06050088 CITY OF CUPERTINO
BUILbING DIVISION
PERMIT C9TITRACTQR INFOI.tMATION
SUILDINGADDRESS: AIRQUALITYHEATING & AIR Cr"No'06050088
10751 WUNDERLI H D
OWNER'S NAME: PERMIT ISSUE DATE
ASL SUBU BALA KRISHMAN 714 NORTHRUP ST 05/10/2006
NE:
SANITARY NO. CONTROL NO.
(408) 293-7138
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I= C= 0
ipp LICENSED CONTRACTOR'S DECLARATION Job Description
mC 1 hereby affirm Nal I am licensed under provisions of Chapter 9(cammcneing
?iW with Sotion7W0)of Division Sof the Business aid Pmfesslom Code.and my lic,nx is
wren Tame and a INSTALLED A/C UNIT - REPLACEMENT
Liccnx�rce a es� lY.p LA L
=p
Data J'l —Camnclor r-
s ARCHITECTS DECLARATION
f < 1 understand my plans still h used as public records
7yU ,^
s u F
Licensed hereby from
�6
OWNEhe marrDERmDECLARATION JUN vt00tJ
I hereby
.(sere on I a1.exempt from th Canmamor's License taw for th C
p O following reazon.(Section)(131.5.Business and Professions Calc:Any oily or,...ty
u$ which requires a permit to convect alter,improve,demultsh,ar repair any structure nft0 C 0
prior In its issuance.also requires the applicant for such permit m Bk a signed statement
that he is licensed pursuantto Ne ponwaimed of tic CoatmcwrY LicenseLaw(Chapter9 Sq. Ft. Floor Area ❑
etm-a (commencing with SeedonID00)of Division 3 of the Business and Prafesiou Coac)or
i Nat he is exempt tbcrtfmm and use basis for the alleged es mplion Any violation of
Section 7031.5 by any applicant for a permit subjects the applleanuu a civil penalty of r U U Occupancy Type
not mon:Nan five hundred dollars MOT.
I,u owner of th properny,army employcea with wages as deir sole eompenssuon,
will do Ne work.and rte amratrre a an,kxnded or offered for MI,(Sec.7044.eusineu
Required Inspections
and profrssloo Cade:The Conowasn's License law docs not apply m an owns, e nsr of q P
property who builds orimpresses tim ms.and wW doessucb works himselfmthrough his
own amplayoes,provided Natsuch improvements art notimeaded proffered forsale If.
how..the building or improvement is sold within one year of completion.the awner-
builder wdi have Ne burden of proving that he did not build or improve far purpose of
Mk.).
0 1,u owner of the propery,am exclusively contracting with Handed contractors to
coowct Ne pmlca(Sec.7044,Business and Prafessi on Cade:)The Costracmr's U.
ecru law dao not apply ban owner of property who builds err mangroves;thereon.and,
who contracts for such projects with arnnoacwr(s)Iiaved purswm to lh Contractor's '
License Lan
❑'imb.cmptunder See ,B&PCfor Numason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby air=under pam ity of perjury one of die folkwing declarations:
I bare and will maintain acumn 37 ta of Consent r self-i.for
fa Worker.of Met
Moon, r provided fee mi Souon 3'!00 of the labor Cade.for the perfarmamz of tic
work for which this permit is issued.
Q I save and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the performance of this work for wbich this permit is issued. '
My Worker's Compeuaubym-�].� a.carrier and Polity number art:
Grr. Tf
Carrier, tik-InG £) No.: A
CERTIFICATE OF EXEM PTION FROM WORKERS'
COMPENSATION INSURANCE
mail section used not completed if the permit is for one hundred dollars(SIM) r
or less)
I cmufv Nat in the perfomrmrec of tic work for which his permit is issued,I Me]was
employ any person in any manner an as ca become subjal to the Workai Compeuadon
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.If,after making his Certificate of Exemption,you should
become subject to Ne Worker's Compcnutian provisions of the labor Code,you muse
.Jz farNwith comply win such provision a this permit Nall h domed revoked.
Z O CONSTRUCTION LENDING AGENCY
F-r I hereby affirm dist Vert is a conn Mm lending agency for tic performance of
Ni >
the work mi
far which this pert u issuer309'1
ed(S . .Civ.C.)
Obi
1-cmis f Name
M z lender's Address
U O 1 certify Nat 1 have read his application and sets,nm dsc above information is
I, F comma 1 agree in comply with all city arm county ordinances and sum tan relating in
pU building construction,and hereby auNorim representatives of this city to enter Pon the
Lf] above-mentioned property for imNcuon purposes.
(We)acme to save,iedcmnify and keep sambas th City of Cupertino salmon
r/y liebilidea,judgments.casts and expenses which may in any way accrue against Mid City
U Z in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2 1
SOURCE REGUvL'Aw O
rII'L l Ii i.�.�.vf �, d� Re-roofs
SignatureofAppliariVC roe I Dam
HAZARDOUS MATERIALS DI LOSURE Type of Roof
Will the applicant or future Wilding occupant stare or handl,hvaNaus mao:rial
as defined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Cale, 0yes35572(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea ri m"
t/ If a roof is installed without first obtainingan inspection,I agree to remove
Will Nc applicant or umrt building acupam vx equipment or devices which P g
it loounimus it coetamimous as defined by the Bay Ama Air Quality Mamgcmcnt all new materials for inspection.
DiMicR
0 Yes
I havenead Nehasard..WAalsmquimmtnuunder Chipmr6.95ofN Califon -
niaHcalN&Sdity Codc,Sccu.o M5.35533an M3a.Iunecrstand thatiflbc building
does not curendy have a tenant,that it u my rapomibility,m miry the occupant of dm
reqmints w hicbMasca b,met prior in issance uofa Cerufics up y.
,� / Signature of Applicant Date
Owner or atrnori,< agent Dam All roof coverings to be Class "B"or better
• Community Development
f J 10300 Torre Avenue
Cupertino CA 95014
1. Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
d si el-
OWNER'S NAME: Su.b LL cti PHONE #(L051
GENERAL CONTRACTOR (}, II\�� AX # o
I am not using any subcontractors: /fit// (I/144"
Signatur Date
Please check applicable subcontractors and complete the following information
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
Lbwner/C ntractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37529004 . 00
DATE ISSUED. . . . . . . : 05/10/2006
RECEIPT # • • . . . . . . . : 34336
REFERENCE ID # . . . : 06050088
SITE ADDRESS . . . . . : 10751 WUNDERLICH DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SUBU BALA KRISHMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AIR QUALITY
CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791
COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON
ADDRESS . . . . . . . . . . : 714 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 293-7138
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 .86 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 160 . 73 0 . 00 160 . 73 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 160 . 73 52238
TOTAL RECEIPT 160 . 73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
CITY OF CUPERTINO5�g�
a4 FURNACE/AC
OUPEkTINO PERMIT APPLICATION FORM
Date:
Building Address: rd� 1 I 1
kkY1CQ e ci/l
Owner's Name: Phone#:
Su-b 40S- fol - 10170
Contractor: Phone: O(&) 9-'/3•-'9135 License #:
it v-aA'% ie� �' Y�i� Conk ��ocf��(o
Contact: I Phone: Cupertino Business License#:
Lle Vck-r ber (LOO.) aq3 -7/:3 3 Ra 7
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description: -
zc.112cPLe�Y.1—
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor❑
Adhere to min setback requirement 0'
or 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 Construction: Occupancy group:
i!So-uo .®o C-i p 2. 3
Strapped ❑ On Platform Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BRENIFURN Relocation of Furnace MECHANICAL
- BREMACOVER -" A/C Unit> 10,000 cfm MECHANICAL
/ BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING