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B-2016-3315 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3315 21074 RED FIR CT CUPERTINO,CA 95014-4258(359 05 057) AIR QUALITY HEATING&AIR CONDITIONING INCORPORATED SAN JOSE,CA 95126 OWNER'S NAME: KADAVAKOLANU DIWAKAR AND VELPURU 1 DATE ISSUED:12/22/2016 MAHALAKSHM OWNER'S PHONE:408-252-9077 PHONE No:(408)920-3910 LICENSED ONT A TOR' D T ARATION BUILDING PERMIT INFO: License Class C-20 Lic.#769446 Contractor AIR QUALITY HEATING&AIR CONDITIONING INCORPORATED X BLDG _ELECT _PLUMB Date 06/30/2017 X MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION: license is in full force and effect. REPLACE FURNACE(SAME LOCATION) • I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 9�''"I have and will maintain Worker's Compensation Insurance,as provided for by �Cy/ Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$6700.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county ordinances 359 05 057 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 indemnify and keep harmless the , PERMIT EX 'IRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180'DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the upert o Municipal Code,Section 9.18. Issued by:AbbyAyebde Signature sI' • Date 12/22/2016 Date: 12/22/2016 OWNER BMIILDER pp: •TION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:12/22/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazakdous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued,I material. Additionally„should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Se' 'ons 2550 5533,and 25534. exemption,I 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. Owner or authorized agent: Date:12/22/20161 APPLICANT CERTIFICATION CONSTRUE-170N LE i•D G AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a constructio g agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed GENERAL PERMIT APP 'PS. LIGATION cQ mE p ,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ee, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPE� � (408)777-3228•FAX(408)777-3333•building al cupertino.orq M I S C ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS _\ c F-is APN# 1 'o5 OWNER NAME PHONE E-MAIL `Q‘ S�i\c-O� \�\icAy_ .ck+n,j �cf•2,52. -ct S -- STREET ADDRESS ,, CITY, STATE,ZIP FAX 2.`01A-1 ' -ec` 'P%C C..-r- 0c Si)e. }-\enc, ,c-p,, a 9.ssik...11 CONTACT NAME PHONE t E-MAIL .. \.\-e °-[c>c- o• 'c tc: , G --.'�Go.mk\e•eaT t ek STREET ADDRESS CITY,STATE,ZIP o�t Y\c u 5. ���'Y-c�C, �.. 1 ! _6N ` la FAX - ❑,OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT. CO/NTRACTOR ❑CONTRACTOR AGENT 0 ARdHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME "\ �` q /, LICENSE NU ER LICEN TYPE BUS.LIC#'r q \ c1 COMPANY NAME\\ � A\t+ \\ \r- ',C E-MAIL R 'S\.e_ civccp,,,,,,C'\ CL\1f \FAX L ©5r -!1 as,.© `9 STREET ADDRESS CITY,STATE,ZI•• PHONE t �J L \+ � _. �. cam., C / C C 2Co -A-.6t 2O G g q.k. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF S DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT 0 YES IS THE BLDG AN 0 YES BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO DESCRIPTION OF WORK �X- (-C. lCLC-vie �r \Y\. (:).... \---±_\-S.,_ TOTAL VALUATION: (.0 C wOCD RECEIVED BY: GIN Ctiti'litAttoCkm By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on 1}he property owner s behal 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.uilri• ,.nstructjo r. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: f.IJJ I Date: t 2 f 22.1 2-C) I(o PLEIV A I"A, INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER X 0 EXPRESS v 0 STANDARD u ❑ LARGE F 0 MAJOR MEPMiscApp_2011.doe revised 06/21/11 D �m p Co m O O Fir; z c r n co W ��+ H N D c > nm w' 3 N et G O n /� N n 3 > 3 n m 'n mFi a1 '^ 1r O 'a D fp D m c 0 ,� f D c m o d o e, m' n r ) v cr- mu 3 01 3 3 3 3 fp O.i •e .4. .4 -n O - to -1 m 0 0fD r N 0 m m 0 -„ t Q. N O Z (D O O 171Vf 3 D 0 T To rn in. f- 7 0 rD -i -0 m n o . r N .oP �9 O vi d A Ou O Q O O D 0 ft. 0 yr N 0 a' 3 3 r a) C Cr. 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