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10070176 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7494 SHADOWHILL LN CONTRACTOR:A PLUS HEATING&A/CPERMIT NO: 10070176 OWNER'S NAME: RAJIV&ANJALI DESHMUKH 244 GREAT MALL PKWY DATE ISSUED:07/27/2010 NER'S PHONE: 4084465404 MILPITAS,CA 92683 PHONE NO:(408)934-0730 E LICENSED CONTRACTOR'S DECLARATIONr 7 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class�� — Lic.# [ � 1 Sr MECH RESIDENTIAL COMMERCIAL Contractor — Q ' S Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RMV OLD FURANCE&REPLACE W/NEW FURNACE IN (commencing with Section 7000)of Division 3 of the Business&Professions SAME LOC 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:$5000 permit is issued. 0715 APPLICANT CERTIFICATION APN Number:36230096.00 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. .71-07 -7 �� Issued Date: Signature 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 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: 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 Oer or au rized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date:---2 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 upon the above mentioned property for inspection purposes.(We)agree to save i iify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address a,_ ,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 4 ITEMS OF 9 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl{: Lot : APN . . . . . . . . : 36230096 .00 DATE ISSUED. . . . . . . : 07/27/2010 RECEIPT #. . . . . . . . . : BS000010976 REFERENCE ID # • • . : 10070176 SITE ADDRESS . . . . . : 7494 SHADOWHILL LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RAJIV & ANJALI DESHMUKH ADDRESS . . . . . . . . . . : 7494 SHADOWHILL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : APLUS HEATING& AIR- CONTRACTOR ADAM P. PHAM LIC # 31293 COMPANY A PLUS HEATING & A/C ADDRESS 244 GREAT MALL PKWY CITY/STATE/ZIP . . . : MILPITAS, CA 92683 TELEPHONE . . . . . . . . : (408) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000. 00 1 .00 0 . 00 1 . 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 211 . 00 0 . 00 211. 00 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: DATE: REVIEWED BY: APN: BP#: "VALUATION: 1$5,000 -PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair APPLICATION 1 RMAP6 USE: PRIMARY SFD or Duplex � a 00 3U APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Furnace, Forced-Air 1MFIt=<100 1 $126 TOTALS: $126.00 Mech.Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 1 hrs 1 $42.00 NOTE: These ees are based on the preliminary in ormation,ivailable and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 09-051 Fff' '/1109) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $1213.00 PME Permit Fee: $42.00 Work Without Permit? Q Yes G No $).00 Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.001 $0.00 TOTAL FEE: $211.00 Revised: 7/22/2010 CITY OF CUPERTINO 11 FUI;CvACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # ~- Date: Building Address: -74q4 /c I„ad o „ / 4H11 . L0X D , Owner's Nan V �' �� /, Phone#406 (�Ka i Lf - ... Contractor: U 11 �+ Phone A FJWS qe4qfit7 G Fax#: Contractor License#: Cupertino Business License#: ? lv 3 Contact: pl V Phone#: 06 -c?-3q —a 730 a` Fax #: Building Permit Info: Elect [�'" ^ Plumb Mech [� Residential 1z Commercial ❑ Job Description: v Ap Qffo% % 2 d F4mRCe af-e/ fePI4 e WJ(IIVV fu-rnLqCe *-0 sccm.e For Residential Installations: Attic El 1st floor E�- 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): Strapped On Platform El Bonded New Location E] Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: I �- 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 M.Indoor Air Quality and Finishes �• 1 IAQ/Health pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IAOIHealth pts y--yes p 7 M 3 IAQ/Health pts y=yes p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6 IAQ/Health'pts y--yes p p 6.Use Exterior Grade Plywood for lnterior Uses 1 lAQ/Health pts y=yes 41AQ/Health. pts y=yes p 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts ryes 0 1 D.Install Whole House Vacuum System 3 IAQ/Health pts y--yes p H.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2 Use Rapi. Finoring?Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes p 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 Available: 1 1401 130E-- 30 57 Total Points Project Received: 1 0 0 0 t G:data/progs/c eenbuildinoguidelines/remudeler-Igreenp6intsfina1212.04protectedxls 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: ;t9.1+52, \J().5,5 V WItPERMIT# D l OWNER'S NAME: V y\\ q \CxV PHONE# 40Y C(34 - 0730 GENERAL CONTRACTOR: A_ 'P U 5 BUSINESS LICENSE# 6 3 ADDRESS: ?_jq 61C-gooAvy\ot ( PVw7y CITY/ZIPCODE: VvV 1P t S TS o 3S *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. /(Z) I am not using any subcontractors: ignature D to Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINH�SS 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