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10020146 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1085 NOVEMBER DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 10020146 COOLING 'NER'S NAME: ICHULLAR,SANJAY 1171 N 4 TH ST DATE ISSUED:02/26/2010 OWNER'S PHONE: 4082572115 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB License Class -7-0 Lic• q / MECH l— RESIDENTIAL r— COMMERCIAL Contractor ate _` JOB DESCRIPTION:REPLACE FURNACE 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. I Sq.Ft Floor Area: Valuation:$3800 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:36216022.00 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 relating 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. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 2j; t O with all non-point source regulations per the Cupertino Municipal Code,Section Issued b ' Date: ye 9.18. 4416 /o '"' nature Date 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 of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS I hereby affirm under penalty of perjury one of the following three 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. Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or an Date: �G 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 mus t forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ereb 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 relatin; to building construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save :nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,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 reg�afio�nsrupertino Municipal Code,Section \ 9.18. I Licensed Professional g Si nature Date �L CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 36:?16022 . 00 DATE ISSUED. . . . . . . : 02,126/2010 RECEIPT # . . . . . . . . . BS')00009841 REFERENCE ID # 10 )20146 SITE ADDRESS . . . . . : 1035 NOVEMBER DR SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER KHULLAR, SANJAY ADDRESS . 1085 NOVEMBER DR CITY/STATE/ZIP CUPERTINO CA, CA 95014-4129 RECEIVED FROM VALLEY HEATING & CO CONTRACTOR A'IKINSON, THOMAS LIC # 141 COMPANY VALLEY HEATING & COOLING ADDRESS 1171 N 4 TH ST CITY/STATE/ZIP SIN JOSE, CA 95112 TELEPHONE (908) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- --- 1BCBSC VALUATION 3, 800 .00 1. 00 0 . 00 1 . 00 0 . 0 1BSEISMICR VALUATION 3, 800 . 00 0 .50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1 .00 63 . 00 0 . 00 63 . 00 0. 00 1PPERMITFE 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 232 . 50 0 .00 232 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 232 .50 #20306 --------------- TOTAL RECEIPT 232 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION __ _ ------ -------------------------- -- -- ----------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FUWiACE/AC CITY Of CUPERTINO PERMIT APP)JICATION FORM APN# ,f, Date: T C?-1 (-P C) (T-Vim. • O �J 2 r?j V l l.V Building Address: 0 04W e 49--� Owner's Name: Phone#- ^ Q A5-- q Contractor: Phone#: it �''�, Fax#:Cu ertino Business License#: Cractor L' ense#: P Contact: Phone#: , L ff—> Fax#: Building Permit Info: / Elect�' Plumb ©/ Mech Residential [ Commercial ❑. Job Description: For Re ential Installations: Attic ❑ 1 S`floor D-, 2n' floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement saine weight ❑ Additional weight (structural talcs} ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ ost of Project: Type of Construction(Usage Class): Strap d F-1 On Platform ❑ Bonded�� New Location F-1Replacement Valuation: Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FUWiACE/AC CITY OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group_ FURNACE FURN/AC -1PGASRES e -Residential fo: a gas piping system of —P 1-4 Outlets 113PGAS For each gas piping system of 5 or P more per outict. 1BSEISMICR Residential Seismic B 1M .CPLNCK Mechanical P'Lan Check M 1MFR=<100 Furnace Syst ;=100k BTU install or M relocate ea fo-ced-air/gravity type ��� famace/bume r, incl ducts/vents attached to s-u ch appliance up to and include 100,00 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type fumace/burn(,r, incl ducts/vents attached to stl.ch appliance over 100,000 Btu/..i 1EPERMITFEE Electric Perndt Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Pernlit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO -' FUR21ACE/AC CUP TYOf FEE S12.HEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE _ FURN/A 1MCRAA Commercial-l:epair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,a)sorption unit,or ea heating,coolirg,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 L nit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUS HTR Commercial :nstall. elocate ea M suspended heater,recessed wall htr, or floor mounte i unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per out_et. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed&not incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1MRRAA Residential I:epair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit.absorption unit,or ea heating,cool ing,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential"nstall/Relocate ea M suspended heater,recessed wall htr, or floor mount:d unit heater. 1MRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install &no:incl in an appl permit. Community Development " . 10300 Torre Avenue r: Cupertino CA 95014 Telephone(408)777-3228 `C(TY OF Fax(408)777-3333 XPEkTINO Buildin De artment JOB ADDRESS: PERO O al OWNER'S NAME: eA,) GL- PHONE # GENERAL CONTRACTOR: ef FAX# — ,2 I am not using any subcontractors: Sf:nature Date Please check applicable subcon ctors and co m Mete 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 Tile O Date Contractor Signature