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06120032CITY OF CUPERTINO - CONTRA CTOR�INFORMATION ?; - BUILDING DIVISION PERMIT BUILDING ADDRESS. DAY & NIGHT HEATING & COO ir1"TNO'06120032 10146 CARMEN RD OWNER'S NAME: PERMTTISSUEDATE Sk SHIRLEY MARSEILLES 368 KEYES ST NE: - SANITARY NO. CONTROL N0. (408)268-0561 ARCHI'rECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMD MECH 0 LICENSED CONTRACTOR'S DECLARATION Job Description o 1 thereby affirm Net 1 am licensed under provisions of Chapter 9 (commencing P with Section 70(10) of Division Sof the Business and landeuiors, Cade. and my license u inrnnfamsa REPLACING THE FURNACE License,wf$�, ^II_U�tmg DdIC Tit,-- Garanew' ARCHITECTSDECLA ATIOI , 1 understand my plans dull he used as public records Liccoed Professional OWNER -BUILDER DECLARATION I hereby alum that I am exempt from the Contractor's License Law for the following mason. (Section 7131.5, Business and Prefecture Code: Any city or county which oqut. a Permit to construct. alley. improve, demolish. nr repair any structure - $4000 ! to ms Neapplie o far such pentita0leasigaacdsuacm)ne islicenseds�J to the Conuanessan Sq. F[. Floor Area Valuation thiormiuiensed PursuantPrwlaw(Cbpur9 (cone Auction of Division 3 otheft ando.An vi Code) or (commencing nr beed,on3 Be,CBueinev thomion7N10) of ! Na(k u exempt thucrsom and Be baso for talleged eaempuom Any violation of don he its r U U Occupancy Type Section 7031.5 by any applicant for a permit subjem the applicant to a civil penalty of not mom Nan five handled dollars ❑ L az owner of the property. or my amployeea with wages As Jack role compensation, Required Inspections will do the work, end the structure isnot intended or offered for sale (Sec. 7044, Business and prerfeaions Codm The conuacmrs L ecr¢e Law docs aor apply in an owner or property who builds or imperatives thmmn, and whodrcasuchwarkbimulfor though has own cmploy¢s, provided thus such improvements Me tat intended craRertd for ale If, however. Ne building or improvement is mid within one year of completion, the moral. builder will have du Mnde t of proving that he did not build or improve for purpose of . ale.). ❑ 1, as owner of du property, am exclusively contracting with licensed common an ,NumuCr the, project (Sec. 7044. Sued. and Profusions Code:) M Commcar's Li- ' cense law arca not apply to an owner of property who, builds or impowu dacmon, old. who cOnVdrla far Such projects with a corm aear(s) licensed pursuant in the L'onVacrar's - License law. ❑ I am exempt under Sec . B & P C fur Nis mason Owner Data WORKER'S COMPENSATION DECLARATION 10 1 humbly alrum under penalty of perjury one of the following declarations: ❑ T haw: and will maintain aCerdfeate of Consent to self -insure for Worlds Compere anon, az provided far by Section 3700 of the takf Code. far the performance of IN wok for which Ws permit is issued ❑ I haw and will maintain Worker's Campers ation Insurance, az restudied by Section 37W of NC labor Code, far AM peRarmance of the work for which dou permit is issued. My Wofker s Compensation Imuran carrier and Policy numy)YvFi Lam, / O Carrier.P_�,^_tL /' Policy Na I(f V'%�_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE OTusecrim,recdnotkcompkledKIM permit is fmrone hundred dollars (SIO ) m IessJ 1 cuufv that in the performance of do work for which Nis peemil is issued, I Mail at employ any Noon in any mortar so az to become subjecuo the Workers Compensation Lam of California Data Applicant NOTICE TO APPLICANT: If, akf making this Certificate of Exemption, you should become subject to to Worker's Compensation provisions of Ne Labor Code, you must - forthwith comply with such provisions or Nu permit shall he deemed eevakd. j CONSTRUCTION LENDINGAGENCY 1 kr wy aRndi Ne them is Agency Inc Nc performance of s ed(Sec.30 7, Civ. ler whim Ulu perms u issued (Sec. 309'/, Ger. C.) - La lark Lendeh Name ' Lender's Address 1 1 certify Nat 1 have read Nis application Mulatto, Nu Ne above info m ilom u correct- T agree to comply with all city and county ordinances and suer laws relating to buildings rStrooOn, and hereby authorim represcrianvcs of this city to cater upon the abow mentioned property for iopecGor purposes. (We) agree to ave, indemnify and kap harmless the City of Caper inns against expenses which may in anyway accmc against mid City j incoiueepjnctofthe runca ning in consequence of the granting a(Nis permit. APPLICANT UNDER DS D WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUPEG T O L Z--/ / 01. Re -roofs SignatureafApplra�i,UConuactor pate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building apt store or lundk ha]afdaamaterial As defined by the Cupertino Municipal Cade,e, Chapter 9.13. and the HCi1N and Safety code, Secrlar z5532(a)T ❑Yes ,'-8 No All roofs shall be inspected prior to any roofing material being installed. w11 Ne a Brant arratam baildin atter devices which pP g wan tau If a roof is installed without first obtainingan inspection, I agree to remove P g emit us air canumiruns, a defined by Nt Bay qma Air Quality Management . Ail Qu it all new materials for inspection. District' Disulct7 \ C3 Y. [jTga I have mail Ne harardous materials oquilemenu under GTapters95 Of thu Califon. nia Hcahh&Safety Cadc, Stearns, 35505,8533 and25534. 1 undcrsund Nuifthc building ' doe currently nave t. I it u my respomibility a notify Jac occupant of do lenm me cera mn«nraC III w0foae_ Z �d� Signature of Applicant Date r, �� All roof coverings to be Class "B" or better g Do., W mNonsa agar Dare � �f CITYOF �UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: IL L�� PERMIT # 0(v1 aa03 aU OWNERS NAME: S i p e a PHONE # 4 GENERAL CONTRACTOR by FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following informatinn 61 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 Ilya, /`�J� Owner/ContractorNy 012RM 1AFMEN 01 Date om 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35709061.00 DATE ISSUED.......: 12/11/2006 RECEIPT #.........: 36996 REFERENCE ID # ...: 06120032 SITE ADDRESS .....: 10146 CARMEN RD SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... SHIRLEY MARSEILLES OPERATOR: kiersaw COPY # : 2 RECEIVED FROM ....: DAY & NIGHT HEATING CONTRACTOR .......: LEONARD RHODES JR LIC # 21900 COMPANY ..........: DAY & NIGHT HEATING & COOLING ADDRESS ..........: 368 KEYES ST • CITY/STATE/ZIP : SAN JOSE, CA 95112 TELEPHONE ........: (408)268-0561 FEE 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 4,000.00 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 ---------- ---------- 164.78 0.00 ---------- ---------- 164.78 0.00 METHOD OF PAYMENT AMOUNT ----------------- NUMBER ------------ CHECK 164.78 ------------------ 10606 TOTAL RECEIPT 164.78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 07 FINAL PLUMBING 0 505 508 FINAL ELECTRICAL FINAL MECHANICAL *CUPERTINO 1l CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM OLP Ia()a3R--� APN # Energy Date: Building Address: v Furnace Owner's Name: SW /V- ti(A 2 SEl L Lam$ IBREMACOVER Phone #: yog- . -/- ffSZ?;� Contractor: hone: BREMAIRHAN License #: MECHANICAL BREMRECEPT Rec tl, Switch & Outlets Conlact: Phone: Zc/< -�, `-/dye iit/-G7oo BSEISMICRE Cupertino Business License #: Building Permit Info: BSEISMICOM Bldg ❑ Elect ❑ Plumb D-' Mech Job Description: Elec Permit Issuance EEL lam- C /,0-/6- MPERMITFEE Residentia Commercial ❑ MECHANICAL For Res' ential Installations: Plumbing Permit Issue Attic LfJ 15t floor ❑ 2"d floor ❑ BPERMFEE Adhere to min set back requirement E] BUILDING For Commercial Installations: Plan Check Fee Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ Gas Piping System Fee New installation Planning Approval Required ❑ BUSLIC Cost of Project: Type of Construction: 00 — `� Occupancy group: - Z-- Strapped❑ On Platform ❑ Bonded El Sq.Ft. Floor Area: ❑ 8--� New Location Replacement Qty. if Applicable Fee ID Fee Descrintinn FPP �11111T Energy BUILDING PEq§ENERGY BREMFURN Furnace MECHANICAL IBREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfrn 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