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06070106 CITY OF CUPERTINO �[ � "sem /''t3 e'"' 'BUILDINu mvlson PERMITONTRACTOaRINk'ORMATION BUILDING ADDRESS: A B S HE & AIR COND PERMIT NO.06070106 10134 S TMTAU AVE OWNER'S NAME: PERMIT ISSUE DATE 0ilk RAMAN MUMMIDIVARAPU 334 SHAMROCK 1 NE: SANITARY NO, CONTROL NO. (408) 238-7178 ARCHI ECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH =1 0 (� LICENSED CONTRACTORS DECLARATION Job Description wC 1 hereby affirm Nat I am liam ad under provisions of Chapur 9(commencing wish Section 7")afDivislon3ofine Butimas and ProfCosiom Code,amp my is c�F mfall fame end cff U INSTALL FURNACE, AIR CONDITIONER & DUCT SYSTEM j la z Liccnu Class _ Lic.N . F Da¢ Contractor ARCHITECTS DECLARATION i¢ 1 undersand my plans shall he used as public records >yU a rot, Licensed Professional 3 OWNER-BUILDER DECLARATION iI hereby affirm that I am uempt from the Contractor's License Law for the D O fallowing reason.(Section 7(n 1.5,Business and Professions Cade:My city or county e m which acquires a permit to construct.also,improw,demolish.or repair any$EMCwae $9400 u Z y prior w its issuance.also requires the applicant for such Permit in rile a signed moment < that be is Restricted pursuant to the provisions of the Contractor's name Law(Chaptn9 Sq.FL Floor Area Valuation eFC (commencing with Section 7")of Division]of Ne Business and Professions Cult)or Nat he u exempt therefrom and de basis for the alleged exemption.Any violation of Section 703M by arty applicant for a permit subjects the applicant to a civil penalty of erOccupancy Type not mom Nan fsw hundred dollars(S500). e(/7�(]p p ❑I.azawur of Um yoprrty,mmyemploycaz wish wagnasdev ale compcnuuen, /I ifN fit /A• A will do the work and tk structure is not intended or offered for sale(Sm.7064.Busimss Ad �� +I ss. s and Professions Cade:The Contractors Liana Law does not apply to an owner of P.'eq irred-Itnts,Lp&i C, ns property who builds improves demon,and who deessuch work himulforthmugh his up own cmployeaz,provided Nonsuch improwmensart nrtintemr4 moffeaedforsalaff, � ) 1(1 however,the Wilding orimprowment is sold withinou ye.of complcuon,the,owner- `11. builder will have the based of proving that k did net Wild or improv for purpose of a� ZOOQ cony (g/Jt(.,++y+\/B ,,� {� 1,as owner of Ne property,am ezdusiwly contracting with licensed eontrumrs m '/,{,/'t a �� a the project(Sec.on im Business and Pfessionswho Wilds Code)The Co therad..Li- Co.cou law don rot apply w ut with a alpinism,woris who Wilds or fmprows Commences and, who c La .for such projees wish aeenvanogs)liunsed pursuant to the Conuaewh LKtnm IoW. ❑lam mempt under See .BkPCfor Nu reason Owner Dau WORKER'S COMPENSATION DECLARATION 1 thereby eR nm under penalty of perjury one of Now e following declarations: 1 hawandwillmainuina Carinateof Cementwcalfinsurefm Wor sCompcn. urian,as provided for by Second 37M of rite labor Code.for the Panto mamc of the work far which this Permit is issued. j2FThaw and will maintain Workers Compensation Immaatt,as acquired by Section 37M of the labor Code,for the onam mace of the wart for which this Permit is issued. My Workers Campemauon 1 umom renin and Policy number ane: Cartier. Polity N . CERTIFICA OF EXEMPTIONtcalo FROM WORKERS' COMPENSATION INSURANCE (Ibis senima need not kcemplcmd if the permit is Tania hundred daRars($10() or less.) I unify chat in Nc Wrfunmenc,of to work for which this permit is issued.I shall not employ any peraon in any indoor so as to kcome subpel to the Werkcrf Compensation Laws of Llliforam Dam Applicant NOTICE TO APPLICANT:If.after making this Cmificam of Exemption.you should become subject to me Workers Compensation provisions of Use Labor Code you mus .J z foMwim Comply with such provisions or this Permit shall k Clamed rt okcd. z'� CONSTRUCTION LENDING AGENCY (-+ 1 barely alrma that Vert is a commandos lending agency for the penformarox,of tYdm work for which this Permit is issued(Sec.3(y97,Ci,O) Lenders Name .7 z Lenders Address U Q 1 certify Nat I haw mad this application and sum that the about information Is Iy f--' toren.1 agree to comply with all city and county aNioancn and sum laws relating to p Wilding construction.and hereby authonim rtpresenusivcs of this city to enter upon the Uabbre-ms.judg dnts,Co farinspersion purposes. gy (We)agree to use,indemnify and keep harmless dm City of Cupertino against Tn inconseque ceofthecon�ing cspcnsu which may in anyway roam gaunt said City U z in eonseguemc of me germing of this permit. v-' APPLICA UN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 5 E TlOyy Guam ��IO ata S art of App n�canmaetar O.Ic Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle lowardous matenal az Cleaned by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety Cattle,ESection33512(a)? El Yes Nn All roofs shall be inspected prior to any roofing material being installed. 41 Will the applicant or future Wading ecmprea use equipment or dewcca which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air cm urrimm"as dcfincd by me Bay Area Air Quality Management all new materials for inspection. DisuiCO —/ 1 haw real the hmaadons mamriafsmyvimmcns un@rChapmrd.93 ofNe Califor- nuHnlNd:Saf Cade,Secuam 23503.253]1 ami 2553d.lunnknund dutifshe Wilding d arc y ho none Nat it u my rnponsibility w notify she=van,or the q bo t orwiazaanaof. ertiram f a Signature of Applicant Date rorauthorizedagent Dow. All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue la Af-le Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: PERMIT # \0\3q nVC0 OWNER'S NAME: OkCeoli PHONE # GENERAL CONTRACTOR: FAX # _ I am not using any subcontractors: cz& ---� ignature 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 ile • Owner/Contractor Signature Date CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37507038 . 00 DATE ISSUED. . . . . . . : 07/17/2006 RECEIPT # . . . . . . . . . : 35290 REFERENCE ID # . . . : 06070106 SITE ADDRESS . . . . . : 10134 S TANTAU AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAMAN MUMMIDIVARAPU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : ABS HEATING & AC CONTRACTOR . . . . . . . : ROBERT HALL LIC # 22481 COMPANY . . . . . . . . . . : A B S HEATING & AIR COND ADDRESS . . . . . . . . . . : 334 SHAMROCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 238-7178 �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 BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 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 280 . 54 0 . 00 280 . 54 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - ----------- - - ------------ ------------ - ----- CHECK 280 . 54 10552 TOTAL RECEIPT 280 . 54- VOICE 80 54VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO �tl aomoluj FURNACE/AC CUPEI,TINO PERMIT APPLICATION FORM 41 APN # ?31 r r O Date: 1 11n co Bu\d6ngA dress: Ow er's Name: Phone#: - s- Baas Co tractor: Phone: License#: 0% - 1 a976 Cntact: Phone Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: tic c� LuC-+ �S Residential Comme tial ❑ For Re idential Installations: Attic Is` floor ❑ 2nd floor❑ a �C Adhere to min set back requirement❑ J or Commercial Installations: eplacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: o Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY --Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING