06030083 L
CITY OF CUPERTINO x4.
�M
BUILDING DIVISION PERMIT
OT OU,
BUILDING ADDRESS: PERMIT NO.
MTL CONTROLLED SYSTEMS 06030083
0 @AmCA INO VISTA DR PERMIT ISSUE DATE
ONE: SANITARY N LNO.
ARCHITECTIENGiNEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
i0 LICENSED CONTRACTOR'S DECLARATION Job Description
Ipp 1 hereby affirm Nn I em licensed under provisions of Chapter 9(commencing P
jW with Section 7")ofDivislan 3 of Ne Business end Profusinennss CRAM,md my license is
G in full force and effe._Zo Lk.Y r ��
1 LkenseClm INSTALL 2 48000 BTU OUTDOOR A/C CONDENSORS
Dam 't g1( Contractor
i ARCHITECT'S DECLARATIO i
a 1 undermarm my plans shall be used a public records
au
it; Licensed Professional
rI OWNER-BUILDER DECLARATION
i 2 I W mhy eBirm that I am exempt from the Conlnmors License Law for the
l o following mason.(Sudan 7031.5,Business and Profession Code:Any city at county
which requires a Permit to construct,alto,improve.demolish,or repair any structure
prior era its issuance.alga notdreathe applicant forsuch permiuo rile a signed guememUUU
ra that he is licensed pursuant at the provisions of the ConlmmeraLcen.Law(Chapter 9 Sq. Ft. Floor Area �/ 1
a (commencing with Sudan 7000)of Division 3 of the Business and Prolamines Ceoe)or
. that he 4 exempt therefrom and the basis for the alleged exemption.Any violation of
Sidon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of TsT ,,,,,{,�r. O O QC P T1 pe
am not mthan five hundred doled(5500} i '�•g' `7
❑I,.owner Of the Property,or my employee with wages As Inch sole enmpermmdon,
will do the work,and lhesacmm is not Intended OR offered for M.(Sec.7044,Budaas Required Inspections
and Profesdons Cade:The Contraurs License Law doe not oer apply Re an wnof 9 P
property who builds or improves thereon,and who dou such work himself or through his
own employ.&,provided that such Improvements art not intended croEered fatale.IL
however,the building or improvement is old while one year of completion,Ne owner.
builder will have the burden of proving dot rte did no Wild or Improve for purpose Of
am.).
❑I,as Owner Of the property am exclusively contracting with licenced cemaatem to
marginal the pmjm(See.70th.Bmimss and Profession Code:)The Conmma'a Li-
cense taw dao not apply in An weer of property who Wilds or Improve Vernon,and
who contracts for such pmjems with a eon racter(U licensed pursuant m time Convactoh
License taw.
❑Iemexemptunder Sec .B@PCfafthlsmason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arc of the following occlusions:
hive and will maintain a CW Bate of Cc nxent to self-insure for WorkeM1Compen-
m,u provided for by Sudan 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compe em on Insummtce,a required by Section
3700 of the Labor Code,for f performance of the work for which this permit is issued.
My WarkerLiSompu9sation Insurance carrier and Policy number are:
CaMcr. Policy No.:
CERTIF CATE OF E)(EMP ION FROM WORKERS
COMPENSATION INSURANCE
flhtasectimneed not be completed If the permit is fmone hundred dollms($100)
or lea.)
I unify Net in am parfnfmanee of the work for which on,Permit is laud,i Nell not
employ anymmon in any manner su As to become subj.t to Ne Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
home gahj.t m ac Worker's Compcnsatian provisions of the labor Code,you mum
O forthwith comply with such provlslnns m this permit shall be deemed revoked.
rCONSTRUCTION LENDING AGENCY
> hereby affirm that Nem in amostmctinn lending agency for the pefforman.or
.. the work for which ON permit is issued(See.3097.Cib,C.)
0 Landers Name
z Lenders Addrm
Q 1 cenify that 1 hove mad this application and sen that the above information is
FcormcL 1 Ime to comply with all city and county ordinance and sun laws mlating to
U building construction,and hereby suaorim Representatives of this city to enter upon the
W above-mentioned property fa insinuation purposes.
CL (We)agree to new,indemnify and keep harmless the City of Cupertino against
v) liabilities.judgments.costs and exegeses which may in any way acme against aid City
Z in consequence of the granting of this Permit. (^
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
SOURCE REGULA ONS.
zin Ds. Re-roofs
Signature of AppliunUDa or
Ham US MATERIALS DISCLOSURE Type of Roof
WIIINeapplicfuture
-
building mupantstore or handle hamJous mawrial
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Came.s.tian 25532(a)7 t
❑vas � All roofs shall be inspected prior to any roofing material being installed.
GfNa
Will the applicant or future Wilding Occupant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
hevmdnus air conuminan a defired by Ne Bay Arta Air Quality Muugemcm all new materials for inspection.
it'?
❑Yes Nu
I he.read the harem ergs materials requirements under Chapter 6.95 of Oe Caliper.
-is Health Be Safety Code,S.mns 25305,25533 and 25534.1 understand that if the Wilding
docs not cumnaly have a MORAL that it is my responsibility m notify the Occupant of the
requirements which mum be mel prior In lssumem of a Ccrdfcam of Occupaw Signature of Applicant Date
3 pq1 O All roof coverings to be Class °B°or better
Owner or authori
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34214085.00
DATE ISSUED. . . . . . . : 03/16/2006
RECEIPT #. . . . . . . . . : 33592
REFERENCE ID # . . . : 06030083
SITE ADDRESS . . . . . : 10161 CAMINO VISTA DR
SUBDIVISION . . . . . . . -
CITY . . . . . . . . . . . . . : CUPERTINO '
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MUSSON ARTHUR A AND MARY B
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2607
RECEIVED FROM . . . . : MTL CONTROLLED SYSTE
CONTRACTOR . . . . . . . : MIKE LEITCHMAN LIC # 27467
COMPANY . . . . . . . . . . : MTL CONTROLLED SYSTEMS
ADDRESS . . . . . . . . . . : 2283 MORA DR.
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040
TELEPHONE . . . . . . . . : (650)964-8353
0EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
______ _____________ __________ __________ __________ __________ __________
BREMAIRHAN NO.UNITS 2.00 20.52 0.00 20.52 0.00
BENERGY PERMIT FEE 1.00 34 .86 0.00 34 .86 0.00
BSEISMICRE VALUATION 4, 000.00 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 170.99 0.00 170.99 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ --___-____________
CHECK 170.99 2076
TOTAL RECEIPT 170.99
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
50.5 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
1 z� Cupertino CA 95014
Telepbone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: L ( �^ PERMIT # D(p oom
za V �(i✓1't ih d V I.P�G LI
OWNER'S AME: I PHONE #
GENERAL CONTRACTOR: T Con I P S AX # .SD -9
I am not using any subcontractors: �77
ature D to
Please check applicable subcontractors and co Tete the following information:
60 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
er/Contractor Signature bate
CITY OF CUPERTINO
' FURNACE/AC
�UPEkTINO PERMIT APPLICATION FORM 0b0. W'65
APN # 3La -)4-065 Date: 3//(-
Building
/6Building Address: 10 l G ( 31fv\
Owner's Name: / , Phone#:
` Ian 08 -
Contractor: Phone: License#:
A, -rot C- Zv 8(, 18-7
Contact: I Phone: Cupertino Business License#:
dA-, k or, ka/h SaM Z ` q(g7
Building Permit Info:
Bldg ❑ Elect 1311- Plumb C`1' Mech
Job Description: 1 p
Tn 2 - yg o ov 7"v O J' Door CojcjscrS
Residential Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2nd floor❑
Adhere to min set back re uirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Proje t: Type of�struction: Occupancy group:
OOG k e b�-7 (L-'3
Strapped 11 On Platform LJ Bonded ❑ Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
2 BREMAIRHAN ✓ A/C Units <= 10, 000 cfin MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE 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 BUILDING