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11010030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22466 LINDA ANN CT CONTRACTOR:CONDITIONED AIR PERMIT NO: 11010030 OWNER'S NAME: JAWAHAR MALHOTRA 1701 LITTLE ORCHARD ST DATE ISSUED:01/05/2011 OWNER'S PHONE: 6503058351 SAN JOSE,CA 95125 PHONE NO:(408)291-2220 LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C`20 Lic.# l/ljs�'bZ- /� MECH r RESIDENTIAL r COMMERCIAL r Contractor 4Jy,_/1_i 0x& / Date 1A111-_ 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE(IN CLOSET)&AC (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:$8650 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. ! 1 APN Number:32613071.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued b Date: 9.18. 01 Signature Date f� RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or aut r' t• Compensation laws of California. If,after making this certificate of exemption,I SDate: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, c--'c,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. w..,.all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32613071.00 DATE ISSUED. . . . . . . : 01/05/2011 RECEIPT #. . . . . . . . . : BS000012400 REFERENCE ID # . . . : 11010030 SITE ADDRESS . . . . . : 22466 LINDA ANN CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JAWAHAR MALHOTRA ADDRESS . . . . . . . . . . : 22466 LINDA ANN CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1026 RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 650 . 00 1. 00 0 . 00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 0 . 00 1BSEISMICR VALUATION 8, 650 . 00 0 . 87 0 . 00 0. 87 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 274 .87 0 .00 274 .87 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 274 .87 VISA --------------- TOTAL RECEIPT 274 .87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22466 linda ann ct. DATE: 01/04/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$8,650 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: I I PERMIT TYPE: WORK add a.c replace existing furnace at closet location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check0.0 hrs $0.00 Pitta/' I'1(m C ht cA 1'J" P/an C h"Ck Mech.Permit Fee: IMPERMIT 1 w"b. �'c�vnw 1""e, I;Irt rrr!uit 7°,t L01her Mech.Insp. 0.0 hr's $42.00 t?Ih�t f'r ,,.1 <,>. C)t°htt I;i�>c. 1t�st�. Li Itit�r. 1'cc NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 Elf 7/1/10) FEE QTY/FEE MISC ITEMS flan Check sr pp/. 1'('Fc'e PME Plan Check: $0.00 Perinit Supp[ hiss Fee PME Unit Fee: $189.00 PME Permit Fee: $42.00 (011N1F11('t70P7 747X �tcou.s1ic:al Work Without Permit? 0 Yes (F) No $0.00 1'lczrartitr,�>f�'c��'s. Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: 1BSEISMICR $0.87 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.87 $0.00 TOTAL FEE: $274.87 Revised: 12/07/2010 • Building Department City Of Cupertino La 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ZZ 1o6 L i Kc(q 0V PERMIT# 0 OWNER'S NAME: JcK wakav- A4 R( y- PHONE# •Z /-Z Z 2� GENERAL CONTRACTOR: OvtCh><i6Ned Aiv- BUSINESS LICENSE# Z- ADDRESS: /7Q/ l rf��e G(uvcl CITY/ZIPCODE: -Sa v- 05e *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 THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 6/ 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 Tile Owner/Contractor Signature Date ( ISI � 0 _ CITY OF C UPERTINO = cm- F FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: 2Z y CSG Owner's Name: WPhone#: Contractor: one#: C�tc�6� C��IL'k,\ o''�d �� ��SOC�c�c �S Fax #: Cc-lc�') ZG I ' 2ZZ(-/ Contractor License#: Cupertino Business License#: "L-v5 162 Contact: Phone#: S`PtrnE' y? Fax #: Building Permit Info: Elect Plumb ❑ Mech [� Job Description: W"O Je � `cam C P- � 1z C e -k QPw.p✓e �t�Y✓�ac� Residential /K �Ascf Commercial For Residential Installations: Attic ❑ 1" floor [� 2" floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight [�t- Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): Strapped On Platform El Bonded New Location LT Replacement Valuation: 1?i 6 S0 � ©c-' Green Building: Must attach Green Building Check list to this application