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09090156CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22812 LONGDOWN RD CONTRACTOR: SUPREME AIR SYSTEMS PERMIT NO: 09090156 OWNER'S NAME: SUSHIL VISHWARUPE 80 GILMAN AVE STE 1 DATE ISSUED: 09/22/2009 ER'S PHONE: 4083907430 CAMPBELL, CA 95008 PHONE NO: (408)376-0406 Zr LICENSED CONTRACTOR'S DECLARATION I— ELECT r PLUMB r License Class a � Lic. # / II C'� C-� BUILDING PERMIT INFO: BLDG {" MECH RESIDENTIAL COMMERCIAL Contractor ehic Date _ Q I hereby affirm Am I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: CHANGE OUT CONDENSER (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 Sq. Ft Floor Area: Valuation: $956 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 APN Number: 34233009.00 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 180 DAYS 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 180 DAYS FROM LAST 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 r - �— 77" 2- Z� granting of this permit. Additionally, the applicant understands and will comply Issued by: - Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signatury/y�t,� _ ��j�+---- Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is ❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection, I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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) ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Compensation, as provided for by Section 3700 of the Labor Code, for the Safety Code, Section 25532(a) should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance, as provided for by contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Section 3700 of the Labor Code, for the performance of the work for which this Health & Safety Code, Sections 25505, 25533, and 25534. permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall OwnVL or author' d agent: not employ any person in any manner so as to become subject to the Worker's^ Date: c;V 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address 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 i nify and keep harmless the City of Cupertino against liabilities, judgments, C, , 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. Signature Date 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34233009.00 DATE ISSUED.......: 09/22/2009 RECEIPT #......... BS000008737 REFERENCE ID # ...: 09090156 SITE ADDRESS .....: 22812 LONGDOWN RD SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER SUSHIL VISHWARUPE ADDRESS 22812 LONGDOWN RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: SUPREME AIR SYSTEMS CONTRACTOR ALLEN SENNERT LIC # 21614 COMPANY SUPREME AIR SYSTEMS ADDRESS 80 GILMAN AVE STE 1 CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE (408)376-0406 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 956.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 956.00 0.50 0.00 0.50 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 ---------- TOTAL PERMIT ---------- 190.50 ---------- 0.00 190.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 190.50 --------------- 190.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #12937 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN # g P 3 2 0v9-00 v0 Date: 11-09 Building Address: L- 0 A A UJ (I 1K= -J Owner's Name: 0 V S� Phone ; '32 L 1" IA.) C4 09) Contractor: Phone �p� _�� 6 _00406 5 U (`e (K�A',� ` c� S � Fax #: ' 316 —0,S% Contractor Ncense #: Cupertino Business License Iq0 � (0-1 X Contact: Phone #: 5 Ae-f k(- r -1 e-- Fax #: Building Permit Info: Elect Plumb ❑ Mech ❑ Reside tial a Commercial ❑ Job Description: bn 1's i For Residential Installatio : Attic ❑ 1St floor (PI, 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 ❑ Bonded ❑ New Location ❑ Replacement Project Size: Ex ress E�K Standard ❑ 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. 62 -- Revised 01/07/09 CUPEI�TINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P l BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1 BUSLIC Business License B W" , CITY OF ,;UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # IF 6 fco OWNER'S NAME: ry PHONE # 6 — C GENERAL CONTRACTOR: �,� FAX # I am not using any subcontractors: !2- old 6c Signature Date P1PacP r,hPr L- nnnlicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 Owner/ Contractor Signature Date