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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 :.TiZ 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