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08020103 CITY OF CUPERTINO B�3Loegc DAvlslon PERMIT 'ytCO1�IT=RACTO INFORMATItN _ �=s. PERMIT NO. a« ""TD ra,Apq"16-RICKET HILL RD A PERFECT CLIMATE 08020103 NER'S NNA4Ml1E: U PERMIT ISSUE DATE TAKAHASHI 8375 BRENTWOOD BLVD STE B 02/.15/2008 PHONE SANITARY NO, CONTROL NO. (408) 861 9545 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 30 ; LICENSED CONTRACTORS DECLARATION Ib Description 1 hereby urban that 1 are licensed under pmvaru idof Chapter 9(commnmOesCrlp ing with Section'/Ofn)af Division 3 ofum Brmams and Professions Code,angry license is R&R FURNACE ONLY 80K BTU ^� in fuli rare and cff _ license a Lle.g _ S F Date Contrator ARCHTIECTS DECLARATION I understand my piece Nall he used as public mcoadt Ddu k S� Licensed Pmresuocal' 3 OWNER-BUILDER DECLARATION S I hemby aRirm on 11. aempt Gum the Cnsimrs as License taw for the p O which moon. emtion 7031.6, t,aims antl on.de ons Cala:Any city or county $� which mqulr•permit m cnnwueL alter.ImPmw,demolish,or repair any swdure -Zi prior units issuance.also requir themmieant!.,such permitm Sleasigmd smerem FF < Sq.Ft. Floor Area Valuation dot he h licensed purauant to the provisions of Ne Contractor's liana Law Y� (commcnringwi Secdon700B)of Diwhim3ofum Busin wd Pmf=iom Cale)or 3300 t R 9 l ata be s acrept th efrom and the bash for the alleged exemption.Any Antedate of Seaton 7031.5 by any applicant far a permit subjccs,Ne applicant to scoot penalty ofNumber Occupancy Type notmartthmnwhundred dollars(ssm 34235006 ❑La owner clans property,army complaints with wages as their win compensation. will do thworkmd the suactum Is not ImandedoraBered for sale(Sm.7044,Business Required Inspections and Professions,Cade:The Commutes L.kmmn e Law donot apply to an owner of q p pmpeny wboW ilW ceirepe.atmcon,mE wMdom uch wo kAimwlfor through hes mart employees,prided dot seen impro emmu art not intended oroRerM forsela IL hmmw,the Wilding or improvrmwt Issold within ane yea of completion.the counter. builder will bow um WWen of proving that he did set build or impr me for purpose or ale.), ❑1,as owner of Ne property,am acluaiwly connecting with licensed contnnon to constnsct the project(Sec.704x,Business and Professions Code)The Contravenes Li- cense law does not apply to an owner of pmpmy who Wilds or impmvns Neuron,and, what contracts,far such projects what•cmmel t.)licensed pennsnt at um Cnnmwme, License taw. ❑lamaemptunder See .BlPCrarthfsreawn ner Dam WORKER'S COMPENSATION DECLARATION I hemby sfMo under porosity of pedury am of the following anclanuons: ❑IhavemdwillmainWna Ce mmol Cansenttoself-Imumfw Work sCampen. scion,as pmvidod far by Section 37W of the labor Code,far W performance of the work for which this permit is issued. - 1 ban end will maintain Worker's Compensation Insurance,as required by Section .. 3 of the Labor Code,for dm Performance of the work for which Nes permithlased. ' My Wa Ek ftlC "enation Wemnm camfSmad Policy number am: C. a �Ci9g c r'<eWkc 'reyNa:�)eA r)c>26s0 n( CERTIFICATE OF EXEMPITON FROM WORKERS' COMPENSATION INSURANCE (Thhsecuan may wtbecomple ed from permit Is fceauhmdrtsdonan($100) lir less.) 1 artily that in the performance of Ne work for which this permit Is indeed,I shall not employ any person in my manorw as to become subject to Ne Workers'Compensation Lem of California.Dam Applicant NOTICE TO APPLICANT.IL afar making NW Certifiato of Exemption,you should become subject to Ne Wartefs Compensation pmvhloes of mac labor Code.you most .J O forthwith comply with such MVWOM or this Permit shall be deemed revoked. T:IZI CONSTRUCTION LENDING AGENCY [-v I hereby affirm that Nem is a commowdon lending agency for the Performance of Ci ate work for which this permit is issued(Sea.3097.Civ.C.) ' WQ tandors Name M.z Landers Address U Q 1 certify that I haw mad ods application ars ram ata the abow information is . CL^ cartcvL I agree m comply wits all city and county ordinances and sum lam Rlaung to building comWNon,and hereby mhadm reprnsomati s of this city to enter upon Na W ahove-mentioned property for inspection purposes gy (We)agree to stow,indemnify and keep hsrn less the City of Cupertino against yr fA liabilities,Judgments,casts and expenses which may in my way acerae against said City U Z in comegmnce of the granting of this permis APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date sou EGULATIO S. - �— �S' 08 Re-roofs J Sigmture ar Applicam✓Connmmr Data HAZARDOUS MATERIALS ISCLOSURE Type of Roof Will the applicant or future Wilding occupantstom or handle Wounduns material ' dented by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety .Semonzsslz(.)? ❑Yu All roofs shall be inspected prior to any roofing material being installed. Will the applicant or(utore Wilding occupant tic equipment ar dcvim which If a roof is installed without first obtaining an inspection,I agree to remove emit hairdos air conuminants m dcfined by the Bay Ama Air Quality Management all new materials for inspection. District? ❑Ya Rho ' 1 haw read the haardoamateriats requirements um1c,Ch pter6.95 ofum Califor- hHeslNkSafayCade,S .6 505,25533and25534.IunWrnandumifuc building does rrtn0 haw a mount that it h my responsibility,to ramify ate acupanr of the l mqu n Wehmm metpri ,mmeofaccn wteaforenpmmy. Signature of Applicant Date Own,armauatorifedge 'T m All roof coverings to be Class"Bo or better • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34235006.00 DATE ISSUED. . . . . . . : 02/15/2008 RECEIPT #. . . . . . . . . : BS000003960 REFERENCE ID # . . . : 08020103 SITE ADDRESS . . . . . : 22940 CRICKET- HILL RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TAKAHASHI ADDRESS . . . . . . . . . . : 22940 CRICKET HILL RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM EDWARD A�•GREGORY CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS . . . . . . . . . . : 8375 BRENTWOOD BLVD STE B CITY/STATE/ZIP . : BRENTWOOD, CA 94513 • TELEPHONE . . . . . . . . : (408) 861 9545 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 3, 300. 00 0.50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40.79 0 . 00 1MPERMITFE FLAT RATE 1. 00 40.79 0 . 00 40.79 0. 00 1MRRAA UNITS 1. 00 61. 19 0. 00 61. 19 0 . 00 1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 224 . 85 0. 00 224 .85 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 224 . 85 MC --------------- TOTAL RECEIPT 224 . 85 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- . .. ------ --------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO /03 FURNACE/AC cUPE �TiNO PERMIT APPLICATION FORM APN# 2 L1�q 2 N / / O 0 Date: Building Address: �> Z 9 YO Owner's Name: Lei Phone #: Mgrc / c? 11r9 40S61,/ 6L- FjYs3 Contractor: Phone #: /J/O� d96/— psYJ�' /--1 ���GC� l/L/ R / _ Fax #: X108 ?6/—.9,r 416 Contractor License#: Cupertino Business License #: 7 Z 3 1,5-- Contact: sContact: Phone#:,SlO— Yf//r— 6 2/ Edward Gre ory North Ba Pe! Fax #: Building Permit Info: Elect ❑ Plumb ❑ Mech 1W Residential Commercial Job Description: 0 k aTC/'R �✓✓' ri 8 19�2/y/ For Residential Installations: / Attic ❑ I"floor g 2"d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: 3 U-0 . Type of Construction (Usage Class): Strapped ❑ On Platform ❑ Bonded New Location Replacement Valuation: 3 300 Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FURNACE/AC •CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. IMCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. IBSEISMICO Commercial Seismic B IMRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, / cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. CITY OF CUPERTINO S®RIM FURNACE/AC CITY OF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC -1PGASRES -Residential-for ea—gas system of —P- 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst > 100k BTU install or M relocate ea forced-air/gravity type fumace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h / 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • r CITY OF CUPERTINO . CC� " FURNACE/AC CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= lOk CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BRENWRI-IAN Residential A/C units <= l Ok CFM B IMRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E IMPERMITFEE Mechanical Permit M IPPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408) 777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT.# L IcSYD ^ ! I4 O 2a /D OWNER'SNAME: 4 I105W1 PHONE # f/OP-2(vS'- YS-3 GENERAL CONTRACTOR: r,�ccf'Cjjw FAX # L10 I am not using any subcontractor Signature Date Please check applicable subcontractors and complete the followin information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing X Heating t�i7� i.►w�� 2el Y Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Sign e Date