B-2017-2131 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO.B-2017-2131
10365 STERLING BLVD CUPERTINO,CA 95014-3830(375 25 044) T F F HEATING AND
AIR CONDITIONING
MILPITAS,CA 95035
OWNER'S NAME. LAKSHMINARAYANAN BHARATHWAJ M AND KRISHNAN DATE ISSUED-12/12/2017
OWNER'S PHONE.614-260-6227 PHONE NO:(408)500-9245
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class C-20 Lic.#917350
Contractor T F F HEATING AND AIR CONDITIONING Date 06/30/2018 X BLDG _ELECT _PLUMB
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
license is in full force and effect. JOB DESCRIPTION
I (N)HEAT PUMP;INSTALL 4 INDOOR MINI SPLITS
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 fot which this permit is issued.
i,i1/4ps ,'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. Sq.Ft Floor Area. Valuation.$17000.00
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 APN Number- Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 25 044
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulatio s ler the Cupertino'Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
12/12/2017 Issued b Abby A
/.Signature - -�---��q Y' Yende Y
(.1 Date: 12/12/2017
OWNER-BUILD 1 E ATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or,my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 12/12/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
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
a. 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
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25, 0.5.,pd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. r--Owner or authorized agent: EilL ._—
CERTIFICATION
APPLICANTDate:12/12/2017CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending 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
Signature Date 12/12/2017 Professional
1
CONSTRUCTION PERMIT APPLICATION
# " COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B ,
is,/ 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 g y
�t.ays X014- 1
(408)777-3228 • building@cupertino.org PEMIT#B- -
CUPERTIO s REV# DEF#
❑ NEW CONSTRUCHON ❑ADDITION ❑X ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS (APN#
10365 SterlingBlvd Cupertino Ca 95014 cb
OWNER NAME PHONE E-MAIL
Bharat Lakshminarayanan 614-260-6227
STREET ADDRESS CITY,STATE,ZIP
10365 Sterling Blvd Cupertino Ca 95014 mlbharathwaj@gmail.com
I]CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
TONY FERREIRA TFF HVAC 917350 C 20
STREET ADDRESS CITY,STATE,ZIP
10435 NEW AVE 1 GILROY CA 95020
E-MAIL PHONE BUS.LIC it
HEIDI@TFFHVAC.COM 408-500-9245 31778
0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME I E-MAIL
TONY FERREIRA
STREET ADDRESS CITY,STATE,ZIP PHONE
408-500-9245
DESCRIPTON
;INSTALL 4 INDOOR MINI SPLITS.1 OUTDOOR HEAT PUMP ENCLOSED BEHIND FENCE. ISIO A v -
r. ..yt 2-2O
®SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH.SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL
SF REMODEL KITCHEN REMODEL OTHR ..GARAGE ❑ATTACHED
SF SF SF 0 DETACHED
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING 0 YES 0 ATTACHED 0 DETACHED OTHER
UNITS I UNIT ADDITON: 0 NO".. S F
POOLS) 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
RECEIVED BY: TOTAL VALUATION:
Commercial Or_Multi-FamiluBuildings with Public Swimming Pools requires Department ofEnvironmental Heath approval (n `t 19- D 00 tCQ
RE-ROOF'EXISTING ROOF TYPE: ElBUILT-UP ROOF❑ASPHALT SHINGLES ID WOOD SHAKES D WOOD SHINGLES Q TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 0 l ❑3/8" PLYWOOD TYPE: PITCH: (ROOF CLASS
El YES #OF LAYERS THICKNESS 0 5/8" OTHER ❑OSB ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF (]ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF not SQUARES
Bymysignature 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
� �Y
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 relatin building co coon. I authorize representatives of Cupertino to
enter the above-identified property for inspe 'on purposess."I acknowle ge and orize all information contained on this application form
to be made available for public record. c
Signature of.Applicant/Agent: Date:12/12/17
SUPPLEMENTAL INFORMATION REQUIRE
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17