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CITY OF CUPERTINO
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13UILDINGPDIvis10N PERMIT
1R 1NT,AA A I�k�Xt'DRIMA.TIQN
BUILDING ADDRESS:
J P GORMAN INC
1ERMITN0.06050070
21373 DEXTER DR
OWNER'S NAME:
PERMIT ISSUE DATE
lk CHAMBERLAIN PARK AND JOAN 11
305 VINEYARD TOWN CENTER
304 05 09 2006
NE:
SANITARY NO, CONTROL NO.
(408)779-3296
ARCHITEC (ENGINEER:
-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
p
eby aflBt I am Massed under providm aof Chapter 9 (commencing
bam W
with Section 7000) dDiviston 2 ofgm Business and Professions C andmylicemcis
mmnfo—and ret. ��30i
FURNACE AND AC REPLACEMENT
Lse Ci O Lk. p
icen
Date Conlrxmr
ARCHITECTS DECLARATION
I understand my place shall be used as public records
Licensed Professional
OWNU-BUILDER DECLARATION
I hereby alTim that I am exempt from the Com entars License Law far the
following moron. (Section 7001.5. Busmoss and Profeadom Calc: Any city or county
$14000
which require, a permit m cnnmod, esr, impinve. demolish, or roper my sructure
Sq. Ft. Floor Area
Valuation
prior m its issuance. also requires the applhcsnl for such permit m file. signed succorer'
Ne C..Mwea Um U. (Chapter 9
Net he is licensed pursuant m dee pmviaium of
(commencing with Section 7000) of Division 3 of the Easings and Protestants Code) &
ton he is exempt therefrom and the basis for the alleged mmpdon. My violation of
Mirer 0
Occupancy Type
Sexual 7031.5 by any applicant for a pewit subjtts an, applicmL m a evil penalty of
not more Nm five hundred dollars (SSW).
0 1, as owns of the property, or my coplaye. wed wage as hall =to cmnpewton,
Required Inspections
will do the work and dosuuctum is nut lmeded or offered for &.1.(See . 7044. Business
aees Lkwe Law doerm m napply an owner of
and Pmfeudam Code: The Canum
q p
property who builds or improsea dsemn, and who duce such wark hi welt for trough his
own enployea, provided Natmch improvements art not imanded motioned forsale. If,
however, the building or improvement ismld within aro year of completion. the owner -
bottom will law the burden of proving that rte did not build or improve for purpose of
sale.).
0 1, as owner of the property am exclusively contracting with Ranged mnramon to,
enmtrum the project (See. 7044. Business and Prole siom Code) The Contrmmra Li -
come Law docs not apply m an owner of property who builds or improves thereon, red,
who contracts for such pmKw with a eonuamor(s) licensed purmml m Ne Convectors
'
License Law.
❑l am exempt under See .B&PCfor this myon
Owner Date
WORKER'S COMPENSATION DECLARATION
10 1 hereby efilm under penury Of perjury am of is following dealwllam:
0 1 Mw and will maintain aCerdBato o(Co mesh m self -insure for Worker's Compen-
saten, as proHMA (m by Section 3100 of the Lab. Code. fm Lha perfmmm¢ of Us
work for which this permit is issued.
0 1 ban and will maintain Warkces Compensation Insunna, as squired by Section
3700 offs Labor Codd. for dee perfaantana offs wale for which this pewit is issued.
'
My Workers CopehpemNon imarra ac aria and Polity numberrue:
Casrier.i \t I4r`S NA10
PON
ROWyRKERS'
CERTIFl hTS FEX WORKERS'
COMPENSATION INSURANCE
COMPENXEM N INSURANCE
v
(This sectio, nerd mthecompkrd if is permit Is two= hundred dollen ($100)
or isle.)
I comfy that in the performance of the work for which this permit is imued, l shall not
employ any pawn in my mmrcra as or become subject to tic Wortesf Coorpmsrdon
Laws of California. Das
Applicant
NOTICE TO APPLICANT: 11, &Mr making this Certinam of Exemption, you should
become subject m tom Workers Compensation provisions of ton Lab& Code. you most
forthwith comply with such provisions or this permit vast ed ducmcd revoked.
CONSTRUCTION LENDING AGENCY
erluof
1 thereby Nal Nem u•comnending agency for Ne pwana
ha1Rmh
ton work furorwhich this perms is Wood (Ser.S..]3007. Civ. C.1
-
Landers Name
Landed Md^.s
I i anify that I have sad this application ash sub dead the above Information is
"MCL I a{rte m comply with all city and county oMnanm and sur laws nh off m
building convection, and hereby anthem. mpwenuum or this city m enter upon is
above-mentioned property for impcetion purposes
(We) agora to ave, indemnify and kap harmless is City of Cupertino quint
liabilita,Judgmenu,com and expenses which may In my way acme gemlaaid City
in consequence of the gMd"s of this Peor h.
APP CANT UNDER DS AND WILL COMPLY WITH ALL
G `
Issued by: Date /
qNO^N-POINT
SOU E REGULATIO r
Re -roofs
Type of Roof
� N
iinad of ApplianUConlncmr Data/L
HAZARDOUS MATERIALS DISCLOSURE
the applicant or future building omvpantsmre & handle heardom material
LWill
de nth by the Cupertino Municipal Cock. Chapter 9.12. and is Health and Safety
Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yaa
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Wm building aaup.nt use cgWpmenl Or devices which
emis Incommode air contsorimnu as defied by.the Bay Ama All Quality Management
all new materials for inspection.
District? , r7
❑Yea r
IhavereadlhehvudummasaalssquimmenuunderCNper6.95af Lhe CaBfor-
,
ri. Knith&Sarmy Cao, Senlmu255D5,25533 uW 25534.1 undemand Nmifft building
dean ren on nlly hash a oulang, thal It is my wpunruNity m nnllry the 0.Cupmt of the
requlorww hkb comm t rrwiuu..f.cmka¢arayl �r_
Signature of Applicant Date
All roof coverings to be Class "B" or better
Own eror ret riaadagent Dam
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32641087.00
DATE ISSUED.......: 05/09/2006
RECEIPT #.........: 34313
REFERENCE ID # ...: 06050070
SITE ADDRESS .....: 21373 DEXTER DR
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA ......
OPERATOR: amyw
COPY # : 2
OWNER ............: CHAMBERLAIN PARK AND JOAN B
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1316
RECEIVED FROM ....: JP GORMAN
CONTRACTOR .......: JOSEPH GORMAN LIC # 24918
COMPANY ..........: J P GORMAN INC
ADDRESS ..........: 305 VINEYARD TOWN CENTER, #304
CITY/STATE/ZIP ...: MORGAN HILL, CA 95037
TELEPHONE ........: (408)779-3296
•FEE ID UNIT
BREMAIRHAN NO.UNITS
BREMFURN NO UNIT
BENERGY PERMIT FEE
BSEISMICRE VALUATION
PPERMITFEE FLAT RATE
BUSLIC FLAT RATE
EPERMITFEE FLAT RATE
MPERMITFEE FLAT RATE
TOTAL PERMIT :
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
1.00
----------
10.26
----------
0.00
----------
10.26
1.00
14.31
0.00
14.31
1.00
34.86
0.00
34.86
14,000.00
1.40
0.00
1.40
1.00
38.37
0.00
38.37
1.00
105.00
0.00
105.00
1.00
38:37,
0.00
38.37
1.00
,.38..37
0.00
38.37
----------
280.94
----------
0.00
----------
280.94
NEW BAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 280.94 8803
TOTAL RECEIPT 280.94
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------------------------------------------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
•
49
D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
a-��-�3 r-
PERMIT #
060 sC>o70
OWNER'S NAME:PHONE
# k -77P -1x5 L
GENERAL CONTRACTOR: ,j C_
FAX # 'to
I am not using any subcontractors: _ `l,0
Signature Date
Please check applicable subcontractors d complete the following information:
Ulw� er 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
Ulw� er Contractor Signature
Date
ai�&RRS
• CUPEkTINO
•
CITY OF CUPERTINO W06W-10
FURNACE/AC
PERMIT APPLICATION FORM
APN # n co �' 1 C,1�
'T U
Date:
Building Address:
BREMFURN
Relocation of Furnace
Owner's Name:
Phone #:
-12
q&s .
Contractor:
License #:
MECHANICAL
BREMRECEPT
Contact:
Cupertino
Is�icense #:
T , �r
-T—I
"'i�
I
Building Permit Info:
ELECTRICAL
J
Bldg ❑ Elect p Plumb ❑
Mech
Job Description:
PPERMITFEE
I
I6 --a(,
PLUMBING
Residential Commercial ❑
Bldg Permit Fees
For Res' ential Installations:
BPLANCHK
Attic MI` floor 2nd floor ❑
BUILDING
Adhere to min set back requirement /
Business License
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: Type of Construction:
Occupancy group:
dam
Strapped n Platform Bonded
Sq.Ft. Floor Area:
RT
New Location E3Replacement
Qty. if
Applicable
Fee ID
Fee Description
Fee Group
BENERGY
Energy
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
0
0
n
�J
CITY OF CUPERTINO
A FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM