09110139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10377 LAS ONDAS WAY CONTRACTOR:SANDIUM PERMIT NO:09110139
OWNER'S NAME: SATESH MENON 4223 VERDIGRIS CIR DATE ISSUED: 11/24/2009
ER'S PHONE: 4082429110 SAN JOSE,CA 95134 PHONE NO:(408)894-9072
❑ LICENSED CONTRACTOR'S DECLARATION
u o BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C,—Zy Lic.# �c78111
��,, �� ,// r7 MECH RESIDENTIAL COMMERCIAL
Contractor�{/tN+t t.n,, � / Date 9 G L�)
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE AC,MOVE FURNACE TO ATTIC
(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:$10000
1 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:36929038.00 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 DAYS FROM 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 -�' Date?/
9.18.Signature k4-L P-" - ate
G
RE-ROOFS:
CJ 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 fallowing two reasons:
1,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)
1,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
1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 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(a)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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 O%VneK or authorizgd agent:
Compensation laws of California. If,after making this certificate of exemption,I ; ` Date:
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
nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
c and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36929038 . 00
DATE ISSUED. . . . . . . : 11/24/2009
RECEIPT #. . . . . . . . . : BS000009270
REFERENCE ID # . . . : 09110139
SITE ADDRESS 10377 LAS ONDAS WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SATESH MENON
ADDRESS 10377 LAS ONDAS WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : NIKOLAUS MOROCUTTI
CONTRACTOR MICHAEL LEE LIC # 28867
COMPANY . . . . . . . . . . . SANDIUM
ADDRESS 4223 VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE (408) 894-9072
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 000. 00 1 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 10, 000 . 00 1 .00 0 . 00 1. 00 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 2 . 00 126 . 00 0 . 00 126 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 254 . 00 0 . 00 254 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 254 .00 VISA
---------------
TOTAL RECEIPT 254 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
lctyy
CITY OF CUPERTINO
11-11 FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN#�) I J v Date:
�O`7 �/ 2 y ,b ter'
Building Address:
1020-7 Lis 0(60ra5 iSA
Owner's Name: Ph a
#:
Contractor: Phone#:
Fax#:
Contractor License#: Cupertino Business License#:
Contact: Phone#:
11(14E Ize,
Fax#: qae b' Y- �OTL
Building Permit Info:
Elect Plumb Mech
Residential DQ Commercial
Job Description:
For Residential Installations:
Attic [ 1 st floor ❑ 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):
10(000 U 0
Strapped On Platform LJ Bonded New Location Replacement
Project Size: Ex ress ❑` Standard❑ Lar e ❑ 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. Com_..
Revised 01/07/09
CITY Of
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing,cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
1BSEISMICO Commercial Seismic g TYPES
1 MRR.AA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1 MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
city of,
CITY OF CUPERTINO
FURNACE/AC
CUP RTINO FEE SCHEDULE
1BUSLIC Business License B
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units<= IOk CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units<= 10k CFM B
/ 1 MRR.AA Residential Mech Repair/alt/add M
/ 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
r 1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
' 1 MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
Community Development
10300 Torre Avenue
lzl�b
W�' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�MkTINO
Building Department
JOB ADDRESS: PERMIT #
►o 37l LAS oNnas wPx 4?1491/13' 9;1
OWNER'S NAME: PHONE # 08-242 Ilo
GENERAL CONTRACTOR: SAN 0 t 0-k-r t N c- FAX #
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
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