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11010055 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10430 MANN DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11010055 CONDITIONING OWNER'S NAME: SANDEEP AND MUNA KHANNA 1712 STONE AVE DATE ISSUED:01/10/2011 'ER'S PHONE: 4083903490 SAN JOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATION [_ BUILDING PERMIT INFO: BLDG ELECT PLUMB LicenseClass 'u, Lic.# (b $ `7 t r MECH RESIDENTIAL COMMERCIAL r Contractor i-P h k rN'Ace Date I^ 1 U —f( I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISITNG FURNACE IN SAME LOCATION (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:$3622 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 w 'ch this permit is issued. APN Number:32645013.00 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-poin sou regulations per the Cupertino Municipal Code,Section Issued b Date: /),�2, 9.18. Signature Date U 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: I,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) I,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. I 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 Additionatthata equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminfly the Bay Area Air Quality Management District I will maintainh the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Jk*Uh& ections 25505,25533,and 25534. 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 Own)rr nt: Compensation laws of California. If,after making this certificate of exemption,I Date: 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. N RUCTION LENDING AGENCY I hereby aa 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 '-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 g�nting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 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 32645013 .00 DATE ISSUED. . . . . . . : 01/10/2011 RECEIPT #. . . . • • • • • : BS000012441 REFERENCE ID # : 11010055 SITE ADDRESS . . . . . : 10430 MANN DR SUBDIVISION . . . . . . . CITY • CUPERTINO IMPACT AREA . . . . . . . OWNER SANDEEP AND MUNA KHANNA ADDRESS . . . . . . . . . . : 10430 MANN DR 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, 622 . 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 3, 622 . 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: 10430 mann dr. DATE: 01/10/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,622 ;PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK re lace 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 Check 0.0 t hrs $0.00 r�f�%�?'. Ix=��°��`�� ' Mech.Permit Fee: IMPERMIT ,. F'c7rt711 l"C' F1O, Mech.Insp. 0.0 hrs $42.00 C)�,��t i't-WI)fnf'P. F-1 _L_ Otlr I!<r.h?"o. Irma. I''e: 1'!rrrd). f op, 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 Resolaation 09-051 E 7%'1.-'101 FEE QTY/FEE MISC ITEMS Plan Check Fee: Stpp/. 11C.Fee F PME Plan Check: $0.00 Permit Fec: Su/)rel. hiss 1'*ec? PME Unit Fee: $126.00 PME Permit Fee: $42.00 C`vnslrlwfion 7-CM, r I Work Without Permit? 0 Yes 0 No $0.00 I'lcanrn`n,�> F'c�cs: Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 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: 10 L} 3 0 MG T)L• PERMIT# I tv v OWNER'S NAME: ,AyNe Vin ri n c., PHONE# 40& -310 - 3 V 9� GENERAL CONTRACTOR: r O BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: 54,01 D Fe., 6-1 9,r/Z. *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: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood ass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � - 7lt Owner/Contr or Signature Date CITY OF CUPERTINO FURNACE/AC CUPEkTY TINO PERMIT APPLICATION FORM APN # 0 1 -3 Date: Building Address: IDL43o ►Mang t-,�> it. Owner's Name: Phone #: 'a,r��'�e..e P I� 4 n ric. O $- -5 9 0-3 LOO Contractor: Phone #: g o e _g 9 -3-q,71-7 R pi p, �urr�ace ll?anWo No4c Fax #: qOt-a93—& 7-7/ Contractor License#: Cupertino Business License# •7887 / \"Y � U Contact: lbm C-tQrve- le4nCld �7 o4 — Phone #: Grog -Ay3 - �/7/ 7 11 Fax #: L-10k —R1 7- / Building Permit Info: Elect ❑ Plumb ❑ Mech 0� Residential Commercial Job Description: -�Q ��uCe �'�t� Sf•rre L,Qce Sa vre l oc a For Residential Installations: Attic ❑ 1St floor E9-- 2nd floor ❑ Adhere to minimum setback requirement D For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: 3 (.- 2 Z. o 0 Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ _ Valuation: 8(o ZZ. VC) 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