and the information I have pr ' Is hgyz.Wad the Description of Work and verify it is accurate. gree to comply with all applicable local
ordinances and state laws relating to Ild' c do an ze representatives of Cupertino to enter the above-identified prope14y for inspection pu[poses.
Signature of Applicant/Agent: Date: 7
pi NOL INF TION RREQi.MDOFFICE USE ONLY
�LDj VER-THE-COUNTER
P✓ �^ ❑ EXPRESS
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u ❑ STANDARD
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❑ LARGE
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❑ MAJOR
MEPMiscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10384 MELISSA CT DATE: 04/03/2013 REVIEWED BY: MELISSA
191 APN: 342 45 022 BP#: *VALUATION: $9,100
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E FURNACE IN GARAGE AREA& REPLACE E A/C UNIT IN SIDE YARD
SCOPE
00 IM-Em�
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMITPlumb.Permit Fee: Elec. Permit Tee:
FOther Mech.Insp. 0.0 hrs $45.00 Cl(hEr Plumb Insp. ETI_ Other Elec,Insp. Li
1Iech. Insp. Fee: Plumb.h1sp. Fee, Elec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS Lee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
Suppl. PC Fee: (j) Reg. ® OT F0_.01hrs $0.00 $133.00 IWR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00 1 I # Mechanical
Permit Fee: $0.00 $67.00 IBREMAIR A/C Units(<=1OK cfin)
Suppl. Insp.Feer Reg. Q OT 10701 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
C onswuction Tax:
Administrative Fee: ]ADMIN $42.00
Work Without Permit? ® Yes (E) No $0.00 E)
Advanced Planning Fee $0.00 Select a Non-Residential
Travel Documentation Fee:: ITR.4VDOC $45.00 Building or Structure ®�
Strong Motion Fee: 1BSEISMICR $0.91 Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC $1.00
' - '4" $3
,r
$133.91 $200.00 - s 33.91
, a " ,�_
Revised: 04/01/2013
T'lot Flan of A/C Location,
Job Name I. f.'4r/AL 40 i Address: 0Q ) GG j t _
C � LL,
11 Drawing must have the distance to property line from A/C in all directions`.' Y� l Y}0 C�-
❑ Draw in all property lines(usually the fence).
❑ Change the shape of the box to represent the home.
❑ Place A/C unit 12"from home and label as such.
❑ Draw in the streets that border the house.
0 Show electrical panel,furnace&garage.
❑ This map is required for Santa Rosa,Petaluma and Sonoma
CUPERTINO COMMUINITY Dc DEPARTMENT
Building Department 3UILDiN1G DIVIE7iON-lup;-R iNo
-'l
APPROVED
APR
.'fications MIUST be kept at the
job site during constructiAfromth
! wful to make any
changes or alteratioor to deviate
R, VIEWED FOR CODE COMPLIANCE therefrom,without apprh Building Official.
Reviewed By: The stamping of this plan i tions SHALL NOT
be held t o bv I of the violation
v' s of ya ce or State Law.
DATE
PERMIT NO. 3� 6
PL(y� L' S
CMUCgID BY
Ar 2'� -
" 7aM�NG DEPT.
BLDG• DCpT.
UFFICE (;OF
l,eN : 4f--Ir - 027
C:1Documents and Settings\Owner\My Documents\checklists\CA paperwork packet\Plot
plan 1.0.doc