10070200 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11254 CATALINA CT CONTRACTOR:TFF HEATING AND AIR PERMIT NO: 10070200
CONDITIONING
""'NER'S NAME: DEEPAK SHERLEKAR 299 CORNING AVE DATE ISSUED:07/30/2010
t.rJNER'S PHONE: 4087868120 MILPITAS,CA 95035 PHONE NO:(408)786-8120
IL LICENSED CONTRACTOR'S DECLARATION r— r-
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C 2 Lic.# q (?
MECH I- RESIDENTIAL r- COMMERCIAL r
Contractor_DYt.�2 ��1��.!//� Date 3c) to
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REINSTALL AIR CONDITIONER(2)UPPER/LOWER LEVEL
(commencing with Section 7000)of Division 3 of the Business&Professions &
REPLACE FURNACE
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$8500
permit is issued.
APPLICANT CERTIFICATION APN Number:35621040.00 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.
O Issued by.'�� _ Date:
c��nature � Date � ��
❑ 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
1,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: 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 Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: 0
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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
,n 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
costs,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 Date Licensed Professional
CITY OF CUPERTINO
ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl ,,: Lot:
APN . . . . . . . . : 35521040 .00
DATE ISSUED. . . . . . . : 07/30/2010
RECEIPT #. . . . . . . . . : BS)00011028
REFERENCE ID # • . • : 10)70200
SITE ADDRESS . . . . . : 11254 CATALINA CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DEEPAK SHERLEKAR
ADDRESS . . . . . . . . . . : 11254 CATALINA CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HEIDI FERREIRA
CONTRACTOR . . . . . . . : TONY FERREIRA LIC # 31778
COMPANY . . . . . . . . . . : TFF HEATING AND AIR CONDITIONI
ADDRESS . . . . . . . . . . : 299 CORNING AVE
CITY/STATE/ZIP . . . : MILPITAS, CA 95035
TELEPHONE . . . . . . . . : (438) 786-8120
FEE ID UNIT QUANTITY .MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 8, 500 . 00 1 . 00 1. 00 0. 00 0 . 00
1BREMAIRHA NO.UNITS 2 . 00 126 . 00 126 . 00 0. 00 0 .00
1MFR=<100 UNITS 1. 00 126 . 00 0. 00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 42 . 00 0. 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 .00 42 . 00 0. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 337 .00 211 . 00 126 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 126 . 00 MC
---------------
TOTAL RECEIPT 126 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$8,500
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex APPLICATION
1 RMAP2
USE: p ' r ' t _: TYPE:
a, a
p0
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
A/C Units (<=10K cfm) 113R=MAiR 2 $126
-T
TOTALS: $126.00
Mech.Plan Check 0.0 1 hrs $0.00 ,.
Mech.Permit Fee: 1 MPERMIT '.
Other Mech.Insp. 0.0 1 hrs $42.00 >�.-, F-1 I r, , 1,,,,
T-T-1
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Hee Resolution 09-051 F_ff %/I1,0.9) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $126.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes No $0.00
x
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $11.00
SUBTOTALS: $21' .00 $0.00 TOTAL FEE: $211.00
Revised: 7/27/2010
CITY OF CUPERTINO
FUF24ACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date: -�-fi U/(0
Building Address:
Owner's Name: � � S� Phone#:
�e.
Contractor: Phone#: p g �, - g 12.Z>
` O& 1 T p
I Fax #: c{OV C(35 CW`{ °I
Contractor License#: Cupertino Business License#:
C r4 91`73 5-0 3 1 1 Z W
Contact: Phone#:
Fax #: cloq
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Sa-
Residential F- Commercial ❑
Job Description:
i n s twt kir CO 44dec_e_ F- .,±
For Residential Installations:
Attic ❑ 1" floor L9}- 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: Type of Construction(Usage Class):
£s , !VD o t-/O
Strapped ❑ On Platform El Bond;-d New Location Replacement .
Project Size: Express ❑ Standard ❑ Large [] Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, incl ade in plan set & the sheet index.
Revised 01/07/09
M.lndODr Air Quality and Finishes
1 IAQ/Health pts y--yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0
3.Use LDWNO VOC Advailm-= . 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywoodfor Interior Uses 1 IAQ/Health pts y--yes 0
MAM, 4 IAQ/Health. pts y--yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
i
N.Flooring 1 1
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
Use flapk!Y Hanewable fbofin9 Mated& 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yesl 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Avails le: 1 1401 1301 57
Total Points Project Received: 0 0 0
o
G:data/progs/gree ibuilc ino_pidelines/2modelers/greenpointsfinal2.12.o4protected.xis
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: 2 y CL+&(i Aa, PERMIT# L(O T'" Z T $)2-0
OWNER'S NAME: PHONE#
GENERAL CONTRACTO : F>✓r V->✓•'na, BUSINESS LICENSE# 6L( -T3 S C7
ADDRESS: _q 9Gpr�i A-c/ CITY/ZIPCODE: � 1S $a
*Our municipal code requires all businesses working it 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 SUBCONTVACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. (�
I am not using any subcontractors: ��
Si;nature 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