13030172CITY OF CUPERTINO BUILDING PERMIT
1 BUILDING ADDRESS: 10402 NOEL AVE I COOLING NTRACTOR: VALLEY HEATING & I PERMIT NO: 13030172
I OWNER'S NAME: SOMAYAJULU ARYASOMAYAJULA 1 1171 N 4TH ST I DATE ISSUED: 03/29/2013 I
I OWNER'S PHONE: 4087610454 [SAN JOSE, CA 95112 I PHONE NO: (408)294 -6290 I
V LICENSED CONTRACTOR'S DECLARATION
C—�2b
License Class4M�6 Lic. # 2SK_cW0
Contractor. V4 y ffel. -1. 0 Date J <2�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division of the Business & Professions
Code and that my license is in full force and effect.
1 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.
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
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
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.
BUILDING PERMIT INFO: BLDG F ELECT 1 PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: REPLACE (E) FURNACE, SAME LOCATION. INSTALL (N)
A/C UNIT IN SIDE YARD AREA -5' CLEARANCE FROM UNIT
'1'0 PROPERTY LINE
Sq. Ft Floor Area: I Valuation: $9290
APN Number: 32647050.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: /%fir✓ �! l/f� Date:
Signature �iti � �,G2.� � :mss —Date 3 /2nt
❑ 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See.7044, Business & Professions Code).
I hereby affirm under penalty of perjury 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
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
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 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 accrue against said City inconsequence 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.
Date
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 Applicant:
Date:
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(x) 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, Sections 25505, 25533, and 25534.
Owner otr autriz d ag na
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 Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profession
CUPERTINO
r, a_� - Y_ Z
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 misc
(408) 777 -3228 • FAX (408) 777 -3333 • building�a.cupertino.orq
❑ PLUMBING Mac. HANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS APN # If S
iD o tJoe clue 7
OWNER NAME PHONE E -MAIL
STREET ADDRESS CITY, STATE, ZIP / pt� FAX
1 D K 02 Nia e 1 4,)e C cC 1 /6 f( l
CONTACT NAME PHONE E -MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER- BUILDER
❑ OWNERAGENT
❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER �c ' J�
Jam'[
LICENSE TYPE -��
BUS. LIC #,�
COMPANY NAME i r
E -MAIL
FAX
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STREET ADDRESS N �
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CITY, STATE, ZIP S
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95112
PHONE
Yag- 2��E -CPZPo
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX
BUILDING: ❑ COMMERCIAL
❑ MULTI- FAMILY
PROJECT M WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK �/
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X/C i/A Z177
TOTAL VALUATION: ( Qb
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's be a . I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I au rite representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMAT ON REQUIRED nrr v I Mr.
nNS,Y'
MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
UV 1 cT7M A rrn1D — RI TII .illNf_ nlVlClnN
APPLIANCE / EQUIP TYPE
ADDRESS: 10402 NOEL ANE
DATE: 03/29/2013
REVIEWED BY: MELISSA
UNITS
APN: 326 47 050
BP #:
*VALUATION: $9,290
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
#
PENTAMATION FURN /AC
PERMIT TYPE:
USE:
Furnace, Forced -Air
1MFR = <100
WORK
REPLACE E FURNACE SAME LOCATION. INSTALL N A/C UNIT IN SIDE YARD AREA 5'
SCOPE
CLEARANCE FROM UNIT TO PROPERTY LINE)
APPLIANCE / EQUIP TYPE
FEE ED
FEE
QTY
UNITS
BP FEES
A/C Units ( < =10K cfm)
1BREMAIR
1
#
$67
$0.00
Furnace, Forced -Air
1MFR = <100
1
#
$133
PME Unit Fee'
PME Permit Fee:
$45.00
Conswuction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? ® Yes (j) No
TOTALS:
Advaneed Planning Fees:
$200.00
x
Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Plan Check Elec:..Plan (:;heck
Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Ocher Plumh Insp. Other E'lec. Insp.
,11ech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp, Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fiW are based on the prelhiniina information available and are only an estimate. c,onract me ve r or auun a en u.
FEE ITEMS ('Fee Resolution 11 -053 E . 7ff 11112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
SupPl. PC [,ee
PME Plan Check:
$0.00
Permit .Fee.:
SuPPI. Insp Fee
PME Unit Fee'
PME Permit Fee:
$45.00
Conswuction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? ® Yes (j) No
$0.00
Advaneed Planning Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.93
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$1.00
$333.93 $0.00 _ _: ' E $333.93
Revised: 01/01/2013
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