08020108 CITY OFCUPERTINO
BUILDING DIVISION PERMITRACTbRYNFORMATH
: 2Yv'
Bu1LpI1d,M RgkER LN CONDITIONED AIR 08020108
NER'S NAME:: PERMIT ISSUE DATE
GARY LEHRMAN 1701 LITTLE ORCHARD ST 02/19/2008
PHONE: (408) 291-2220 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 C p LICENSED CONTRACTOR'S DECLARATION
B a T hereby affirm that 1 am licensed under provisions of Chapmr 9(commcncing Job Description
with Section 70)(B of Division 3 of the Business and Profeadmo Code,and my license is RMV be REPLC FURNACE, IN CLOST ON 1ST FLR
;I O; in full fame and eBut
Ll Cl Lia
ARCHITECTS DECLARATION
1 understand my plans shall be used as public r.nrds
JyU
gQ� Licensed Professional
may M
OWN ER-BUILDER m Me aON
EMS I Wnam .(Sero on 11. anempl from the Contractor,C Licca Law far am
EMO following wan.(Saran 7031.5,Business W Pmfetioli Code:Any city or county
whish requires a e.mi,ac corers,alux)meow,demolish.,ter e a sig ed udemen
_zy priumiuraamrt.ala requites Meapplicantof for atrthptar',Li wo Lnndnammem
Man he iamev with
SommmN)ofDivlom arthe ortheB ncattllxx�lAw(CMpuT9 Sq.Ft. Floor-Area Valuation
$5s MatInI.engwihhecUon]andMe awfrafaeeuainess and on.AnyuCMe). 62450
Nat W u exempt therefrom and pee aper for the alleged assumption.Any Aetna on of
not
Man .any applicant for a permit objects the appiram ro a civil penalty of e.17�Number Occu anC e
nm roma Na five hundred dollars(SSW). 36624016tlt7' P Y�YP
0 L u owner of tW Fra may,per my employees with walrus u deer saleeompensu on,
will do the.&..ad thasw.um is nmimmaind moffernd retitle(See70M,Business Required Inspections
and Professions Cade:The Commissars Licence Law dean rot apply m na an owner or q p
property who buiIdaperimpar athcrum,and whodoessuch work himselforthrough his
awn employers,provided thatsuch improvements tie not intended aro@rod for ale.IL
however,the building or Improvement is sold within am year of companion.the owner.
Wilder will have tie burden of proving dant he did not Wild or improve for purpose of
sale.).
❑1,u aweer of the property,am exclusively comuacting with licensed eentranron a
contract the project(Sec.7W.Business and Professions Cade:)The Cmmustar's I.I.
roue Law dean at apply to an own.of property who Wilds or rnprowa aerton,and
who concocts far such projects who a com eannr(s)licensed possum,to dte Caromears
License law.
ElI ateaccept underSec .B&P C(a this recon
Data
WORKER'S COMPENSATION DECLARATION
I Wteby M.trader penalty of perjury am of the following decrndow;
❑Iluw and will malnalnaCeNfiote o(Cananl to tel(-WonfarWorkersCompete-
cation,a provided for by Section 3700 of the Isbm Code,for the performs Ice of the
work far which this permit is issued.
❑1 haw and will maintain Wa kiss Compensation Insurance,u acquired by Section
3700 of Be Labor Code.far Ne performance of the work for which Nis permit r laved.
My Wcu^kke�rs,,,Comp/s/psaaon Insunmm cerins and Polity numbcnre: p// d-
Grtier(�(.IIL KI✓E(/ Polity No.Z2��R/0'( -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thr section read mtocompicted if the permit is foram hundred dolrm(SI W)
or less)
1 cemiy Thar In the part...of the work fu which thin Permit In issued.I Nall not
employ any person in any manera as to become subject or the Workers'Compensation -
Laws of California.Data -'-
Applicant
NOTICE TO APPUCANT:IL after making this Ccrtifmate of Exemption,you should
become sub)M m Me Workers Comprttition provisieu of the Isbor Cade,you most
.,O forthwith comply with such provisions.thin permit small Ise damW rooked.
Z v"' CONSTRUCTION LENDING AGENCY
14 1 Mem aRrm that dt.ren comuuctim leadin a for the
F r g gems prfurmana of
ate work for which dais Remit Is Wood(Sec.7091,Civ.C.)
W A Lenders Name
� z Lenders Addw
U Q I certify that 1 haw read this application and state that the move information la
[7. F cones.1 agree ur comply with all city and county amlinances and state laws missing to
0 U Wilding construction,and hereby muthodn mpmantstives of this city to enter upon the
W move-mendoned property for inspection putpws.
G (We)agme to saw,indemnify ad keep harmless Bre City of Cupertino against
say inn liabilities,judgement.cora and esp.which may in any wayactm against said City
in consequence of the gra ming of this permit
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU
Z! / Z 19,0 Re-roofs
Signature of AppliamiContneer Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
will the applicant per(utero Wilding caupamsmre or handle houNaus materia
Odefined by tW CopeNm Municipal Cade.outpost 9.17.and the Hulth and Safety
Samoa 2553:(.)7 J
❑van }gnus All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant ape equipment or devices which If a roof is installed without first obtaining an inspection,,I agree to remove
emit haemo air cmssmimnas an defaced by the Bay Area Air Quality Management all new materials for inspection.
Distant.?
Ya u
1 have road the hanGnumatcriabmquiremenu un l rChap cr15.95 of Ne Califor.
ria HasIM&Smery Ce@,Sum.ts25503,25533 and 75534.1 understand Mu f ae Wilding
deer not currently haw•tempt that It it my nspmibili,y m notify Ne acupat of pee
require Is. 'hmtrR an au ofaCeniaceteo(Occu Signature of Applicant Date
q n ho r �5-��ow -All roof cover sags to be Class"B"or better
Ow err mlhontt agent / Dple
V
CITY OF CUPERTINO
FURNACE/AC
® CUPERTINO PERMIT APPLICATION FORM
APN # Date:
366 �+ 6 6 0 C
Building Address:
164 s 'Ash Ln GA %o I y
Owner's Name: Phone#:
Contractor: eh '1 C90< q� 3 - X30 3
Phone#: 1 . 2,2_7_0
cam,;
`� f,*0- `A � els oc�
S Fax #:
Contractor License#: Cupertino Business License#:
titis� 62-
Contact: Phone#:
F #:
ax
Building Permit Info:
Elect Plumb ElMech
Job Description:
[Adh7eretominimurn
Commercial
nstallations:
151 floor [ 2°d floor ❑
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):
Z c-lSp . O G
Strapped LJ On Platform LJLJ New Location .-1 Replacement
aluation:
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
z FURNACE/AC
® Iran o
CUPEkTwO FEE SCHEDULE
AIR CONDITIONER:
Qty. if
Applicable Fee ID Fee Description Fee Group Permit Type
BCAIRHAN Commercial A/C Units<= l Ok CFM B FURN/AC
MCRAA Commercial Mech Repair/alt/add M
SEISMICOM Seismic Commercial B
BREMAIRHAN Residential A/C units<= l Ok CFM B
lei MRRAA Residential Mech Repair/alt/add M
/ BSEISMICRE Seismic Residential B
/I
EPERMITFEE Electric Permit E
/ MPERMITFEE Mechanical Permit M
/ PPERMITFEE Plumbing Permit P
BREMRECEPT Electric Receptacles E
PGASCOM New Gas Piping System Commercial P
1-4 Outlets
PGASRES New Gas Piping System Residential P
1-4 Outlets
BPGAS Gas Piping System 5+ Per Outlet P
TRAVDOC Travel Documentation B
BUSLIC Business License B
® CITY OF CUPERTINO
6 ITEMS OF 6 PERMITRECEIPTOPERATOR: patg
-- COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36624016 .00
DATE ISSUED. . . . . . . : 02/19/2008
RECEIPT #. . . . . . . . . : BS000003973
REFERENCE IO # . . . : 08020108
SITE ADDRESS . . . . . : 1645 ASTER IN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GARY LEHRMAN
ADDRESS . . . . . . . . . . : 1645 ASTER LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5214
RECEIVED FROM . . . . : CONDITIONED AIR
CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334
COMPANY . . . . . . . . . . : CONDITIONED AIR
ADDRESS . . . . . . . . . . : 1701 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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 450. 00 0.50 0. 00 0 .50 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
ITRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
---------- --------- ---- ----------
TOTAL PERMIT 224 . 85 0. 00 224 .85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 224 . 85 VISA
---------------
TOTAL RECEIPT 224 . 85
VOICE ID DESCRIPTION .VOICE ID DESCRIPTION
-------- ---------- ------------ -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Community Development
10300 Torre Avenue
aim , Cupertino CA 95014
. ' Telephone(408)777-3228
CITY OF Fax(408)777-3333
®CUPERTINO
Building De artment
JOB ADDRESS: PERMIT#D
1 r CX) o N O CA p( 0
OWNER'S NAME: (-, a, PHONE # 2(011- 227-0
GENERAL CONTRACTOR FAX # t ZZzcI
I am not using any subcontractors:
Signature Date
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
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Me
Painting/ Wallpa
Paving
Plastering
Plumbin
Roo
Se c Tank
eet Metal
Sheet Rock
® Tile
Owner/Contractor Signature Date