11010056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22898 CRICKET HILL RD CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11010056
CONDITIONING
OWNER'S NAME: SREEDHAR VAJRALA 1712 STONE AVE DATE ISSUED:01/10/2011
4ER'S PHONE: 4088232340 SAN JOSE,CA 95125 PHONE NO:(408)2934717
❑ LICENSED CONTRACTOR'S DECLARATIONI—
(� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Cl C Lic.# 7 t1
6 �
MECH r— RESIDENTIAL r COMMERCIAL�
Contractor 4& FUCNaCO-' Date I " U f
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE&REPLACE IN SAME
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3859
Section 3700 of the Labor Code,for the performance of the work for whicli this
permit is issued. -09
APN Number:34235015.00 Occupancy Type:
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 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 of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses h ay accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this pe t. ditionally,the applicant understands and will comply
with all -poi so regulations per the Cupertino Municipal Code,Section ��
9.18. t Issued by• Date:
Signature Date
C.. OWN -BU DER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following 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(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this perntit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation htsurance,as provided for by Safety Code,Section 25532(a)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
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
p maintain c 'anc with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health& afe o e,Sections 25505,25533,and 25534.
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 O ner a rued agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: "` 10
forthwith comply with such provisions or this permit shall be deemed revoked.
CO TRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm 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
'-mnify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting 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
CITY OF CUPERTINO
5 ITEMS OF 25 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34235015.00
DATE ISSUED. . . . . . . : 01/10/2011
RECEIPT #. . . . . . . . • : BS000012441
REFERENCE ID # . . . : 11010056
SITE ADDRESS . . . . . : 22898 CRICKET HILL RD
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SREEDHAR VAJRALA
ADDRESS 22898 CRICKET HILL RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM RANDO AAA HVAC, INIC
CONTRACTOR RANDO, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . . 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
___ ---------- ---------- ------
1BCBSC VALUATION 3, 859 . 00 1 . 00 0 . 00 1.00 0 .00
1BSEISMICR VALUATION 3, 859. 00 0 .50 0 .00 0 . 50 0 . 00
1MFR=<100 UNITS 1. 00 126 .00 0.00 126. 00 0 .00
1MPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00
------ ---------- ---------- ----------
TOTAL PERMIT 211.50 0 .00 211.50 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------- ---------------------------- -------- -
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 22898 cricket hii rd. DATE: 01/10/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$3,859
7*PRMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
MARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK replace existing furnace at same location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: $126.00
Mech.Plan Check0.0 hrs $0.00 t'l:mlb.1 hw Chc cr r i"i. 1'11cdn Check
Mech.Permit Fee: IMPERMIT I'<"3nrt
Other Mech.Insp. 0.0 hrs L $42.00 «„��; T ,�� 1� CJr11Li
� I�lz�c.Ins'k.
-fcrh. Insp, fc:e: T.'xnrh la 1;. V"”" I;le( Inv'), FCC
NOTE. Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS(Fee Resolution 09-05I F . T`1/10) FEE QTY/FEE MISC ITEMS
Plan Chuck
Suppl. 1)(1,/eye
F 'A
PME Plan Check: $0.00
Perinit Fee:
.Srlppl. hasp I'ee
PME Unit Fee: $126.00
PME Permit Fee: $42.00
Cot]str??('tion I cry
,4cou,sih.wll cvh,t ['e<':
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $42.00
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50
Revised: 12/07/2010
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
240,� 36 (0 1 1--7
Building Address:
a 9. $cr g er c)4-v, µ-,-1 i2c.1
Owner's Name: t' Phone k 19 a 3 - 3 O
reep� !}ar JQJ ¢.a Lc. 40k -
Contractor: �c} Fr N4 ec / �Qa n ql a �t�(V i4 c Phone#: L4 osr -.2-9 2-U '7 1 7
Fax #: i4orr -aci3 - 10 7-7 1
Contractor License#: -7 X08$-71 Cupertino Business License#:
Contact: DQ rvc,, C--i ct+ru �C-IQ r 7u w2 c r-- Phone #: qog--079' 3 -14-7 11
Fax #: 4OS- -gG 3- 40 7 '7 1
Building Permit Info:
Elect❑ Plumb ❑ Mech [•]�
Residential Commercial
Job Description: 1ZenmOv C arNctcc ,t- �e�O/a
Sa n-e- 16 c4,4-101J
For Residential Installations:
Attic ❑ 1' floor 0-- 2nd floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: 3g 59• vo Type of Construction (Usage Class):
StrappedEl On Platform Bonded New Location Replacement
Project Size: Express Standard Large ❑ Major D.
Valuation:
Sb" -0u
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09