06010129CITY OF CUPERTINO�.;
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INIrURMATION.�
BUILDING DIVISION PERMIT
➢ C�NTRCOR
BUILDING ADDRESS:
A PERFECT CLIMATE
PERMIT NO.06010129
10421 CASTINE AV
OWNER'S NAME:
PERMIT ISSUE DATE
COOLEY GERALD M AND LEANNE
K T10570 S DEANZA BLVD
01/24/2006
NE:
SANITARY NO, CONTROL NO.
(408) 861-9545
ARCHITEC tENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nat I am licensed under provisions of Chapter (Commencing
with Section 7000).f Division 3 of Ne Business And fhofrssians Coke. And my Ikensat b
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in fulls force cC�
REPLACE FURNACE
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License s Lk. R
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ARCHITECT'S DELLA ATION
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I understand my plans 8n811 be used Y pYbIIC records
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Licensed Professional
OWNER -BUILDER DECLARATION
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1 bo.byaRrre that I am exempt from to Canuacloes License Law for IM
following mason. (Salon 7031.5. Business and pro(e,cnns Code: Any city or county
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which requires a permit m enm rmL alter. Improw, demolish. or repair any structure
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prior N its issuance. Alan requires dm applicant for such permit to file a signed summenl
tatMI.licensedpersonalMNcprovisionsortheConuuloesLiansalaw(Chapler9
Sq. Ft. Floor Area
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(commencing wit Section 7000) of Division 3atlneBusiness and Professice,Code) or
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That he Is exempt teref ant and the bub for the alleged exemption. Any violW on of
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Occupancy Type
Section 7031.5 by any applicant for a Permit subjects Ne applicant in a civil penalty of
not mora than Eva hundred dollars (SSW).
❑ I.uowncroflhepmpeny,umyemployce,wltwgesuteirmlecompenulion,
Required Inspections
will do the work and Neswcwm bnm Intended oroRerad for We(Sec. 70".11mitrcu
and Professors Cc&: The Committees LIanY Law doe, not apply b an owner of
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property who bui lda or improwa deemon, and who docs such work himsel f or through his
ave employees, provided that each improvements are not irandtd oroRencd for sale. If,
however due building or improvement Is sold within oro year of Completion, At owner.
builder will have to burden of proving Nat he did not build At Improve (a purpW of
sale.).
❑ 1, a Owner of to Property. am exclusively Contracting with licensed eanlnemn to
Conslmct the projeu (Sec. 7014, Business and Professions CW.:) Th. Canlramen't U.
came Law data not apply An an owner of property who builds or improves Nelson, and
who contracts for such pmjecm wit A eontrawKa) licensed pursuant in W Contractors
License Law.
❑ l am exempt under See. , B At P C for this moan
Owner Date-
ataWORKERS
WORKERSCOMPENSATION DECLARATION
1 hereby grim under penslty of perjury one of the following decdantiou:
1 new and will maintain a Cmfifiwte of Consent be self -insure for WOrkeraCompen-
samn, As provided for by Salon 37W of to labor Cade, for that performer. or the
.,it for which this Permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, As required by Section
PW of the Labor Code. for to performance of Lie work far which this permit b issued.
My Worker'4yCcontansulan Insurance caries and Policy number art:
Carlo: 'I i'A Polity No{TTY �O
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CE�RfIFICATE OF EXEMPnON MOM WORKERS'
COMPENSATION INSURANCE
(This section need mal bo Completed If Ne permit Is foram hundred dollars (SIM)
or hu.)
1 certify that in the PCrfnrmaACC of the work for which Nis Permit is issued. I mW not
employ any parent in my manner an As in bcCome subjal or lea Workers Compensation
Laws of California. DOW
Applicant
NOTICE TO APPLICANT: If, After making ria Ccnificale of Exemption, you should
become subject to to worker's Compensation provisions of to Labor Code, you must
Oforthwith
Comply with such provisions or this Permit hul he dammed revoked
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CONSTRUCTION LENDING AGENCY
I hereby affirm that ten It. mammalian lending agurT for to pe fimounceof
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to work far which tis permit Is brood (Sac. 3097. Civ, C.)
Lenders Name
-
Landers Address
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1 certify that I haw rtAd this applicedan end sate Nn to above let .aim I,
Fcorre
I. I agree w comply with all city and county ordinances and state law relating to
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building convection, and hereby authorize representatives of Nis city to enter upon the
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above-mentioned property for Inspection purposes.
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(We) agree to save, indemnify and keep harmless to City or Cupertino against
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liabilities, judgments, cuss and expenses which may in any wry accrue against said City
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in consequence of to greening of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued by: Date ("" ✓ _ d—
G CATION/!L
Re -roofs ^
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HAZARDOUS MATERIALS DISCLOSURE Dad
Type of Roof
Will to applicant or ruwre building occupant store w handle huallou material
defined by the Cupertino Municipal Code. Chapter 9.17. and the Health and Safely
do. Section 25532(a)?
❑Yes u
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future building occupant use equipment or devices which
h haaardue, air cu earmata u defined by to Be, Area Air Quadimy Management
all new materials for inspection.
IDI.uict?
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haw mal Ne huamou materials requimmenls under Chapter i95 of Uta Cadifor.
Hcalt&saruycode.Sam.25585, 255»aw 25534. lmmaeeatamd to a to wilding
s not canonry have A umanL tat It b my responsibility u Autry Ne a.upa, of dmlsei@menta
nk uuwmet rwiunaneaneenifie,moraaapanry.
Signature of Applicant Date
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All roof coverings to be Class "B" or better
Ownerorauhoriacdagcnl One
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
1vqa1 �{� A�.�
PERMIT #
66°16 2
OWNER'S NAME:_
r
PHONE # 0?- 335-63S'7
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followine information:.
Owner/ Contractor Signature
Date
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
i , 0.,
UPEI,TINO
CITY OF CUPERTINO OU0�
FURNACE/AC
PERMIT APPLICATION FORM
APN# 3a(v- 4)-03'?'
Date:
I ob
Building Address: O l Ns t v 'e J
BREMFURN
Owner's Name:
Phone
BREMACOVER
A/C Unit> 10,000 cfm
Contractor �� n�C M 0A eI Phone: �f195
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License #:,
Contact: Phone:
Cupertino Business License #:
a 1 k
uj-k
Rec tl, Switch & Outlets
Building Permit Info:
BSEISMICRE
Bldg ❑ Elect 12 -1' Plumb
Mech
BSEISMICOM
Seismic Commercial
Job Description: 11
EPERMITFEE
Residential Commercial ❑
ELECTRICAL
For Residential Inst;dations:
Mech Permit Issuance
Attic ❑ 1" floor M 2nd floor ❑
PPERMITFEE
dhere to min set back requirement ❑
PLUMBING
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Bldg Permit Fees
Structural Calculations required for new installation ❑
BPLANCHK
New installation Plannin Approval Required ❑
BUILDING
Cost of Project: s T e of Construction:
41.
Occupancy group:
0 t; 0.G tA>Cv�0.0
Strapped On Platform LJ bnded LJ
Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
AnnI;Onhln
FP.P M
Fee Descrintion
Fee Group
/ BENERGY
Energy
BUILDING
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
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
BUSLIC
Business License
BUILDING
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