08110050 CITY OF CUPERTINO >x '+ -
BUILDING DIVISION PERMIT C®NTRAC�'TQR�INFORMATI�N
BUILDING ADDRESS: PERMIT NO.
10225 CARMEN RD RESIDENTIAL HEAT NQ ANT) A/C o8iinotio
OWNER'S NAME: INC PERMIT ISSUE DATE
Lk
ONE: 65 C1412TIC14 Q!
A CONTROL NO.
4083774073
ARCHITECfrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�o Z' LICENSED CONTRACTOR'S DECLARATION Job Description
m I batty enm Nal 1 am licensed under provisions of Chapter 9(aommmacing
•O with Section 7")of Dimino 3 o de Business and Pmfesiou Code.and my licanseis
n�H imfull faraand eSttL ADD AIR CONDITIONING TO EXT HTING SYS ,
? License Ciaass `3D Lk.0 70TSS�1
n_ Dow_[I I' �ContractortVryTaA
` ARCHrIECrS DECLARATION u
Y I uadcrwnd my plans shall be wed u public menta
s
yaG Licensed Profeadmant
3 OWNER-BUILDER m Ce Contractors
.�<M L Wreby aRia the I 1 exempt limn the(cmimes Co :A n c law for do
p o w
following reason.(Section 7 construct,
Business and Proe.,cants Code:Any city or county
$� which requires•permit m conswct.eller,impnw,demuliN,or repair my swctum '
priormiuissuams,also nequiR the applicutforsuch Permiuo fil...igncdaukmcnl
< mat he u licensed pursuant W the provisions of the Conueclues Liense lzw(Chapter 9 Sq.Ft.Floor Area Valuation
x�ro (commencing with Section 7000)of Division 3 of the Business and Profsedom Code)or
y $ mat he u eumde
adman dman and do basis for me alleged exemption Any violation of $7900
Section 7031.5 by airy applicant far a permit subjects me applicant he a civil puWty of APN Number Occupancy Type
not mare this fin boosted dollars(SSW). 35702002 . 00
I,uawoerof the papvry.mmy avployma with wagesu thc'v sok comPensatinn,
will do dawah.and thus structure is Out monad martered forssle(Sec.7044,Buewss Required Inspections
and pmfenaimu code:The Coma mes License Law does teet apply W an owner of q P
Property wed buil"mimpmvesmeaon,and who does euchwmk himself ar through his
awn employees,provided dist such impmwmenu are notinktded reoffered female IL
bmaewr.the building or impro`vnent is mid within ane year of comFledoa.the owner-
WiWm wiB hart the Wrdr of paving mat k did rot d W m improve far purpau of
sale.).
0 1,as awnm or the pmperty me excluenly contracting with licensed rnnuutars W
construct to pospa(Sec 7044,Business and Profecdom Cade:)The OpUssu rs Li-
cense Law docs not apply to an owner of property who builds or improves demon.and.
who contracts far such project with a contractor(s)licensed pas sumat W the Contractor's
License Law.
lamesemptundersce .Bib Pcr.tisreasan
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby aTom ander pnsity of pajary oro of dm following declarations:
I ban and will maintain a CertiOate ofCowent to self-insum for Wmkeh Compn-
ion,as provided for by Section 3700 of du labor Code,for the prfomuna of to
work fm which this Permit is iaued.
0 1 haw and will maintain Worker's Compensation Wurance,u required by Section
3700 of dte Labor Codc,fm the Performance,of to work fm which this permit is Wool.
My WorkeMr"ComPeesatian Insuru¢stet.and Policynumberart:
Greer./"IQ�G
CRFl n OFXMPDONFRRQMWOORUKE�RoS
COMPENSATION 0'
INSURANCE
(Thu mcdon used tet be completed if the Permits fm one hundred depart(SI W)
ser We.)
1 certih than k the Performance of the work fm which tis permit is issued.I shell am
employ any Person in any manoer an n W Wasme subject W the Warton'ComPensation
Laws of California.Data
Apukans
NOTICE TO APPLICANT:IL after making thin CeniOcaW of Exemption,you should
become subject us to Wariness ComPensetion pmvuians of Na labor Code you man
.,z farthwit comply with such povieans or thin Permit shall W dammed renkcd. '
'Z CONSTRUCTION LENDING AGENCY
[-� I lereby affirm than Nem use contraction lending.gency fm the part...of
a the wash fm which dds Permit u named(Sec.3097,Civ,C.)
Q Lenders Name
.7- z Lenders Address
U p 1 amity Nu I ban read oris application and ata W that the dhow information is
U. corms.I.gra W comply with,all city and county ordinances and sus laws relating W
.0 building conmuaion.and Mob,authasim repreunutiws oftis city W rola upon the
mon-mcndoxd ptoPeny,fee inspection purpo¢a
(We)agree to taw.indemnify and keep haalea the City of Cupertino sores
res Iiabilides,judgments.costs and uPensea which may in any way aaem against said City
V7 APPILICAERD
nceo ruhngfWUPeWILLCOMPLYWITHALLNON-POINT Issued by: Date
F7 SOURCE A
8 Re-roofs
Sign A ion
Data
US MATERIALS DISCLOSURE Type of Roof
will the cep tmtuture building occupentseemmhandle haiallowmmmie
as dcfnned by IAc Cupertino Municipl Code.Chapter 9.11.and the Haith and Safety
Code.Section 25531(a)7 �,"' All roofs shall be inspected prior to any roofing material being installed.
❑res pdrvt
Will thre W
e aPplka t or future occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
It huMmes air contaminator as defncd by the Bay Asa Air Quality M.nsgemem all new materials for inspection.
urict7
❑Yes )dNo y
1 haw read the inactions s materials mquirement under Chapier 6.95 of the Califor.
nia Health dr.6arety Code.Sessions 15505.25533 tad 15534.1 understand that tribe Wilding
dues not ntly haw•mann, it is my responsibility W ec
notify the auput of the
.quit ants 9+,:fIt rinis$..of.caniaaWafo e$ ea. Signature of Applicant Date
/) All roof coverings to be Class'A!'or better
sum m tent DaW
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35702002 . 00
DATE ISSUED. . . . . . . : 11/17/2008
RECEIPT # . . . . . . . . . : BS000006617
REFERENCE ID # . . . : 08110050
SITE ADDRESS . . . . . : 10225 CARMEN RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SINGH MECKER
ADDRESS . . . . . . . . . . : 10225 CARMEN RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2758
RECEIVED FROM . . . . : RESIDENTIAL HEATING
CONTRACTOR . . . . . . . : CATHY HAIRE LIC # 21161
COMPANY . . . . . . . . . . : RESIDENTIAL HEATING AND A/C IN
ADDRESS . . . . . . . . . . : 65 CRISTICH LN
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : 4083774073
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------ ------ --- ---------
1BSEISMICR VALUATION 7, 900 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 .79 0 . 00
---- -- ---- -----
TOTAL PERMIT 225 . 15 0 . 00 225 . 15 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CHECK 225 . 15 #25473
---------------
TOTAL RECEIPT 225 . 15
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------- ----- - -------- ------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN# 2 5 no Oog • ao Date:// 17 0
Building Address: 0 ola57 ►IARME/J �0 A�
Owner's Name: f Phone #:
1 NGH ECJCEti \f� (408) 2 S'3-4 4y (y
Contractor: J , Phone #: t4O$)
gEArioG a A/C2Tti1c Fax #: Cyo3 377- 9�Sy
Contractor License #: Cupertino Business License#:
-70 a/I
Contact: Phone #: Cq o `b)31 i_X-i7 y
Fax #: 040 %)3-7 9 81'q
Building Pe it Info:
Elect ❑ Plumb ❑ Mech
Residentia Commercial
Job Description: Q /'
Abp � O�2- l_o.Jp�'�OP�N6 To fkIST/NG NSA,"/NG e^S
For Residential Installations:
Attic 1St floor ❑ 2nd floor ❑
Adhere to minimum setback re uirement
Nz
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (IJs e Class):
7,�oa •O0 �� 0
Strapped= On Platform Bonded ❑ New Location Replacement ❑
Project Size: Express Standard ❑ Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index. cC�?—
Revised 6/16/08
CITY OF CUPERTINO
a ' FURNACE/AC 0.
CUPEkTINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more er outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M •
replacement of ea appliance vent
install & not incl in an appl ermit.
Quantity Fee ID Fee Description Fee Permit Type
nnn