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06090147CITY OF CUPERTINO TION, gUILDING4111VISION PERMIT cONTitAC'COR IIV ,ORM oil 0 OU, ILDINGADDRESS: A PERFECT CLIMATE 'ER"T"No. 06090147 2,2405 BALUSTROL CT OWNER'S WNER'S NAME: PERMITESUBOATS KEELER FRANCIS W JR 10570 S DEANZA BLVD 09 . /192006 NE! SANITARY NO. CONTROL NO. (408)86119545 ARCHMECrIENGINEER: BUILDING PERMIT INFO ELECT PLUMB MECH 9O EC LICENSED CONTRACTOR'S DECLARATION Description I hereby art,. Met I am licensed War prmiAoAs.fC1p@,n., 9 (commencingJob with Section 700r) ofDiviamn 3 drive Business and Professions Crom,and my license is In fall force and.fifism REPLACE FURNACE License Class Lk. # — Dale— C.mumuer ARCH I F.0 I S DECLARATION I understand my plant sh.;I x used As, public records Licensed Professional OWNIER-BUILDER DECLARATION I thereby affirm MCat I Am "Ampt from be Contradoes License Law for he following mason. (Section 7(13 1.5, Business and Praficashms Code: Any city or comply $40S9 which requires a permit to consomati. almr, borrow, demolish, or repair any succlum prior in its Issuance, 1150 OtAl the IPPHCUL for such permit to file,signed signed smouncou Ft. Floor Area Valuation that he is licensed pumumm to the provisions of Me, Contractor's Ljcc= Law (Chapter 9 (commencing with Section 70010) of Division 3 of be Business and Professions Code) or Wt he is Carearept almonfirsent and that bandis for the Alleged exemption. My violation of Section 7031.5 by any applicant for a parbit subjects the applicant A 2 Civil Penalty Of y Occupancy Type Am ..re thous five hundred Mollars (15003 Required Inspections oI Nd Pstlesshorts Cads: Contractors License LndedM aw duct sea apply M an owns, of property who buildsorimnows thereon. and who doessuchanarklifinatelfor Waugh his own employees. provided Out such improvements Are notimentled orafferd forsain. If. however, the building or improvement is sold within am year oftempledon. the mmer- builder will have the burden of pmvinj that he did an, Wild or Improve for purpose of [3 1. % Owner of Me propen,, am conclusively contracting with ficancesed cenundon; An commuct ban project (Sec. 70w. Business and Ptntfinsticne, Code) The Consad-eS Li - cow Law does not Apply an an owner of property who Wilds or impnowts ftmon, aned, who con aBrom for such projects With a contrume(s) licensed pursuant up the Contmacter's License Law. ❑1 2- P noCar Sac B At PCfarthisacaus. :7 Da 9i 6 Ow= ta WORKERS COMIFENSATIO RATION I Intensity A! Me following of deciffedoese p I haw and will maintain 1 Certificate of Consent to self -inure for Workers Compen- sation, At provided far by Sedan 3700 of the Ladsor Code. for be Performance of Me, muir for whI6 this permit is Wed. 0 9 have and will maintain Workers Compenution Insurance. As required by Sedan 3700.1' ft Labo, Conn. for the performance dthe work far which this permit A Issued. My Workers compermition hadeasec carrier and Policy mordant are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not x completed ifum, permit Is forone hundred daltars (SIM) or It".) I certify mun, In the performance of the work par which this Permit h; Wed. I shafl not employ mypersom I. my ame. sub 110OW71-Compandualson Lawso alifiamialfate r - I A 11 , NOTICE TO-MUCANT: If. after making this Cerafl6Esempoo", you should become subject to the Worker's Com,diation movisi I ons PIT Labor Code, you raw ardswith comply with such provisions or this pcm4,!,h0 he deemed revoked. CONSTRUCTION LENDING AGENCY I Imads'.M. WIMere isa conatruCtine inteffin',cau, Car the performance of Me walk far which ties permit Is brand (Sec. 3097. Civ. C.) Lenders Name Lenders Addrum I certify dust I have wand did, applicac, Ardmore Mae the move idencomer 11 Correct. I agree to comply with all city and county ordinances and sum laws relating to Wilding construction, and hereby authorise representatives or this city to enter upon the move-mentionad property for inspection purposes. (We) agree to saw, indemnify and keep harmless the City of Capons. Against liabilities, judgments, costs and expenses which may in any way seem against said City in comourtuarmc, of the framing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR REGULATIONS. Z� V'9 & L Re -roofs Type of Roof Sign—sure OfApplicantCa Data HAZ=US M&ALS DISCLOSURE Will the applicautc,lutwo bell A As, defined by Me Cupertino Municipal Code, Chapter g.12. and thn Health and Safety Code, section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. E]y. IZN. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant of future building occupant use equipment or dcvIcA; which C.JL Islamic. air connumnares As defined by the Day Area Air Quality Management all new materials for inspection. District? Oyu :UN. I haw resd Me hLasainuarrammials belowerents muscrCh.pic, 6.950(the Calif., a4Ai licafth At SafiatyCodc, Se vase 25505.25533 And 25334. 1 untionsuand Mae lithe Wilding 4.4, .1 Carmody m. MCA, It A my responsibility to notify Me occupant or the to eapti which Amunzia, melt pruuppwmcf rfific.earOccupancy. Signature of Applicant Date iw _?,� All roof coverings to be Class "B" or better vi—ftr 0 or Authorized agent K Dmc !m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35603011.00 DATE ISSUED.......: 09/19/2006 RECEIPT #.........: 36110 REFERENCE ID # ... 06090147 SITE ADDRESS .....: 22405 BALUSTROL CT SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... KEELER FRANCIS W JR n OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: FRANCIS KEELER CONTRACTOR .......: SMITH, BYRON E LIC # 21144 COMPANY ..........: A PERFECT CLIMATE ADDRESS ..........: 10570 S.DEANZA BLVD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: (408)86119545 *EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 4,059.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ---------- 0.00 TOTAL PERMIT ---------- ---------- 164.78 0.00 ---------- 164.78 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ CHECK 164.78 ------------------ 5166 TOTAL RECEIPT 164.78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ---------------------------- ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • .f CITY OF OUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax (408) 777-3333 Building De artment JOB ADDRESS: 2Z Z-/- 43,42- ISTROL GT PERMIT # ��on oI �l "I OWNER'SNAME: Ft'ilA)clS ✓ KEE�cz Te_ PHONE # Z 3 --6zS3 GENERAL CONTRACTOR: PERFEG c<<MA-z= FAX # 17toS'- r,6 i - 95->' not using any subcontractors: �1�'4.:«� Signature Date Please check applicable subcontractors and complete the foowin information Ii t Owner/Contract r Signature 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 Ii t Owner/Contract r Signature I I am - 4fUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM aco�o �� APN # w Date: Building Address: 225/0 !`ecu s -2i oL c.T Cu.��i2i-�,�/o, l,49.5 v i y BREMFURN Furnace Owner's Name: Phone #: Contractor: Phone: License #: 72 3 /S Contact: Phone: Cupertino Business License #: Building Permit Info: BREMRECEPT Bldg ® Elect E7' Plumb El-� Mech Job Description: Seismic Fee Res Residential ® Commercial ❑ BSEISMICOM For Residential Installations: BUILIDNG Attic 0 l" floor ® 2nd floor ❑ Elec Permit Issuance Adhere to min set back requirement ❑ MPERMITFEE or Commercial Installations: MECHANICAL eplacement same weight ❑ Additional weight (structural calcs) ❑ Plumbing Permit Issue Structural Calculations required for new installation ❑ BPERMFEE New installation Planning Approval Required ❑ BUILDING Cost of Project: Type of Construction: yo79. l� Occupancy group: �--3 Strapped On Platform Er Bonded n Sq.Ft. Floor Area: New Location ❑ Replacement PLUMBING L Qty. if Annlirahle. Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 efm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMPI'FEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License I BUILDING