10110135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10806 NORTHRIDGE SQ CONTRACTOR:GOSAL HEATING&AIR PERMIT NO: 10110135
COND
OWNER'S NAME: NORTHPOINT H.O.A. 34492 TORREY PINE LN DATE ISSUED: 11/19/2010
JNER'S PHONE: 4082180652 UNION CITY,CA 94587 PHONE NO:(510)441-2318
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic.#
/� MECH RESIDENTIAL COMMERCIAL
Contractor UJ L V,a-(Late d
I hereby affirm that I am licensed under the provisions of Chapter!) ON
JOB DESCRIPTION:FURNACE CHANGE OUT IN GARAGE,SAME LOCATION
(commencing with Section 7000)of Division 3 of the Business&Professions PLATFORM
Code and that my license is in full force and effect. PLATFORM
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1500
permit is issued.
APPLICANT CERTIFICATION APN Number:31636043.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. `
"
Issued by: Date:
-nature;
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: ^a == Date:
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
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owpgr or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. • Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
-non the above mentioned property for inspection purposes.(We)agree to save
-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,sts,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Z,,- , Date /61 �O Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31636043 . 00
DATE ISSUED. . . . . . . : 11/19/2010
RECEIPT #. . . . . . . . . : BS000012056
REFERENCE ID # . . . : 10110135
SITE ADDRESS . . . . . : 10806 NORTHRIDGE SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER NORTHPOINT H.O.A.
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : SUNNYVALE CA, CA 94086
RECEIVED FROM . . . . : KESAR SINGH
CONTRACTOR . . . . . . . : KESAR SINGH LIC # 22229
COMPANY . . . . . . . . . . : GOSAL HEATING & AIR COND
ADDRESS . . . . . . . . . . : 34492 TORREY PINE LN
CITY/STATE/ZIP . . . : UNION CITY, CA 94587
TELEPHONE . . . . . . . . : (510) 441-2318
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 500 . 00 1 . 00 0 .00 1. 00 0 .00
1BSEISMICO VALUATION 1, 500 .00 0 .50 0 .00 0.50 0 .00
1BUSLIC FLAT RATE 1. 00 220 .00 0 .00 220 . 00 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 431 .50 0.00 431.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 431 .50 2329
---------------
TOTAL RECEIPT 431 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
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: 'r j)4PERMIT#
OWNER'S NAME: y HONE# .SI 0 'T0 / -- S-71 S
GENERAL CONTRACTOR: USINESS LICENSE#
ADDRESS: 3 t/y 2,� On,4�tMc;j CITY/ZIPCODE:
*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
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
`! FURNACE/AC
CUPE( �TINO PERNUT APPLICATION FORM
APN# i 3 O Date: ll /W o
Building Address:
Owner's Name: Ks ��f3 �S� Phone#: ,Y 2—/k Zt/, S 4--;?,
Contractor: Phone#: S/C, -d
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Contractor License Cupertino Business License#:
Contact: Phone#: �-�� ._ 5-6;% S7
Fax #: /d
Building P t Info:
Elect Plumb Mech
Residential ly Commercial ❑
Job Description:
CHw4,4 E 607— //v
For Residential Installations:
Attic ❑ 1'c floor C'] 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 P oject: Type of Construction (Usage Class):
Strapped El On Platform Bonded ❑ New Location Replacement 0
Project Size: Express Large ❑ Major❑
Valuation:
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