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06090079 CITY OF CUPEPERNIIT CONT�R.�GTOR INFORMAf ON, 'BUILDINt:DIVISIONSION f _;t,s.�;y',r�'n.+..e- *'✓h"tag eT i.n.riL+.--'�.&'* Yu kis..Y'N�'.. BUILOINCADDREss: PEL E HEATING & AC INC PEaMITNo06090079 11109 FLOWERING PEAR DR OWNER'S NAME: PERMIT ISSUE DATE STICKLER DIANALEE 3728 C CHARTER PARK bR 09/12/2006 NE: SANITARY NO. CONTROL NO. (408) 978-7060 ARCHITECT/ENGINEER: BUILDING PERMRINFO BLDG EO PLO MEOCH W p LICENSED CONTRACTOR'S DECLARATION lob Description i V F I bath,affirm Wt Inn Iimneed under provitons of Chapter 9(mmmeocut i�:.{ wiNSecdnn70M)af0ivWon3ofthe Euai..MProfusion Ca .-M-yi"cC is m in fdi raceand effect FURNACE CHANGE OUT Z Lkenm Cl Lm - 791 M g Dam��y zT—ComrmmrATI �- ARCHTIECTS DECLA ON I understand my pans shall he used as public records t .a Licensed Pmfusional a OWNER-BUILDER DECLARATION Z I hereby affirm that I for exempt foam the ConlcaaWs License Law far the 0 o following moon.(Sudan 7091.5.Ben.and Profestinn Cade:Any city or aunty j3 r which acquires a permit an consumer,alms impmw,demolish,or repair my smamme $3618 ZO, prior in bounce.its issnce,also requires,the applicants,rot such permit to rite a signed imminent Nat he is licensed pursuant 101114 provision of me COntrtho'S license Law(Chapm9 Sq.Ft. Floor Area Valuation g (commencing with Section 7")of Division 3 of The Busincsemd Profudmn Cad4)or Nm he is ewmpt lheref nese and me basis for me alleged emmpdon.Any vloladon of Section 7031,5 by airy applicant for a permit subjects the applicmt m a rn11 penalty of Occupancy Type Mt more than five hundred dollars(SSM). 0 1,u owner of dm Property,army ctoployces with"Was their mm Compensation, will do the wor"Od meauuman is not intended or offered for Sam(Sec.7041.Business, Re aired Inspections and Profesdans Calc:The ConuacmYs License Law does nut apply m an owner of q P property who builds or Impmwa dammR,andwho doetsuch work donator through his own employ=,provided that uch Improvements are notion ndnd oaffemd for We.If, however,me Wilding or impavereenl4 sold within one year of compo i n,me owner- builder will now the burden of proving that he did net Mid or improve for purpose of code.). 0 I,u awns of the property,am exclusively contracting with liamed antrmmR to construct the project(Sec.70".Business and Profession Cade:)The Caotrmmis U. cease Law does not apply to an owner of property who Wilds or impmws damen,sed, who concocts for such projects with a eantrlctart0 licensed Pursuant m tin ConuacmrS License Law. 0 tom exempt under Sec. ,B&PCs for this reason Owner Data W ORRER'S COMPENSATION DECLARATION 1 hueby affirm under penalty of perjury ore of the falmwtng declared—: 1 have and will maintain a CeNfiom Of Consent m self-inure fa Workers CumPen- mton,at provided for by Section 3700 of the labor Code,fm the Perfommm of the wink for which this permit is Wood. 0 1 haw and will maintain Worker's Compensation Insurance,a required by Section 37M of the Labor Code,far the performance of the work far which mu .it is issued. My Wofteseccm,b-ppenradan I//na``mmme canter sad PoI¢y number ape: Cartier.SHR k lIM H Policy No.: p',5?AT��[(/ - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CThu ecelinn need not he completed it the permit is fmonc hundacddollan(SIM) or less.) I certify that In to performance of the work for which this permit is lamed,I shall not employ any Person in any manner m as In become wbject to the Warkeoi Compensatan Laws of Calift.u.Data Applicant NOTICE TO APPLICANT:If.after making this Cenifiam of Exemption,you should became subject he the Wer aces Compensation provisions of tin tabor Cade,you mum wJ Q forthwith comply wile such provisions Parent or this Peit shall be deemed revoked. z rA CONSTRUCTION LENDING AGENCY [.a wN. I hereby affirm that mem Is a construction lending agency for the Performance of C(i +✓ the work fur which this Permit Is issued(Sec.3097,Civ.C.) "IQ Undoes Name ' D z Lcmi Address U0 I certify that I haw Rad this application and sum that me,'Wvc infomntun is U. (~ coma.I agree to comply wit all city and county ordinances and sum laws muting to OU building convection,and hereby aumorine mprescnutivec of this city To enter upon the W about-mentioned progeny far inspection pugnscs. (We)agree to save,indemnify and kap handless the City of Cupcnino against faA liabilities,judgments.costs and expenses which may in anyway scene age faced City U 7 Inconsequence of the granting of this permit. h� APPLICANT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -� Da � SOURCE�MYLAT�ytz/� NS. '1��3f- Re-roofs sigma of AppncmaContnnnr m HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding acupanutate Or harWk heaodom material as defined by the Caperton Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 35533(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Yu equipment or devices which Will the applicant ar fmuR building a'cupant um If a roof is installed without first obtaining an inspection,I agree to remove emit hmNnus air canuminants m defined by the Bay Amo Air Quality Management all new materials for inspection. District? 0Yes EPIC - I have mad the hnardnm materials requirements under Chapter 6.95 afthe Califor. nia Health&Safety Cade,Sections 3550 35533 and 27534.1 understand thus ifthe Wilding dos,not currently haw ate n a is my responsibility m nod It the accupanT Of the mqulremenu t 'i missuumard.coNficacorOccup ft. Si14" gnature of Applicant Date Owner ar oath tad agent D, All roof coverings to be Class"B"or better CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32345028 . 00 DATE ISSUED. . . . . . . : 09/12/2006 RECEIPT # . . . . . . . . . : 36006 REFERENCE ID # . . . : 06090079 SITE ADDRESS . . . . . : 11109 FLOWERING PEAR DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STICKLER DIANALEE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : STEVE PELLE CONTRACTOR . . . . . . . : STEVE PELLE LIC # 27593 COMPANY . . . . . . . . . . : PELLE HEATING & AC INC ADDRESS . . . . . . . . . . : 3728 C CHARTER PARK DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 978-7060 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- - --- ------ ---------- ---------- ---------- ---------- BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 3 , 618 . 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 164 . 78 0 . 00 164 . 78 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 164 . 78 VISA TOTAL RECEIPT 164 . 78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 . ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • f Community Development 10300 Torre Avenue j > Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 46UPEI�TINO Building Department JOB ADDRESS: PERMrr # d l,�cn� $d 1p -7 OWNER'S NAME: PHONE # 7 2 8&/r GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 9 2 Signature I bate 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 Tile • � Owner/Contractor Signature Date CITY OF CUPERTINO oaza� ' FURNACE/AC ( ( �� •CUPERTINO PERMIT APPLICATION FORM APN # s^n '" ro^,� Date: Building Address: �rj^ /(/0? rowcisi tA/L Q Owner's Name: Phone#: l17.+N 44-- Con actor: Phone: License#: U4 d" 3f� ►ii ' ��'�77 —lobo �J Contact: Phone: Cupertino Business License#: S�crc /( P 9UY 97F-7oba 2 7553 Building Permit Info: Bldg ❑ Elect Plumb Mech a Job Description: L J J f Residential Comme ial ❑ For Residential Installations: Attic ❑ 1" floor RL 2nd floor❑ Adhere to min set back requirement[-] §pFor Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: 3, =` Type of CQn=ction: Occupancy group: Strapped El On Platform 0 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 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm 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 AML 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