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06040109 CITY OF CUPERTINO BUILDING II)VISION PERMIT ``^ C01�iTRA.CTOR'�INFOI.tMA'xl,t,N ' BUILDING ADDRESS: A PERFECT CLIMATE PEf1A1RN0' 06040109 10714 CARVER DR OWNER'S NAME: PERMTIMUEDATE SUSAN GAUTHIER 10570 S DEANZA BLVD 04/20/2006 ONE: SANITARY NO. CONTROL NO. (408) , 861-9545 ARCHITECTIENGINEER: 9UrLDINO PERMITINFO BLDG EO PLO NEOCH 30p LICENSED CONTRACTOR'S DECLARATION Job Description i 1 hereby&Mm that 1 Am Ikensed under provision of Chapter 9(commencing T= with Section 10110)of Division 3 of the Sudnea And Professww Coda,and my flees is n full raw e sed Affect. INSTALL AIR CONDITIONING UNIALED id Lkenw ILIA CT S g Dam Cone t$ ARCHRDECLARATION I p(O I understand!my plans a1Wbeuse l be used As puh11<records '83 Licensed Profcasional g�� 0(tofi OWNER-BUILDER DECLARATION yf o Lu <E I hereby ainm that 1 am escmpt from de Contractors License Law for she OO following mason.(Snown 7031.5.Bulinus and Professions Code:Any city or county O 2 110! which mquim a permit in construct.alcor,improv,demolish,or mpoir my structure fir^ prior An iss lssuaneu.atm requiv lMapplicwt far such permit on 0k aligned sucheMm �< that he is licensed pursuant to dm provisions ofde Contractor's Lkmsw lAw(Chapter 9 Sq.Ft. Floor Area B (commenclog with Secdon 7000)of Division 3 ofdw Busineawd Professions Code)w WILUNIqwy CUA he h Asewp,Nemtwm and the huh for the alkged exemption.Any violation of Section 7031.5 by any applicant for a permit wbjecu she applkwt m a civil penally of rU U Occupancy Type Me mart than fin hundred dollar(S5)07 ❑1,u awnu of the pmpm y.m my amployw withmgex u Meir role compemdon, will do the mark and de structure Is notimended"offered farsalo(Sec.7044,Business Required Inspections And Prorecdonsav Ce The Canuaers Lice=Law dao,not apply m w owner of 9 P properly who builds orimprovs dmreog and who does sa h work himvd f or through his Cwnempioyeex,provided that such Improvements Are notimmmded moneyed for We.a. - however.thebuildingorbepho i is aald within ons year ofcompletion.theawm- builder will haw di burden of proving that M did net build or improve for pupate of sale). ❑1,as owner of the property.Am exclusively contracting with ficensed romtractua in construct the pmjca(Sec.7014.Business and Professions Code)The Contrwmr's Li- cense Law dors not apply mp owner of property who bulbs or lmpmwa demon.And, who conuacu for such pmjcOm with a eondcmr(s)licensed pursuant m the Conuamo fA Lee w. 1 IF, .B&PC for Nis reawn ❑ v Dme,ll WORKER'S COMPENSATION DECLARATION 1 hereby Arm under penally of perjury,aro of me following deelaratmns: ❑IhaK and wBl matnainaCWRow afCansentm alf-IuurtfarworkersCmnpen- ation,As provided for by Section 3700 of dw Labor Code.for the performance of dm Work for which this permit is issued. ❑1 haw aed will maintain Workers Compensation InRuwee,As required by Sutton 3700 of the Labor Code,for the performance often work for which mil permit is issued. My Workers Compensation buurance caner and Policy number sm: Conk,. Polley No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tills seedem need trot be complao U the permit Is for one hundred dollan(S 100) v or less) I urtih, a' 0e Pcrfmmanec of the rte w which%h permit ta iuved.I shall not employs yp donp in wy melwc _ o ma wbJenmme Wgrten Col IAmof C,pmlld\nI yr a IL,1 1 Appli NOTICE TO APPLICANT:If,after making this Certificate of Esemption.you should become subject m she Workers Compensation provisions of the Labor Code,you mus, .JO foMwith comply with such provisions m oris Permit shAll W doomed revoked. zCONSTRUCTION LENDING AGENCY _ [-r 1 hereby.M.that there h a conswNan lending Raney for the performance of lYi > the wart for which Una pewit Is owed(Sec.3097.Civ.C.) W G Lcndae:Name z Lenders Address U O 1 certify mal 1 Mw read this Application and slow than the NICK information Is W F cormtt 1 agree in comply wish all city and county oNlnancesand sok bre rtlong m OU building construction,and hereby aumarix rtpresenlosiws ofthis city to enter upon me W above-memi,med proecny for inspection purposes (We)agree to UK,indemnify and keep harmless the City of Cupertino against v., y Ilabllitiex,Judgmonta.cosu d expenses which may In my my acme gdnstaatd City U z in consequence of me{ruti of nth Pon ((�� CANT UNDERSTAN NO WILL COMPLY WITH ALL NON.POIM Issued by:S � Dale ,.. 310 EREGUI.A NS. ( OURe-roofs Sigassurb d App'ewVContiexem Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or room building accuPut stem W handle haysrdW1 mawrid As defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety Cade.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Oyes ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hvsmu nair comaminwu u defined by tiro Bay Arca Air Quality Management all new materials for inspection. / Diaoim7 ❑Yo d\ (_ J I low read the hutNom dalliquimmcnuunder Chwmr6.95o(the Califon niallual&Sa1cIYCode Sccdoro .25533And25531.Iandmnwld LrWkii.9 dais Illfff,c Y bK A .Wt my respoulMlity p f occ t of ma mqul crus ich coup. r hwmce of a Ccrgl>ha Le Date L. 1 Signature of Applicant Owncrur w hariacd agent DnmAll roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 SUPERTINO Building De artment JOB ADDRESS: �U� I t arUe r pr PERMrr# 66yo"oma OWNER'S NAME: UL S a n C5EUlFk La-;;: PHONE # Z5 3 - GENERAL CONTRACTOR: tr C. r�,.l 4 FAX # - 5 U I am not using any subcontractors: — -- (-111910(9 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 er/Contracto`r Signature Date CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37532011 . 00 DATE ISSUED. . . . . . . : 04/20/2006 RECEIPT # . . . . . . . . . : 34060 REFERENCE ID # . . . : 06040109 SITE ADDRESS . . . . . : 10714 CARVER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUSAN GAUTHIER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SUSAN GAUTHIER CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408)' 861-9545 •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 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 4, 802 . 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 161 . 93 0 . 00 161 . 93 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 161 . 93 12016 TOTAL RECEIPT 161 . 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO O (.OD 40 FURNACE/AC SCUPERTINO PERMIT APPLICATION FORM APN# n^ rf,/L Date: 19 I o cp Building Address: I0`11L► (-a(UP-r -Lr . U-4-p- CA l Owner's Name: Q U5 ar) Phone #: -zS 3 ^ 'I-�z 7Z Contractor: P� rhe G} C 1Chone: iR ^ q S- License#: 'In1s;1 Contact: pry-+ Phone: (-2Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ©� Plumb L9' Mech Job Description: lr—st-odl a-c,- C ty--,d t�uy, t'� + ResidentiaPEk Commercial ❑ For Residential Installations: Attic ❑ Is` floor ❑ 2nd floor❑ Adhere to min set back r uirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs)❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: HOZ Type of Construction: Occupy, roup: Strapped El On Platform 4E9 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 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 MPERMTTFEE 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