06010134 OITY OF CUPERTINO t «" ' ,'ani�'` ' ",
BUILDING DIVISION PERMITC�T�1,R�XIV 'OYtMATdQN,�s
BUILDING ADDRESS: PERMIT NO.06010134
OWNER'S NAME: PERMIT ISSUE DATE
LOAFMAN RUSSELL O AND ALICE C 24 2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION
[ 1 hereby effirm Net I am licen,ed under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of the Business and Professions COde.end my license is
mm�forceandemcc nye' FURNACE REPLACEMENT.
(g Z License Clan X20 Lk.a tT ss sl
3F Dam Contractor. BL ON FILE FOR PELLE HE G C
e
ARCHITECTS DECLARATION
ARATION V
NK
y 1 understand my plans shall be used as public records
J
y� Licensed Professional ^-
^ OWNER-BUILDER DECLARATION ,y�
4 ISO
aI hereby n(Rrm Nes 11. exempt from the Contractors License Lew for the ye j
p O whfollich requires a permit
i Tonstr Business and r Pmfaaiona,or re ny aircity or county
which requires a p"mit vo cones the elfin Improve,demolish,or repair i i it any atmdum Use
—z shy poor Malkin itsiunted p.aleumgolthelM applicant far such p Common's
fileasLndsammem
F � Nat hebllanudpursuanttoNcprovision,nfthe Contrmcmr'sLiccrcuLaw(Chepur9 Sq.F[.Floor Area Valua[i 618
yFC (commencing with Section 7001)of Division 3 of NO Business and Prof.ssions Cad.)or e
3$ Net he u exempt therefrom and Ne bub fm the alleged exemption.Any violation or I .Br
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number QWcy Type
not more Nan five hundred dollars($500).- 31630054 . 0 0
❑I,as Owner of this property,or my employee with wages as e eirmle compensation,
willdolhewoh,utd Neumcu.i...tinm.kdoroffemdfanale(S=.7W.Bualu
neRequired Inspections
and Profession,Code:The Conusco's Littrue Law does Out apply m nns an awr of Q p
property w ho Wilds or Improves themon,and who does such work himself or through his
own employees,provided Nat mch improvements art oat ImmmdW"offered for ule.If.
however,the building or improvement Is sold within one year of eempledon.the manor.
bull&'will have the burden of proving Net he Old not build or Improve fm purpose or
sale.).
❑1,as Owner of to property,am exclusively cenuacting with licensed convenors to
construct Ne project(Sec.7040,Business and Profusions Code;)M ConuanoYs U.
cetue law dose nm apply ar an own"of property who baits or Improves thereon,and,
who comets for such pmjeau with acontrictot(s)licensed purwam to the Contractors
License Law.
❑I am attempt under Sec. ,B&P C far this mason
wear Data
WORKER'S COMPENSATION DECLARATION
I hemby aninn under penalty of perjury one or the following decimations:
1 have and will maintain a Certificate of Consent to self-Inseam for Wortrrs Compan.
a0on,as provided for by Section 371))of d.Labor Cod.,fm the performance Of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation Insurance,u acquired by Section
3700 of the labor Cade,for Ne erformance of Ne verb for which this permit is humd.
My Worker's omeaadmi car ma cam"and and policy nuummberer...: �fJ
Caller. Policy No.:{„(may 0—(1�
CERTIFICATEOF (EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need notbecompleted ifrise perm tis f"onehundred donna(S100)
or leu.)
1 unify Not in to performance of the work for which this Permit Is issued,l shall not
employ any person In any manner=as in became subject to the Workeri Compen,adon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifscate of Exemption,you should
become subject in the Workers Compensation provision or the labor Code.you must
.JO forthwith comply with such provision w this permit shall W dccmed marked. s
Z 0 CONSTRUCTION LENDING AGENCY
1 hereby a1Mn Nat thea is a convection lending agency for the performance of
C
the work for which this permit is iuuc l(Sec.3097,Civ.C.)
�W Q Lenders Name
=z Lxmds's Addmss
J Q I coolly Net 1 haw read this application and suit Net Ne show information is
Ly ^! correct.1 gree m comply with all city and county ordinantts and sum laws misting in I
0 LTJ' building communion,and hereby authadm mpreunlnlvn of Nis city to enter upon Me /
{Ll aWw-mcndoned property for inspection purposes. 6/
(We)agree to save,indemnify and keep harmless the City of Cupertino against
(..i W liabllides.judgnunta,cuts and expenses which may In any way acme against aid City L
C)^'s APPLICANTin consoUNDEof Me RSTAam
NDSrant fNts W1 LY WITH ALL N N-POI Issued by: Date
it
SOURCE R ONS.
Re-roofs
Signature onmetorDal
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will N.applicant or fretum building occupant rare orhandle hal dues material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Se❑ctioonn 25532(01 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding accupem use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
Id=
hazardous air conamimans a dchned by the Bay Amo Air Quality Management all new materials for inspection.
ict7 ���
❑Yes ax
I haw read the haatdousmucriab requirements under Chepwr6.95 aline Califor.
Health SafelyCode,Section 25505.25 am1255N.l undersmad thnifthe Wilding
not currently have a son b y pon,ihility m notify the cupanl fdmrement kis ustbe tar maofaCcniftcemofOc pan . SignatureofApplicant Date
Owner tneuthjItiaud age. ,m All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
IUPER,TINO
Building De artment
JOBADDRESS: PERMIT# .
z 0�*5 3
OWNER'S NAME: o ^ Idyll PHONE f 408p
GENERAL CONTRACTOR 44n a- h c FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informatiorr.
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
t/ Heating \ 4 "'
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
11- FURNACE/AC X 601 0/3�
CUPEKTINO PERMIT APPLICATION FORM
APN # � �^ D5'/ Date:316o -a4�Olp
Building Address: ,•�/ `Y
Ip gsg fe�-:5 .br .
Owner's Name: Phone #:
1 i c- IM G4–K% '-fU Q•a 53 .`l1 Sb
Contracts - LicensevrA #: �� n
Contact: Cpertin B iness License #:
a o oaw
Building Permit Info:
Bldg ❑ Elect i-" Plumb Mech
Job Description:
rhQ[�
Residential Commercial ❑
For entialI llations:
Atticl:t floor 2"d floor ❑
Adhere to min set back re uirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required El
Cost of Project: Type of Construction: Occupancy group:
36K�0 WA Si 1�
Strapped El On Platform Bonded U Sq.Ft. Floor Area:
New Location ❑ Re lacementx
Qty. if
Applicable Fee ID Fee Description Fee Group
tl BENERGY Energ BUILDING
BREMFURN Relocation of 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
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