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06090280 CITY OF CUPERTINO _:»�• `" �"'° ""�' '' ♦y ' ///`t��`'` ' - 'BUILDING DIVISION PERMIT C01�ITRACT�OR INFb TA'�I( ,N„ BUILDINGADDRESS: S P GORMAN INC PERMIT NO.06090280 11023 CANYON VISTA DR OWNER'S NAME: PERMIT ISSUE DATE ORUTH PALMER 305 VINEYARD TOWN CENTER. 4304 09/29/2006 NE: SANITARY NO. CONTROL NO. (408) 779-3296 ARCHI'IECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 ;GC LICENSED CONTRACTOR'S DECLARATION Job DDSCrIp000 I don 7000) 0)tof that I Am 14cnacd under provision of chose, 9(commencing with$cellonby of ren met nm fft licamund nexub Profusion of Coda,Andco(commencing +� in full fora moniker. REPLACE FURNACE AND. A/C ?24 N License Chir Lu.g Dau Conlncmr 3 ARCHRECrSDECLARATION l I understand my plans shall he used AS public records C e� Licensed Professional OWNER-BUILDER DECLARATION y 1 beseby affirm that I am exempt from dm Convener,License law for the 0 O fallowing mason.(Sxdon 7031.5.Business and Pnofexsiun Cade:Any city or aunty '.3 715 O$E! which requires,a punct m eAme cm,Blue improve,&..am,or repair any mumure -�S° prior m its ismanecalso requires the,applicant forsuch permitu fiurrigacd Nmment Valuation F O that he is licensed pursuant to the provisions of fun Communes UcesvaLaw(Chapter 9 Sq,Ft. Floor Area 5 (commencing with Semon 7000)M Division 3 of Ne Business and Panfeulnns CAM)Or C Nat he is exempt thurofrom and the but,for de Alleged examp Ion.Any Stai&dun of Section 7031.5 by airy applicant fora permit Subject,the applicant AS a civil penalty of r Occupancy Type nal mart dram five hundred dollars(3500), ❑I,uawterof0upmpeny,wmYemploymwith"guuthebelceampcmdon, will do the work.And dueswnu ,is net rounded oraffered formes(See.7044,Business and Profwian,Cox:The Communes License law dm not apply to an owner of Required Inspections Property who builds m impress thereon,and who does such work hff udf m through his own employes,provided that such improvement,are ret inmMed aroffesed far We.ff. havem,the building or Improvement is sold within ane year of completion,the Owner. builder will have the burden of proving that be did not Solid ar Improve for purpose of aal�). rg 1.as Owner of the Property,am exclusively convening with Balled===m comron de project(Sec.7044.Busiseu and Profession Cods)The Coov&cmrs Li- . tune law don sot apply as an owner a property"a builds or impnves mereon,and, who contests for such projects with A eantranor(s)licensed penchant AS site Contrsm es Licane Law. ❑Ion tender See B&PC lqr this nruan. Owner 1A-G�I 11 DAu 01/2, WORK ISSSCCCOOO111NNNPE--_N-_SATION DECLARATION 1 hereby in.under pesWty of perjury mm of rise(slowing declated.. 1 hem And Will maintains CeNfcem of Carus.,in snbina ce far WmkersCmepen- mton,As prejded for by Section 3700 or de labor Code,for me pularmaoa of de work for which this permit is issued. ❑1 haw:and will maintain Workers Compensation Insurance,As required by Section 3700 of the labra Code.for the performance of the work for which Nin permit is Issued. My Workers Cam pensWon Insurance artier and Policy number am: Carrier. Pettey No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE '(This smlon need not W completed from permit 1,forone hundred dallAn($100) he less.) -- I certify that in the performance of the work for which NIA permit is issued.I Shall not employ any person in any mustered AS at become subject to de Warken'COmpenmtion laW s of Cal NOTICE nt 077CE TOcthe Me R,AftermWngmu Certificate Of LAMM Code uumom become h r et y de Workers Compensation provisions of lcl IaMr Cox,you mus .J O foMwith cemp1Y with nth Provt,ion o Nis permit shall de dmmW mmkcd. z N CONSTRUCTION LENDING AGENCY '[r I hereby affirm that there t,a coutructinn lending agency for the performance of G'> de work for which this Permit Is issued(Sac.3097,Civ.C.) .. W Q Landers Name 4 Landers Addrm U O I certify mat I have mad tis application and sum met the&bow:Information is ' I, carrell.I agree to comply wit all 61,and county aNinanm end sum[awe relating in OU building convection,and hereby authorize mpreenmives or this city to enter upon the W about-memioned propeny for inspection pugtows. (We)agree to save,indemnify and keep harmless me City of Cupertino against nF.t rjj liabilities.judgments,costs and expetmer which may In icy way&ceruc against mid City U Z In consequence Of me grousing of this Permit. ^+ APPLICANT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Da SO EGULATION �I l Ydswt� x�Ta giiA(9 Re-roofs Sig...of Appliant/Convacor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant nom or handle hazardous material u defined by the Cupertino Municipal Code,Chapter 9.12.and the Hcalm and Safety COx,S[I Y. $N25532(x)? /it All roofs shall be inspected prior to any roofing material being installed. ❑Yes .41 Wall the Applicant or future building occupant use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove omit hayaudoets air canwnittanu u defined by the Bay Area Air County Mart&ganem all new materials for inspection. Disvic'? // ❑Yes �YIU I hoc mad the harardsms materials requirements under Chapter 6.95 or the Califor. nia Health k Safety Code.Sechore 25505.25533 and 25534.1 understand that lithe building dem tet chummily haw A unset met itis my responsibility m notify de oacupmt of me mqu' ntswhmhmust uprmrmiumn¢of&Ccmftcabe roc q SignatureofApplicant Date -� g�-t" Gl19� All roof coverings to be Class"B"or better Owner or Authomed gant Dau' Community Development 10300 Torre Avenue ft Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 #UPERTINO Building Department JOB ADDRESS: PERMIT# I i 023 (2AV1 on gis-4u 'Dr I 4V GaPaz d,2-0 OWNER'S NAME: V_Uj4,1 V0,Irr&CPHONE ' qq(, --13?)2- GENERAL GENERAL CONTRACTOR: 3argice NowFAX # I am not using any subcontractors:(_?2h V_u 06_� /Olo 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 Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO am 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35628041 . 00 DATE ISSUED. . . . . . . : 09/29/2006 RECEIPT # . . . . . . . . . : 36264 REFERENCE ID # . . . : 06090280 SITE ADDRESS . . . . . : 11023 CANYON VISTA DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RUTH PALMER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RUTH PALMER CONTRACTOR . . . . . . . : JOSEPH GORMAN LIC # 24918 COMPANY . . . . . . . . . . : J P GORMAN. INC ADDRESS . . . . . . . . . . :. 305 VINEYARD TOWN CENTER, #304 CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (408) 779-3296 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 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 8 , 000 . 00 0 . 80 0 . 00 0 . 80 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 175 . 34 0 . 00 175 . 34 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 175 . 34 477 TOTAL RECEIPT 175 . 34 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -=--_--- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • r CITY OF CUPERTINO Off oaaD FURNACE/AC OFUPERTINO PERMIT APPLICATION FORM APN # Sao -ab--041 Date: 9/29 /0(. Building Address: � I 11 0ap 23 Co,.vt 0�'1 v i-1ba- -DT- Owner Dr Owner' tm vo-\ mer PhI40 qq+-32�% Contractor: PhonLicense#: s6vv :�Ce tow � t-tog) l7°I-329(0 X83019 Contact: Phone: Cupertino Business License#: OU-r%R-r'- Building Permit Info: Bldg ❑ Elect Eg' Plumb ❑--' Mech 1J' Job Description: rc �1ace hea+ n Residential Commercial ❑ For Residential Installations: Attic ❑ I" floor ❑ 2"d floor❑ Adhere to min set back requirement El or Commercial Installations: eplacement same weight ❑ Additional weight (structural Elctural calcs) Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Construction: OccupaW group: `6 '7 1 60 . � KCL- Strapped ED On Platform 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 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm 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