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13040101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19056 TILSON AVE CONTRACTOR:KRISHNAMURTHY PERMIT NO:13040101 VASANTH AND SWAMY SEE OWNER'S NAME: KRISHNAMURTHY VASANTH AND SWAMY SEE 10828 ALDERBROOK LN DATE ISSUED:04/11/2013 OWNER'S PHONE: 4084554077 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL[] License Class Lic.# TEMPORARY POWER POLE Contractor Date I 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$225 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:37509005.00 Occupancy Type: permit is issued. 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 I 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 18 S F 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 granting of this permit. Additionally,the applicant understands and will comply Issue Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 017- inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 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. I.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 equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect'ops 25505,25533 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING A NCY 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 forthwith comply with such provisions,or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) 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 & (2A) . ,3 Signature ��, � ate o` GENERAL PERMIT APPLICATION �` MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION . 10300 TORRE AVENUE•CUPERTINO,CA 950143255 CUPERT[N© (408)777-3228• FAX(408)777-3333• building a5CUDertino.org MISC\ []PLUMBING ❑MECHANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS )C,D56 �� �S U APNn O � 005 r_ OWNER NAME LT � V /� ! PHONE c/�.�'��c STREET ADDRESS �! CITY, STATE✓, `ZIP (, FAX CONTACT NAME L '// sW/rl�'�y PHONE f / E-MAIL STREET ADDRESS 11 PC-4 / �Q QK� CITY,STATE,ZIP OU int C FAX ❑OWNER Q161NER-BUILDER ' ❑ OWNERAGGEN"T ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.DUPLEX ❑ MULTI-FAMILY PROJECT IN WII-DL.AND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: CEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope o f. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tQailding construction. I at brize representatives of Cupertino to enter the abov 'dentified tpetbr inspection puaposes. Signature of App]icant/Agent: i Date: SUPPLEMENTAL INFORMATION REVIIED OFFICE USE ONLY OYER-THE-COUNTER ~ ❑ EXTRESS •J v ❑ STANDARD U ❑ LARGE ❑ MAJOR AHPA6scApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19056 TILSON AVE DATE: 04/11/2013 REVIEWED BY: MELISSA APN: 375 09 005 BP#: *VALUATION: $225 %PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1REAP14 USE: Lp PERMIT TYPE: WORK TEMPORARY POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $45 p TOTALS: ... $45.00 ,L1ech.Plan Check Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00 Fiech.Permit Fee: Plumb.Permit Fee: Elect.Permit Fee: IEPERMIT --L Other A4ech.Insp. F1 L (hher•Plumb Insp. Other Elec.Insp. 1 0.0 1 hrs $45.00 . 11ech.Ins7z Fee: Plumb. InSh.Fee: Elec.lee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelfinina information available and are only an estimate- Contact the Dept for addh 7 info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Pee: Suppl. P(.Fee PME Plan Check: $0.00 f erinit Fee: Suppl. Inst)Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tax: Administrative-Fee: 1ADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 Advcatic,ed Planraing Fees: Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $178.50 $0.00 $1.78.50 Revised: 04/01/2013 OWNER-BUILDER DISCLOSURE FORM 'COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPEItTINO (408)777-3228•FAX(408)777-3333•buildingecupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ��s� ' APN BP# OWNER NAME/4 OWNER ADDRESSel l j6 L,1 DESCRIPTION OPWORK: We.are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) / y l I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner.- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. � 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. k3. I understand as an."Owner-Builder" I am the responsible party of record on the permit. I understand that.1 may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. A4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. /k` 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered_an"employer"under state and federal law. V6. 1 understandif I am considered an"employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 .t 9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSL13(2752)or www.cslb.ca.gov for more information about licensed contractors. 4 0. 1 am aware.of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the arty Iegally and financially responsible for proposed construction activity at the site address listed above. 11. I agree that, as the.party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. [.agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the. information i have provided on:this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.). Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: ----------------------------------------------------------------------------------------- - ---- --- --- ---- --- --- -- --- - - ----- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby. authorize the following person(s).to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRAC LIST JOB ADDRESS: ° O PERMI OWNER'S NAME: C4�m w PHONE# og ` D-776 7193 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: t D?2CITY/ZIPCODE: - *Our municipal code requires all businesses workingAn fife ci to ve 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 ->t Owner/Contractor Signatur Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 102 " -FAM-(-&() PERMIT# 304 O 9 OWNER'S NAME: (,C- PHONE# -q 44 GENERAL CONTRACTOR: ,_� Ui L(Jte BUSINESS.LICENSE# 32." ADDRESS: 41S_ AVE jCITY/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: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Z-W 49 Excavation Fencing Flooring/Carpeting Linoleum/Wood -,,,,,Glass/Glazing . ()D 4 Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Pacific Coast Balancing Inc. 715 N.First St.Suite#39 San Jose,CA 95112 Phone#(408)687-3440 Fax#(408)226-8515 TEST AND BALANCE REPORT DATE: 11/18/08 r PROJECT: Apple RC01 South 1006K Tantua Avenue- Cupertino, venueCupertino, CA ENGINEER: Aire Sheet Metal Inc. 1973 East Bayshore Road Redwood City, CA 94063 BALANCING TECHNICIAN: Chris Green HVAC CONTRACTOR: Aire Sheet Metal Inc. 1973 East Bayshore Road Redwood City, CA 94063 PROJECT NUMBER: 1610-08 Pacific Coast Balancing Inc. 715 N.First St. Suite#39 San Jose.CA 95112 Phone#(408)687-3440 Fax#(408)226-8515 ABBREVIATIONS AK............................................................ Area x Constant BTUH ...................................................... British Thermal Units per Hour CC/HC/RHC............................................ Cooling Coil/ Heating Coil / Reheat Coil CED /CEG................ .............................. Ceiling Exhaust Diffuser/Ceiling Exhaust Grill CFM ......................................................... Cubic Feet per Minute CRD/CRG .............................................. Ceiling Return Diffuser/Ceiling Return Grill CSD /CSR .............................................. Ceiling Supply Diffuser/Ceiling Supply Register EA ............................................................ Exhaust Air ESP .......................................................... External Static Pressure FO ............................................................ Full Open (Damper or Valve) FPM ......................................................... Feet Per Minute GPM ........................................................ Gallons Per Minute HP / BHP ................................................ Horsepower/Break Horsepower HEPA ....................................................... High Efficiency Particulate Air(Filter) L1, L2, L3 ................................................ Motor Lead LSD .......................................................... Linear Slot Diffuser MBH ........................................................ BTUH x 1000 NA ........................................................... Not Applicable NL ............................................................ Not Listed NP ............................................................ Nameplate NS/ NOT SPEC. .................................... Not Specified OA/OSA ............................................... Outside Air PSI / PSIG............................................... Pounds per Square Inch /Gauge PD ........................................................... Pressure Drop RA ............................................................ Return Air RH ................................................:.......... Relative Humidity RPM ........................................................ Revolutions per Minute RND ........................................................ Round SA ........................................................... Supply Air SP ............................................................ Static Pressure SWE ........................................................ Sidewall Exhaust SWR ........................................................ Sidewall Return SWS ........................................................ Sidewall Supply VD ............................................................ Volume Damper VLF................ ......................................... Vertical laminar flow VP ........................:.................................... Velocity Pressure Pacific Coast Balancing Inc. 715 N.First St.Suite#39 San Jose,CA 95112 Phone#(408)687-3440 Fax#(408)226-8515 PROJECT NAME: Apple RC01 South PROJECT NO.: 1610-08 SYSTEM: VAV DATE: 11/18/08 GENERAL NOTES I i i Pacific Coast Balancing Inc 715 N.First street suite#39 Santa Clara,CA 95112 }one#(408)687-3440 Fax#(408)226-8515 VAV AIR OUTLET TEST REPORT PROJECT NAME: Apple PROJECT NO.: 1610-08 SYSTEM: VAV DATE: 11/18/08 Area Face/Nock Type Max.Cool Min.Coot Heat Mau.Cool Min.Cool Heat Test/ Served No Size CFM CFM CFM CFM CFM CFM Notes VAV-1 Open Off. 1 24 x 24/10 CSD 430 390 50 Open Off. 2 24 x 24/10 CSD 430 380 35 Open Off. 3 24 x 24/10 CSD 430 395 50 Oen Off. 4 24 x 24/10 CSD 430. 395 35 Total 1720 170 NA 1560 170 NA VAV-2 en Off. 1 24 x 24/10 CSD 430 400 45 Oen Off. 2 24 x 24/10 CSD 430 400 45 Oen Off. 3 24 x 24/=10 CSD 430 420 50 Oen Off. 4 1 24 x 24/10 CSD 430 390 40 Total 1720 170 NA 1610 180 NA VAV-3 Office 1 24 x 24/10 CSD 235 230 95 95 Office 2 24x24/12 CSD 380 375 160 160 Total 615 245 245 605 255 255 VAV-4 Office 1 24x24/8 CSD 120 130 55 55 Office 2 24 x 24/12 CSD 380 360 150 150 Total 500 200 200 490 205 205 VAV-5 Open Off. 1 24x24/14 CSD 410 430 175 175 Total 410 165 165 430 175 175 Readings by: CG Remarks: 1 of 3 Pacific Coast Balancing Inc 715 N.First street suite#39 Santa Clara,CA 95112 .Phone#(408)687-3440 Fax#(408)226-8515 P VAV AIR OUTLET TEST REPORT PROJECT NAME: Apple PROJECT NO.: 1610-08 SYSTEM: VAV DATE: 11/18/08 Ina1 Area Face/Neck Type Max.Cool Min.Cool Heat Max.Cool Min.Cool treat Test/ Served No size CFM CFM CFM CFM CFM CFM Notes VAV-6 Com. Off. 1 24 x 24/14 CSD 44.5 460 175 175 Total 445 180 180 460 175 175 VAV-7 Open Off. 1 24x24/14 CSD 410 400 160 160 Open Off. 2 24x24/14 CSD 410 410 165 165 Open Off. 3 24 x 24/14 1 CSD 410 400 160 160 Total 1230 410 410 1210 385 385 VAV-8 Confer. 1 24x24/10 CSD 210 210 0 Open Off. 2 24x24/12 CSD 380 365 0 Total 590 60 NA 575 0 NA 1 VAV-9 -Open Off. 1 I 24x24/10 CSD 430 230 0 Open Off. 2 24 x 24/10 CSD 430 375 0 Open Off. 3 24 x 24/10 CSD 430 130 0 Open Off. 4 24 x 24/10 CSD 430 360 0 Total 1720 170 NA 490 0 NA 1 VAV-10 Open Off. 1 24 x 24/14 CSD 410 420 195 195 Open Off. 2 24 x 24/ 14 CSD 410 420 170 170 Total 820 60 NA 840 265 265 Readings by: CG Remarks: (1) Lowest controllable minimum CFM is too high. 2 of 3 Pacific Coast Balancing Inc 715 N.First street suite#39 Santa.Clara,CA 95112 Phone#(408)687-3440 Fax#(408)226-8515 VAV AIR OUTLET TEST REPORT PROJECT NAME: Apple PROJECT NO.: 1610-08 SYSTEM: VAV DATE: 11/18/08 DoFinal Area Face/Nock Type Max.Cow Min.Cool Heat Max.Cool Min.cow Heat Test/ Served No Size CFM CFM CFM CFM CFM CFM Notes VAV-11 Open Off. 1 24 x 24/14 CSD 410 420 175 175 Total 410 170 170 420 175 175 VAV-12 Electrical 1 24 x 24/6 CSD 160 155 0 Total 160 0 NA 155 0 NA Readings by: CG Remarks: 3of3