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10120061 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19990 BRENDA CT CONTRACTOR:ADVANCED PERMIT NO: 10120061 CONSERVATION SERVICES OWNER'S NAME: NAGARAJ VENKATAPURAM 1106 WINDFIELD WAY STE 2 DATE ISSUED: 12/10/2010 JWNER'S PHONE: 4088651484 EL DORADO HILLS,CA 95762 PHONE NO:(800)585-2495 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class G 20 F 3,, C b_ L ic.#_91 S U q3 REPLACE FURNACE @ SAME LOCATION 60 K BTU,95% N fl J k N�ri� � AFUE -, Contractor Gr> 5c,rcvA--I+e.J ,1-RJicatej�— 1v I(> 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. 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:$4447 1 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 whic this APN Number:36943012.00 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 WITHIN 180 DAYS OF PERMIT 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 FROM LAST CALLED 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point sourc ions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signatur Date /2-1)P> /O 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 is not 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. 1 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(x)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,Sections 255 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: Z I V lQ permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 that the above information is correct.I 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 property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION demnify and keep harmless the City of Cupertino against liabilities,judgments, ,sts,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 non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ! q0 34u,,7),A C'T PERMIT# OWNER'S NAME: AC;, 2R t n1 A-7• ?v� PHONE# 6 ' q6 SL149f GENERAL CONTRACTOR:f�7JA-,J 4�;J rizJMr�,� �e�2- BUSINESS LICENSE# ADDRESS: 1106 hJ,,d�F rZL> rVZ— CITY/ZIPCODE: N/� yS�d *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 2./lO// b 1 am not using any subcontractors: Si Date Please check applicable subcontractors and mplete 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ;-Z410 /� c Own r/ fo�Sign�ature�� Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36943012 . 00 DATE ISSUED. . . . . . . : 12/10/2010 RECEIPT # . . . . . . . . . BS000012203 REFERENCE ID # 10120061 SITE ADDRESS 19990 BRENDA CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER NAGARAJ VENKATAPURAM ADDRESS 19990 BRENDA CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM JEFF RAINEY CONTRACTOR MICHAEL NGUYEN LIC # 32197 COMPANY ADVANCED CONSERVATION SERVICES ADDRESS 1106 WINDFIELD WAY STE 2 CITY/STATE/ZIP . . . : EL DORADO HILLS, CA 95762 TELEPHONE (800) 585-2495 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- -------- 1BCBSC VALUATION 4,447 .00 1 . 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 4,447 . 00 0. 50 0 . 00 0 .50 0. 00 1MFR=<100 UNITS 1 . 00 126 . 00 0 . 00 126 . 00 0. 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1.00 42 . 00 0 .0042_ -- - -00 0_00 TOTAL PERMIT 211 . 50 _ - - -0 .00 211 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 211. 50 visa --------------- TOTAL RECEIPT 211. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19990 brenda ct. DATE: 12/10/2010 REVIEW7BY: ob s. 77] APN: BP#: *VALUA4,447 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY JF ENTAMATION FURN/AC USE: SFD or Duplex ��, �t;;;� t ;; PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 �hrs $42.00 Lj Li NOTE: These fees are based on the preliminaryinformation available and are onlyan estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resohition 09-05/ Eff. T`1.-70j FEE QTY/FEE MISC ITEMS P/kill t.hcc'n /"t3A' PME Plan Check: $0.00 I�erm'iI F(s' , slipp/. I110/7 f` PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $211.50 $0.001 TOTAL FEE: $211.50 Revised: 12/07/2010 CITY OF CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM lU 12, bO�Q l APN# Date: q `43 O 12 Building Address: Owner's Name: Phone#: ,JAGAR,A JO Nr-A 114 o,2 /4 403 X365- icfIRI Contractor: Phone#: 3-z3 .3 S`16 1 ADJA-��e�� GfJ�5t�2� cu:-� S�}2�;�� Fax #: 966 cNc 7G 3 D Contractor License#: �s" c,� Cupertino Business License#: Contact: �q'�, A-SJR Phone#: 323 3 j S �6 / Fax #: '96 Z) 70 30 Building Permit Info: Elect [ET� Plumb Mech Residential Commercial Job Description: C �c�?Ai e, 15,i-->-4 r toe—+-7t,5,.�J 60K i J� For Residential Installations: Attic ❑ 1 s` floor 912°d floor ❑ Adhere to minimum setback requirement ❑ For 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(Usage Class): ? � Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: � q) ) 4 Lf? 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. Revised 01/07/09