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15050087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10258 COLD HARBOR AVE CONTRACTOR:A&H HEATING PERMIT NO:15050087 OWNER'S NAME: TALWALKER AMEYA AND SAMANT MEDHA TR 770 CHESTNUT ST DATE ISSUED:05/14/2015 OWNER'S PHONE: 6508040895 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 id LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL El COMMERCIAL ❑ REPLACE FURNACE AT SAME LOCATION,ADD A/C UNIT r 2 � g, License Class y �_5.Kk ON NZ Contractor . 0 =rte/-zDafe -'_�'�rU eby affirm that I am he nke un r'diet-provisions of Chapter 9 1( mmencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 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:$6850 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:36909034.00 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 INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, n/n� costs,and expenses which may accrue against said City in consequence of the M O LA I V Date: V `� OW��• granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section i'rrq 'a�<t✓' ,s F;s£ 'ri:v,:' �z r Y J� >1 RE-ROOFS: .� ' Signature av 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 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(See.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 f &Safety Code,Sections 25505,25533, n 25534 I have and will maintain Worker's Compensation Insurance,as provided for by the Health . i performance of the work for which this '. "F ��,' Section 3700 of the Labor Code,for the —� p Owner or authorized agent: ate: permit permit is issued. T 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 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 misc CUPERTINO (408)777-3228• FAX(408)777-3333•building(c)cupertino.orcl El PLUMBING �JMECHANICAL ❑ELECTRICAL PMISCELLANEOUS PROJECT ADDRESS / D 2 �Q�rJ ILJ� APN# OWNER NAME � E-MAIL v SL16� 7-4 UO 4�I,� r.� P OND50la 14 ,7-14L-W[41-11-14I 6 Wk4 STREET ADDRESS 7,t-25_Z, e -� / J` CITy� ATE, IP ��70 FAX CONTACT NAME �./�_i rZ PHONEqDV^ _1��722E I �� /�� ` U� STREET ADDRESS 7-7p�0L6 � A ?� 95-If I(!0 FA>6 09 7 9_/O/ 11 OWNER 11OWNER-BUILDER ❑ OWNER/ AGENT � CONTRACTOR ❑CONTTRAACTORAGENT El ARCHITECT ❑ENGINEER 11 DEVELOPER ❑TENANT CONTRACTOR NAMEW� jz -ml— LICENS l— LICENSE NUMBER�D}c,`_ LICE�/N'SE TYPF? BUS.LIC/## 72 COMPANY NAME E-MAIL,, yr/7,ffj FAX/j✓o 27 lD� STREET ADDRESS (7"-f61 T r CT� l/✓`y- Q'/' /`(�/W PHK D7/ G �L, ARCHITECT/ENGINEERNAME I LICENSE NUMBER ` BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WILDLAND [3YES PROJECT IN ElYES IS THE BLDG AN ❑YES BUILDING: t]COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION OF WORK r L 06�c? (,3�a z- 27 I=� ��c -2VRECEIVED BY TOTAL VALUATION: ��' �' r 'K 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 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 to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ^l SUPPLEMENTAL INFORMATION REQUIRED r ,,oFcE usE oiviY .I OVER THE-COi7NTER Rn 0 o xt, LARGE MEPMiscApp_2011.doc revised 06/21/11 Cityof Cupertino PWT PLANS E Y DATEY PLANNING DEPT MAY 14 2014 CUPERTINO Basemap Labels Abc Street Names ' COM Address Labels N�� LOPMENT DEPARTM N a� '� , � r �.. �Bll��i4�i�i�/�hd f@�1� �aTIIVO d M s APPROVE® R This s lob site during construction. It is unlawful to makean etFtrftAWci specifications MUST be kept at t Ba "Wgs or alterations on same, or to devi t homer. roStMbr0jVrj,ftrliftw the Building offi is The Stamping of this plan and specifications SHALL 0 be-held �aQ�tmty�rNb�9Kr of an "ftI of the violate y provision of n City Qj�inanc or BY Coun9, State Laty DATE PERMI . D Community Development ® City Boundary Aerials - Sept 2013 F R63 E Cw'Pw& P t �GN�CN�Il�� /✓l! SCALE 1 : 386 T