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10020077 CITY OF CUPERTIlvO BUILDING PERMIT BUILDING ADDRESS: 1282 S STELLING RD CONTRACTOR:SANDIUM PERMIT NO: 10020077 OWNER'S NAME: ASHOK BANGALORE 4223 VERDIGRIS CIR DATE ISSUED:02/16/2010 vER'S PHONE: 4088239064 SAN JOSE,CA 95134 PHONE NO:(408)894-9072 LICENSED CONTRACTOR'S DECLARATION � l �� n BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (w Lic.# ` `all / MECH r— RESIDENTIAL r— COMMERCIAL 2 Contractor �1,f1��[�I(�^ Date 14 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT&ADD A/C (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:$8000 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 permit is issued. APN Number:36611107.00 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 DA ROM 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-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. Signature �� -% Date Z �I/ b RE-ROOFS: LI 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(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owr o authorize ent: Zf Compensation laws of California. If,after making this certificate of exemption,I ate_ � Date: 4 1 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a 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 unify 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 granting 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. /-"2 / Licensed Professional Signature Date Z! 6 (� CITY OF CUPERTINO 8 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36611107. 00 DATE ISSUED. . . . . . . : 02/16/2010 RECEIPT #. . . . . . . . . BS000009747 REFERENCE ID # . . . : 1CO20077 SITE ADDRESS 1282 S STELLING RD SUBDIVISION . . . . . . . CITY CL PERTINO IMPACT AREA . . . . . . OWNER AEHOK BANGALORE ADDRESS 1282 S STELLING RD CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5204 RECEIVED FROM . . . . : YIU-HANG LEE CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867 COMPANY SINDIUM ADDRESS 4, 23 VERDIGRIS CIR CITY/STATE/ZIP . . . : SIN JOSE, CA 95134 TELEPHONE (408) 894-9072 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 000 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1BSEISMICR VALUATION 8, 000 .00 0 . 80 0 . 00 0 . 80 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE 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 295 . 80 0 . 00 295 . 80 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- ------ ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FUIR24ACE/AC CUPEI�TINO PERMIT APPJLICATION FORM APN # Date: Building Address: Owner's Name: � Phone#: Contractor: Phone#: (A 64, go7Z Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: � Fax #: Building Permit Info: Elect 2 Plumb Mech Residential Commercial ❑ Job Description: -V vC �d For Residential Installations: Attic El1St floor [T' 2°d floor ❑ Adhere to minimum setback requirement 20, 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 Bonc.ed New Location El 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, inc..ude in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO FUF24ACE/AC CITYCUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 MRAPPVNT Residential for the install/relocate/or M replacement o.'ea appliance vent install &not incl in an ap 1 permit. FURNACE FURN/AC 1 PGASRES Residential fo- ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlf t. / 1 BCBSC Cal Bldg Stan lards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst =100k BTU install or M relocate ea forced-air/gravity type furnace/burne�, incl ducts/vents attached to su-,h appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst 100k BTU install or M relocate ea forced-air/gravity type furnace/burne r, incl ducts/vents attached to su:h appliance over 100,000 Btu/IL 1 EPERMITFEE Electric Permit Fee E / 1 MPERMITFEE Mechanical P-,rmit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO FURNACE/AC CITY OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Descriptic n Fee Permit Type Grou AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/(; Units <= l Ok CFM B 1 MCRAA Commercial Mesh Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for e3 gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 'omm/Resid 1 BREMAIRHAN Residential A/C units<= 1 Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residen:ial B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documen ration B 1BUSLIC Business License B Community Development 10300 Torre Avenue fG.�. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Building Department JOB ADDRESS: 12$2. S �� PERMIT# OWNER'S NAME: a&. xQ, PHONE # GENERAL CONTRACTOR: cam.-, FAX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile _ zl 16 �v Owner/Contractor ignature Date