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10120079 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20116 LAS ONDAS CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10120079 CONDITIONMG OWNER'S NAME: MANISH PATEL 1712 STONE AVE DATE ISSUED: 12/14/2010 OWNER'S PHONE: 4082538777 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REPLACE EXISTING FURNACE IN SAME LOCATION License Class G Z6 Lic.# �to i$ -7 � Contractor f4 Date 12- 1 L/_t 0 1 hereby affirm that I am licensed under the provisions of Chapter 9 (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 Valuation:$3800 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APN Number:36930038.00 Occupancy Type: permit is issued. P9 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issue ," Date: G i granting of this permit. AAditionally,the applicant understands and will comply Lwithall non-poin rc r gulations per the Cupertino Municipal Code,Section RE-ROOFS: ature Date�_0 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equip t or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ar a it Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the up Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, 255 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater Z 4 permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO a10 FURNACE/ACCUPkINO PERMIT APPLICATION FORM ol2, Cgq APN # Date: Building Address: a o t t" L-0 g G N das �- Owner's Name: Phone #: n►S►-� ��,��L 40,x- - 2S 3 -e'7-7-7 Contractor:ArA-h Nc<< Phone#: 4,08-a-9 3- q Fax #: 4.0t - a93 -&7"� Contractor License#: 71��$7 i Cupertino Business License#: roso Contact: � t-7Phone #:410 9- - 29 3-z/7/7 Fax #: Flo k- P9 3 & )-y 1 Building Permit Info: Elect El' Plumb 0� Mech Residential Commercial LJ Job Description: Re ry\tv -iF°,G� s .f�ns _ y�,r,v4cn •� /NS �� i� For Residential Installations: Attic ❑ I` floor 2 2"d 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: Type of Construction (Usage Class): 3"0.04) �-/g Strapped El On Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Valuation: - 38-00.(70 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 CITY OF CUPERTINO 5 ITEMS OF 16 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36930038 . 00 DATE ISSUED. . . . . . . : 12/14/2010 RECEIPT # . . . . . . . . . : BS000012230 REFERENCE ID # . . . : 10120079 SITE ADDRESS 20116 LAS ONDAS CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA OWNER MANISH PATEL ADDRESS 20116 LAS ONDAS CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3106 RECEIVED FROM . . . . : AAA FURNACE 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, 800 . 00 1 . 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 3, 800 . 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------------- --------------- -------------------- CHECK 887.56 37638 --------------- TOTAL RECEIPT 887. 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20116 los ondas ct. DATE: 1 A4/2010 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,800 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY ` t PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK 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 �',�<< 1'=�r� L'; t'i.��< �,��1t Mech.Permit Fee: IMPERMIT �� .< C;l r 1'�: rr Other Mech.Insp. Fo.0 hrs $42.00 :..,:', LJ- 1"CC NOTE. Theseees are based on the preliminaryinformation available and are onlyan estimate. Contact the De t or addn 7 info. FEE ITEMS(Fee Resolution 09-051 Elf 1.`1.%10) FEE QTY/FEE MISC ITEMS F-1 slippl. 1'( F"c PME Plan Check: $0.00 Peril-ii!Fcc' .Sarp/}l. Jlop 1•'c" PME Unit Fee: $126.00 PME Permit Fee: $42.00 ps Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldy,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: r $211.50 $0.00 TOTAL FEE: $211.50 Revised: 12/07/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: I/(o has r'1S c-,.- PERMIT# OWNER'S NAME: P-71y - PHONE# 4/0,f -�-�� 3 ._9 7-7 77 GENERAL CONTRACTOR: 4,,Vo BUSINESS LICENSE# ADDRESS: 1-7(?- h,-� = CITY/ZIPCODE:Cr�- S i Z--t` *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: Date Signature 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 Roe Ti Owner/C actor Signature Date