09070165 1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7545 FALLENLEAF LN CONTRACTOR:H&H HEATING& PERMIT NO:09070165
A/C SERVICES
JVNER'S NAME: NAZEEM NORDEEN 4887 POPEJOY CT DATE ISSUED:07/24/2009
_ XNER'S PHONE: 4083660486 SAN JOSE,CA 95118 PHONE NO:(408)499-6598
❑ LICENSED CONTRACTOR'S DECLARATIONF1___ ✓
BUILDING PERMIT INFO: /BLDG ELECT PLUMB
License Class Lic.# P--"
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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:$5000
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 APN Number:35928038.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 i2
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.
RE-ROOFS:
,nature 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
inspection.
>� OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 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. 1 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,Sections 25505,25533,and 2 534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: ate:
permit is issued. Z�
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 AGENCY
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
'iuilding construction,and hereby authorize representatives of this city to enter
n the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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. ....//',
Signature ,�-4— Date z
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35928038 . 00
DATE ISSUED. . . . . . . : 07/24/2009
RECEIPT #. . . . . . . . . : BS000008267
REFERENCE ID # . . . : 09070165
SITE ADDRESS . . . . . : 7545 FALLENLEAF LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NAZEEM NORDEEN
ADDRESS 7545 FALLENLEAF LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : NAZEEM NOORDEN
CONTRACTOR . . . . . . . : HOANG MAI LIC # 28877
COMPANY H&H HEATING & A/C SERVICES
ADDRESS . . . . . . . . . . : 4887 POPEJOY CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 499-6598
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
1BSEISMICR VALUATION 5, 000 . 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
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 232 .50 0 .00 232 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 232 .50 5643
---------------
TOTAL RECEIPT 232 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Community Development
10300 Torre Avenue
i Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
7UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
7s 4 5 1 le-Wd e cJ �tb�7v I CQ
OWNER'S NAME: Pau(o, Ill aZeem Neo r- F PHONE # 06( a(0 - 04S
G ONTRACTOR: 4 4eA +AQ FAX#
&Vuces
I am not using any subcontractors:
Signature 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
7, -71Z 9/0
Owner/Contractor Signature Dat
CITY OF CUPERTINO
FUIViACE/AC
CUPEkTINO PERMIT APPLJICATION FORM
APN # � g g, CK�Y , Date:
-) 1
Building Address:
5915
Owner's Name: Phone
au 6 42tc�,rn /J�o v- eel
Contractor: Phone
ax#:
Contractor License#: nom, Aupertino Business License#:
Co tact: Phone#:
Fax #:
Building Permit Info:
Elect Bl�- Plumb Mech
Residential Commercial ❑
Job Description:
"d A / C.,
For Residential Installations:
Attic ❑ 15` floor Ev", 2"d 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 C instruction(Usage Class):
1
Strapped On Platform Bondi;d New Location Replacement
Project Size: Express H"'- 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.
Revised 01/07/09
CITY OF C UPERTINO
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= I Ok CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
IBSEISMICO Seismic Commercial B
1PGASCOM Commerical for e gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
IBPGAS For each gas piping system of 5 or P
more per outlet. C omm/Resid
1BREMAIRHAN Residential A/C units <= IOk CFM B
I MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Resident:al B
I EPERMITFEE Electric Permit E
f
1MPERMITFEE Mechanical Permit M
I
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B