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10090268 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10370 MANN DR CONTRACTOR:CONDITIONED AIR PERMIT NO: 10090268 OWNER'S NAME: VISHNUDEV RAMAKRISHNAN 1701 LITTLE ORCHARD ST DATE ISSUED:09/29/2010 _JER'S PHONE: 4082043159 SAN JOSE,CA 95125 PHONE NO:(408)291-2220 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB F License Class C--'L-6 Li,.# MECH r RESIDENTIAL F_ COMMERCIAL Contractor (, �l Date L� 1b JOB DESCRIPTION:REPLACE FURNACE ADD AIR CONDITIONING 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:$9800 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:32645007.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 relatin; PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. cos xs which may accrue against said City in consequence of the grant oft=rmit. dditionally,the applicant understands and will comply with all n r ations per the Cupertino Munic al Co e,Section Issued by: Date: 9.18. Signature Date l h RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one )f inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensatic n, Signature�of An>� 'T ate: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. ;;&Safety Code,S tions 25505,25533,a d25 4.I certify that in the performance of the work for which this permit is issued,I shalnot employ any person in any manner so as to become subject to the Worker's or o ' ed age . I Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I m.rst forthwith comply with such provisions or this permit shall be deemed revoked. CONSTR ION LENDING AGENCY I hereby affirm that there is a construction—lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relat ng to building construction,and hereby authorize representatives of this city to enter Lender's Address -non the above mentioned property for inspection purposes.(We)agree to save ;mnify and keep harmless the City of Cupertino against liabilities,judgments. ARCHITECT'S DECLARATION .,its,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF' CUPERTINO FEE ESTIMATOR- BUILDING DIVISION 10ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $9,800 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair ___TPENTAMATION PRIMARY SFD or Duplex ;'� FURN/AC USE: p �� t PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT ,i,. ''�r""' r 1,0"M11 VA 1 OtherMech.Insp. 0.0 hrs $42.00 t)rl;c�f 1 ��' ta,�, C)rlr "1"70 1i31I' NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/1,101 F]lZE QTY/FEE MISC ITEMS 1 hIn sit/p/. 1'('Fcc PME Plan Check: $0.00 Perin it Fcc: - __-F PME Unit Fee: $' 89.00 PME Permit Fee: ;42.00 C"onso-I(c luno, T'n, "tcorrstical R&'vii'll 1-c°(": Work Without Permit? 0 Yes E) No $0.00 Mannino, FCC'N: Travel Documentation Fee: ITRA VDOC $42.00 i Strong Motion Fee: $0.98 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $:?74.98 $0.00 TOTAL FEE: $274.98 Revised: 9/29/2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN 32645007 .00 DATE ISSUED. . . . . . . : C9/29/2010 RECEIPT #. . . . . . . . . ES000011595 REFERENCE ID # . . . : 10090268 SITE ADDRESS 10370 MANN DR SUBDIVISION . . . . . . . CITY C'UPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VISHNUDEV RAMAKRISHNAN ADDRESS . . . . . . . . . . : ..0370 MANN DR CITY/STATE/ZIP . . . : C"UPERTINO, CA 95014 RECEIVED FROM . . . . : CONDITIONED AIR ASS CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : :.701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE ;408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- --- 1BCBSC VALUATION 9, 800. 00 1.00 0 .00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 00 0 .00 1BSEISMICR VALUATION 9, 800 . 00 1. 00 0 . 00 1. 00 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 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 275 . 00 0. 00 275. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 275. 00 #8527 --------------- TOTAL RECEIPT 275 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 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: 10 PERMIT# OWNER'S NAME: i A e/ Yv�Ja Y 3 PHONE# 2. GENERAL CONTRACT �,ho BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FIN LL S U CON} I CTORS IHAVE OBTAINED AON(S) WILL BE H ITY OF CUPERTINO GENERAL CONTRACTOR UNTIL THE D A BUSINESS LICENSE. I am not using any subcontractors: Date '- ahq e 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 V v Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Shee ock Tile 2 le Date wner/Contractor Signa a ; CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: C 13r O is ame: Phone#: -J- Con tr or: Phone rl�" 0- Fax #: Llob - ah Contractor License#: Cupertino Business Licen a#: Contact Phone #: LJpSa-21 O -')-006 \ Fax #: 1105 2`1) 22o Building Permit Info: Elect Z I Plumb Mech Job escription: M1A 00 � ) S'� Resid ial Commercial For Residential Installations: Attic ❑ 1st floor ��/ 2" floor00/ ❑ Adhere to minimum setback requirement '� For Commercial Installations: el Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of ConstructioA(lisage Class): Strapped On Platform Bonded New Location Replacement Valuation: �� 00 UD Green Building: Must attach Green Building Check list to this application