13040160 .CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7945 CRANBERRY CIR CONTRACTOR:GARY'S FURNACE PERMIT NO:13040160
SERVICE
OWNER'S NAME: MURTHY CHANDRASEKHAR AND GITA 360 CARMELITA DR DATE ISSUED:04/23/2013
OWNER'S PHONE: 4089738671 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)967-8171
❑ . LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# 4;0. REPLACE(E)FURNACE,SAME LOCATION
Contractor Date `f ` Z3
I hereby athat I am licensed under the provisions of Chapter 9
(commenci with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full forceandeffect.
I hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$1850
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:36203009.00 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 VVITIIIN 180 DAYS T 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 LAST LED INSPECTION..
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Z
granting of this permit. Additionally,the applicant understands and will comply Is Date:
with all non-point source regulations per the Cupertino Municipal Code,Section CL
9.18. .
3_ / RE-ROOFS:
Signature Date 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 isnot intended or offered for sale(Sec.7044,
Business&Professions Code)
1,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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio rs 25505,25533,and 25534.
Section 3700 of the Labor.Code,for the performance of the work for which this r3
permit is issued. Owner or authorized agent: Date:
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 thatthe above information is
correct:II.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 propertyfor 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 uon-point source;regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
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G�NERAL'PERMIT APPLICATION
MEP
CQMMUNITY;DEVELOPMENT DEPARTMENT•BUILDING DIVISION .
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERT,INO (408)777-3228•FAX(408)777-3333•buildingCc)-cupertino.org ` M I S C
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CONTRACTOR NAME Ej 2�F 3 LICIT TYKE, BUS.LIC#
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BUILDING'II .I'I,❑4.'OMMERCIAL y.,,if;"I URBANJNTERFACEAREA NO FLOOD ZONE ❑NO "EICHLERHOME? .0 N
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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 prod ed 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 b g co ^ctio u orize representatives of Cupertino to enter the ab�-ident*fied rope r inspe twn purposes
Signature ofApphcant/Agent I!I ,' Date: L � y
S ! EMENTAL INF RMATION REQUIRED
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7945 CRANBERRY CIR DATE: 04/23/2013 REVIEWED BY: MELISSA
APN: 362 03 009 BP#: "VALUATION: 1$1,850
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec,Permit Pee:
Other Mech.Insp. 0:0 hrs $45.00 Other Plumb Insp. Other Elec.Insp.
Allech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc: . These ees are based on the prelimina information available and are on an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12, FEE QTY/FEE MISC ITEMS
Plan Check 1*ee:
Suppl. PC.Fee
PME Plan Check: $0.00
Permit Fee:
Supp/. Ins[)Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Constrztction Tcaa
Administrative Fee:" IADMIN $42.00
Work Without Permit? ® Yes (j) No $0.00
Advanced Planning Fees.-
Travel
ees:Travel Documentation Fee: 17R4VDOC $45.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg.Stds Commission Fee: IBCBSC $1.00
$266.50 $0.00 $266.50
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Revised: 04/01/2013