14050004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20075 NORTHWIND SQ CONTRACTOR:ONE HOUR PERMIT NO: 14050004
HEATING AND AIR
OWNER'S NAME: BALASUBRAMANIAM SIVARAMA K 1400 PETALUMA HILL RD DATE ISSUED:05/01/2014
OWNER'S PHONE: 4088650196 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION r I— 1�
/- BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clasd C Lie.# �y% c -I r— F- F
r MECH RESIDENTIAL COMMERCIAL
Contractor Datet ` LOCATION
JOB DESCRIPTION:REMOVE&REPLACE FURNACE AND A/C IN SAME
I hereby that I am licensed under the provisions of Chapter 9
(comm Ging 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:$7700
Jhave 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:31638008 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
granting of this permit. Additionally,the applicant understands and will comply Issued by:—:2� 4T Date: ,J 'l•1y
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
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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,Section 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 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
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.
Signature Date
GENERAL PERMIT APPLICATION MEP
r
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buildinana.cupertino.or4 MISC
/ sooU y
CUP1=EtTINO
❑PLUMBING CAL El ELECTRICAL ❑MISCELLANEOUS
PROJ£Cf ADDRESS `2 Co 7�" 1 •%1,/,�(r _f �. I APN# '� I f a -59 o0 F
OWI,TERNAME KYIShK� JSlvQr�w�a
STREET ADD IIS-- Y-I'k I cS �. CITY, STATCUDCV. 1 NO10 r
�sO I I FAX
CONTACT NAME PHONE E-MAII,
.��
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OVJNERAGEAf CONTRACTOR ❑CONTRACTORAGEA'T ❑ ARCHITECT ❑ENGINmR ❑ DEVELOPER ❑TENANT
CONTRAhO`R'hTAME 1Ir f��GTtN LICENSERO I LIC �` BUS.LIC# 3377
COMPANY NAME E-MAIL FAX
TE
S ET ADDR S3 � A `t�4�d�/ 7ci
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA OVO FLOOD ZONE O EICHLER HOME?
DESCRIPTION OF WORK .A c C 40.-1
e0, /_)1__
t L01
TOTAL VALUATION: 7 7� 3tPCEIVEDBb � ;
a 3 '-W Z h Y
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provid ' .orrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lays relating to buil ' g co c' I authorize representatives of Cupertino to enter the above-identified property(four inspection purposes.
� /
S i gnature of Applicant/Agent: Date: • t ( /
EMENT INFORMATION REQUIRED
z _
I�Pxsss� �11
WK
,'
1701
Y2EPMiscf4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO M05av�
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20075 Northwind Square DATE: 05/01/2014 REVIEWED BY: Sean
APN: BP#: l 000 *VALUATION: 1$7,700
*PERMIT TYPE: Mechanical Permit PLAN CHECK T PE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK Remove and Replace furnace and a/c in same locations.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209.00
r:
s
Mech.Plan Check 0.0 hrs $0.00 Phwlh. Plan Plarr
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $47.00 Olil"-r plumb lrp. E3
1117Mth.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E f 711/13) FEE QTY/FEE MISC ITEMS
1 hv-i 'heck Foe:
Suppl. PC Fee
PME Plan Check: $0.00
Permit l'e'c�:
r541/JzJT, hisp Fce
PME Unit Fee: $209.00
PME Permit Fee: $47.00
("onswuciion Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (j) No $0.00
lelvanced Planning/*ees:
Travel Documentation Fee: ITRAVDOC $47.00
Strom Motion Fee: 1BSEISMICR $0.77 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$348.771 $0.00 TOTAL FEE: $348.77
Revised: 04/01/2014
Report Page 3 of 3
District Data Title Company ATTORNEY ONLY
School District Recorders Map Number
Elementary School Recorders Page
High School Number Of Buildings 1
Assessor Map 316-33.pdf
Assessor Map Index-Il 316-I1.Dof
Assessor Map Index-I2 316 I2.Ddf
Assessor Map Index-I3 316-316-I3.Ddf
Assessor Map Index-I4 316-I4,Ddf
Total Rooms 6 Lease SgFt Year Built 1962 Fire
Bedrooms 3 Office Sq Ft Effective 1962 1st Floor NaN
Bathrooms 2 Rental SgFt NaN Dishwasher 0 2nd Floor NaN
No.Of 1 Lot SgFt 7,500 Tennis Ct 0 3rd Floor NaN
Dining Lot Acres .17 Frame Type Elevator
Family 1 Lot 75x100 Total Units Wall Height 0
Rec Room 0 Cntrl YES Patio NO Utilities
Utility Room Bldg Class Porch Water
Fireplace YES Bldg Shape Garage Type GARAGE Electric
Pool N Bldg AVG Garage Gas Service
Sauna Bldg SgFt 1,296 Garage SgFt 437
Useable NaN
Addition NaN
Planning Projects
File Number TM-1961-02 I Z-1961-02 I Z-1961-04 I
APN 316 38 008 Percent Improved 50%
Secondary APN Home Owners NaN
Owner BALASUBRAMANIAM SIVARAMA K AND VENKATARAMAN Exemption Type HOMEOWNERS
In Care Of Tax Rate Area 13003
Situs Address 20075 NORTHWIND SQ CUPERTINO,CA 95014-0549 Tax Amount $8,216
Mail Address 20075 NORTHWIND SQ CUPERTINO CA 95014-0549 Mapgrid
Transfer Date ]un 4 2013 Subplat
Document Number 22246131 Zoning P(R1C)
Price $ Land Use Low/Medium Density(5-10 DU/Gr.Ac.)
Price Transfer Date 04/29/2011 L% ht Air
Prior Price NaN Front
Sale Price-Full/Partial Street Side
Use Code 6 Address
Tract And Lot 50708 Phone
Census Tract Owner Phone
Assessed Total Value $637,000 Tenant Phone
Land Value $351,000
Improvement Value $351,000
Structure Value $
District Data Title Company OLD REPUBLIC TITLE
School District Recorders Map Number
Elementary School Recorders Page
High School Number Of Buildings 1
Assessor Map 316-38.Ddf
Assessor Map Index-I1 316-11.odf
Assessor Map Index-I2 316-I2.0
Assessor Map Index-I3 316-I3.0
Assessor Map Index-I4 316-I4.Ddf
Total Rooms 6 Lease Sq Ft Year Built 1973 Fire
Bedrooms 2 Office Sq Ft Effective 1973 1st Floor NaN
Bathrooms 2 Rental SgFt NaN Dishwasher 0 2nd Floor NaN
No.Of 3 Lot SgFt 1,344 Tennis Ct 0 3rd Floor NaN
Dining 1 Lot Acres .03 Frame Type Elevator
Family 1 Lot 24x56 Total Units Wall Height 0
Rec Room 0 Cntrl YES Patio NO Utilities
Utility Room Bldg Class Porch Water
Fireplace Bldg Shape Garage Type GARAGE Electric
Pool N Bldg GOOD Garage Gas Service
Sauna Bldg SgFt 1,487 Garage Sq Ft 468
Useable NaN
Addition NaN
Planning Pro%ects
File Number TM-1970-01 I TM-1970-07 I TM-1971-12 I DIR-2001-26 I U-1971-26 I TR-2002-07 I TR-2003-08 I TR-2007-13 I TR-2009-03 I TR-2009-09 ITR
2012-25 1 TR-2012-29 I -1970-01 I Z-1970-04 I Z-1971.1 1 7-1960-19 I
Show All
http://gissvr/cupertinointranet/home/XSLTransformer.aspx 5/1/2014