12110019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1148 ELMSFORD DR CONTRACTOR:SANDIUM PF.RMITNO: 12110019
OWNER'S NAME: RAMESII SUBRAMANIAN AND USHA V 4223 VERDIGRIS CIR DATE ISSUED: 11105r012
OWNER'S PHONE: 4086050571 SANJOSE.,CA 95134 11I IONENO:(408)894-9072
Cl LICENSED COY IRACIc'7OK7'SS DECLARATION BUILDING PERMIT INFO: BLDG r ELECT C PLUMB 7,
License Class Lic,q b b a `
�+��+ � � ` bI F,CII r RESIDENTIAL r COMMERCIAL(J
Contractor �Lt,VsCt�'•'^ Date (Z
I hereby affirm that I am licensed under the provisions of Chapter!) JOB DESCRIP'PION: FURNACE AND DUCT'REPLACEMENT IN SAME
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION
Code and thin 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 sell'-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this pemtit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$7750
Section 3700 of the Labor Code,for the per(ortyancCp(the work for which this
permit is issued
AI'N Number.36209017.00 Ocrupanry'I'ype:
APPLICAYr CE RTI FICATION
I certify that I have read this application and state that the above information is
correct.I airee to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City ofCupeninoagainst liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,anti
eofthispermihichmayaccmeagainstsaidCityinconsequenceo(the 180 DAYS F M L ST CALLED INSPECTION.
grntin,of this permit. Additionally,the applicant understands and will comply v)
with all non-point source regulations per the Cupertino Municipal Code,Section //—S f
9.18. Issued .... Date:
Signature Date M/S/ '
❑ OR'NER-BIIILDI.R DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Laefor one of installed without first obtaining an inspection,I agree to remove all new materials for
the follmwfng two reasons: inspection.
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(Scc.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVEIRINGS TO[IF,CLASS"A"Oft BVI-11'11
hereby affirm under penalty of perjury One of the following three
declarations: 11.\%AKUf11IS ML\'1'I•;KIAIS DISCLOSURE
I have and will maintain a Certificate of Consent to sel Finsu a for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,fur the California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Cade.Section 25532(n)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally'should I use equipment or devices which emit hazardous air
contaminants as defined by'the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,l shall Ilealth&Safety Code.Sections 25505,25533,and 2.5534.
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 Owne uthorizc rte LI
become subject to the Worker's Compensation provisions of the Labor Code,I must n.t/ Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRI1C1'ION LENDING AGENCY
APPLICA\f CERTIFICATION I hereby afnn that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilitics,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECI"S DECLARATION
,ranting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
GENERAL PERMIT APPLICATION M E 1
- G COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I
sc
CUPERTINO (408)777-322y8 • FAX(408)777-3333 • buildinacDcuaerino.ora
❑PLUT,IDING t[JMECrLkNICA-L ❑ELECTRICAL ❑V.ISCELLANEOUS
PROT17ADDRESs . -1 V -Elm ko'- (v I APN: �(n 2- —�9
ME
kq CL-
OWNERNA54,\I PHONE 0S / DS 057
I I E'A�-1. )!/
STRs"_TIDDRESS I I Cfi Y, S;ATE ZIP I FAX
COT`TACT NAME PHONE
fT1..7.A�W-
STR_Ii ADDRESS (77Y.STAT, ZIP FAX
❑ OWA7l ❑ OWN'E1L-BLT!DER ❑ OrAWER AGE'T r+ CONTACTOR ❑CONHACi OR AGa7. ❑ ARG_=— 0?'GINEEE3 ❑ DEVELOPER ❑ i=4ANT
CONrTRACTOR NAME C1 _ I LICENSE NUMB It (��L rC��N-SE TI?E I BUS.LIC#
MP
COANY NAMP - E-MAIL vi)t ke1PQ(C,�n l FAX
STREET ADDRESS 4W3
=, .STATE,ZIP ` I PRONE n tI9 7
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ARCTIENGil. =- 1J
NAME Vj+yC` LICENSE NU MER J 13US. Cy o W
COMPANYNAA I E-MAIL FAX
STREFf ADDRESS I CfiY,STAT,ZIP I PHONE
USE OF ❑SM m DUPLEX ❑ MULTLFAMILY PROTECT IN W:.DLAND 0 )Es I FROTFS-CT IN ❑ YI S The BIDG AN ❑ YS
BUILDyG,.. CORA cIAL URBAN ATZRFACE AREA NO FLOOD ZONE ❑ NO EICHLER HOMc'I ❑NO
DESCRIMON OF WOR-K
✓fir-CII- �{ Ciu�-E cf.�..� lFxs�ila�
TOTAL VALUATION: 47750 I RECEIVED BY:
By my signa:c-below,i certify to each of the following: I a a;he pmverry owner or zuUIcrized agent to act on the propety owner's behalf. I have read this
application and d-.e in`onnarion I have provided is correct I have read the Description of Work and verify it is acenzte. I zgrr_-to comply with all applicable local
ordinances and state laws mlabng to bD' g consunction. I an;honn;epresenadves of Cupertino to enter the above-identi�-d p. pe:,l;o`r insp/ection pu(poses.
Signature of Apnlicant/Agenr Dare: Z-
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTER
Y
❑ EXPRESS
rj
z ❑ STANDARD
J
< ❑ LARGE
❑ MAJOR
.ASE?-> ua4ppj011.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 1148 Elmford DATE: 11/05/2012 REVIEWED BY: RDW
APN: - BP#: 'VALUATION: $7,750
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTANIATION
USE: SFD or Duplex PERMITTYPE: FURN/A
WORK Furn and duct replacement in same location.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID.,, QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
Heating System 1MRRAA 1 # $67
TOTALS: f $200.00 T
AMech..Plan Check 0.0 Ins $0.00 Plumb. Plan Check Elec. Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Pc'mir Fee: Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Ll
Other Elce.Insp.
Mach.Insp.Fre: Plumb. Insp.Fee: Eler.Insp.Fee:
A'OTE: This estimate does not includejees due to other Departments(i.e. Planning, Public I3'orks, Fire,Sanitary Sewer District,School.
District,etc). These fees are based on the prelintinan information available and are onh,an estimate Contact the Dept for adda'I info.
FEE ITEMS(Fee Resolution 11-053 E/C 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PCFec
PME Plan Check: $0.00
Perinit Fee:
Suppl. Insp Fee
PME Unit Fee: $200.00
PME Permit Fee: $45.00
Consimciion Tai-:
Administrative Fee: IADAHN $42.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC $45.00 A
Strong Motion Fee: IBSEISMICR $0.78 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
S TOTALS:; $333.78 $0.00 TOTAL FsEE $333.78
Revised: 10/01/2012
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Sire Address: EnforcemenrAgency: Dale: Permit q:
D� . � s f
Conditioned Duct insulation
Equipment Typer List Minimum Efficiency' Floor Area mquimment Thermostat
El Packaged Unit ,..,/ Over 40 ft of du
umace Ifl AFUEIr/,- e COP_ Setback
Served by system added or replaced m
Indoor Coil []SEER HS PF On sf umeonditioncd spa« (Ifnor abeadvpresenc mart be
Condensing Unit ❑ EER_ ❑Resistance ❑R 6 (Cy.1,3-5) inualled)
Other
1. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-I R-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• 1 certify that Otis Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform in the
requirements of Tide 24,Parr 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the pemtit
lication.
Name: . 4a Signature:
Company: Date:
Address: /r eL� e44 ., Clrt, License: f?OO 1i
City/State/Lip: L7 to Phone: 4-42q L(- p?'L
2008 Residential Compliance Forms.doc reviser/04110112
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333.
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: I PERMIT# / / l (7(�
OWNER'S NAME: `),P— PHONE # 4SZ
GENERAL CONTR_ ACTOR: fes,,, BUSINESS LICENSE #
ADDRESS: ZZl, Y.% c c. CITY/ZIPCODE: 75t
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license..
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL.TIIE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
�il .re 1l. Pate Z
1 am not using any subcontractors: -� .o
Signature vale '
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
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tila /
/n it
Owner/Contractor Signature Date