05100083 CITY OF CUPERTINO �- + s.
BUILDING DIVISION PERMIT VIM, "
BUILDING AOORESS: A PERFECT CLIMATE PERMIT No.05100083
0VER'S NAME: PER,M ISSUE DATE
BAUER ROD 10570 DE 5
PHONE: SANITARY NO. CONTROL NO.
408) 861-9545
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
0 0 0
1 homby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Sim with Section7")of Division Sof NC Business and Purifications Code.and my licensee ������®
nod in fulls. oil effect. REPLACE EXISTING FURNACE
j,t2? Licsnse Clara Lk.N
n=cm Da¢ Contracts,
Tse ARCHITECTS DECLARATION
gye� l undersond my plans 0.11 he es public¢cords OCT 4� 2005
DyV
a.t; Licensed PmfcssionaI
` OWNER-BUILDER DECLARATION
E0 0 1 naso affirm that 11. exempt item the Contractor's Co License Law for Inc ��,f ^, }
0 o following reason.(Section IID LS,Business and Pmfessiom Code:Any city or county k' b•
m� which requires a permit m construct,aver.improve,demolish.or repair any structure '4 4.5=2
Zit prior its issuance.also requites the applicant for such permilin file a signed statement
0s that he is licensed pursuant to the provisions of NeCommam'sLicvnmLaw(Chapter 9 Sq.Ft.Floor Area Valuation
z1- (commencing wish Section 7")of Division 3 M the Business and Professions Codc)or
.�3$ that he is exempt therefrom and thc base for the alleged cwn,to n.Any violation of
Section 7031.5 by any applicant for a person subjects the applicant in a civil penalty ofr 0 Occupancy Type
not more Nan five hundred dollars(S500k
0 I,m ownerof 0¢properly,or my employes wish wages m thee sole compensation,
will do the work and the structure is not intended oro@red formic(Sce.]Ola,Businw
and Professions Code:The Comrselors Liceme Law does not apply to an owner of Required Inspections
Property who builds o,improves thereon,and who destruct,work himself or through his
".employees,provided that such improvements are not intended oroRered formic.If.
however,the building or improvement is sold within one yen of completion,On owner
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
,P!Q,at owner of the pm,xut,am exclusively contracting with licensed contractors to
eonnmct On Pmjecl(Sec.7WN,Business and Professions Code:)The Contractors Li.
cense Law does not apply to an owner of property who Wilds or improves thereon,ad.
who contracts for such projects with a contramor(s)licensed pursuant in the Contractors
License Taw.
❑Ism exempt unde,Set .B&PC for this reason
er YYYYY//�/k; //�.Lgr�.ftii Dm 0
r7
WORKER S COMPENSATION DECLARATION
1 hereby aRren under penalty of perjury nese of the following declarations:
❑It, maul will maintain scenifieste of Consents.self-immicforworker'sCompen-
m ion,u provided for by Section 3700 of the Labor Cade,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensmion Insurance,sa required by Section
37W of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need notwcompleted lithe permit is for one hund dollars($HXq
or bas)
I certify that in she performance of the work for which this permit is issued.I shall not
employ any person in any man�r�aswlta'a�e� o the Workers'Compensation
Laws of C"Lfoplg Dyr
Applicant�K 6V �+-.-
NOTICETO AP L4ICAL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.,O farthwish comply with such pmvmons or this permit snail W m
deeed revoked.
Z" CONSTRUCTION LENDING AGENCY
(-ice Ihereby affirm that there is a construction lending agency for the performance of
x 7 the work for which this permit is issued(Sec.3(199,Civ.C.)
Uj Q Lender's Name
7 z Lenders Address
()Q 1 mnify Nat I ban mad this application and some Nat On aW w information is
Fcorrect.I a&=t0 comply with all city and county ortinanms and soon laws relating in
V Wilding construction,and hereby authpfise representatives of this city m enter upon the
r CS1 shove-mentioned property for inspection purposes.
(, gy (We)agree to save,indemnify and keep harmless the City of Cupenum against
h liabilities.judgments.costs and expenses which may in any way accrue against said City
V z in consequence of the granting of this permit. _6
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t�
SOURWEGULAT}�"�S.-
R; p 44� 10//7/0`� Re-roofs l x
Signature of ApplinnVCo tractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant lir forum Wilding occupant nom or handle nmardous material
u defined by the Cupertino Municipal Cot,,Chapter 9.11.and the Health and Safay
e Seetion 25532(01 - All roofs shall be inspected prior to any roofing material being installed.
Yu �ho
'If a roof is installed without first obtaining an inspection,I agree to remove
Will the apprnmi car future budding occupant use equipment or devices which
emit Int/2 dous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
CYcs gNu
1 have feud thc hvardousmaa:rials requirements under Chapor695 of the Califor.
nix Health&Safmy Co@,Se,wma 255115,25533 and25534.I undcrnand thuiru a building
duns not currently Rhamve a Iron.that it a my responsibility to notify the occupant of the
req NcanauIn/ (yypW,�.j3estust W met priorm issuance ofa cemraasof/Occupancy. Signature of Applicant Date
9;�owner or autos d ztA— / I fD�� All roof coverings to be Class"B"or better
® CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35611029.00
DATE ISSUED. . . . . . . : 10/17/2005
RECEIPT 4. . . . . . . . . : 31628
REFERENCE ID # . . . : 05100083
SITE ADDRESS . . . . . : 918 FT BAKER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BAUER ROD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4010
RECEIVED FROM . . . . : ROD BAUER
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
oTELEPHONE . . . . . . . . : (408) 861-9545
FEE 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 4,452.00 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
_________________ ____________ _____--_____-_____
CHECK 164.78 3826
TOTAL RECEIPT 1G4 .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
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 #
918 P02T 8<FKe2 D2l vE OS'/ Q6b e3
OWNER'S NAME: RoP 5A)M PHONE #(¢0 8) 7-59-S-247S
GENERAL CONTRACTOR: FAX # C¢o8 -Z5;7- f6-&6
0W1V - 60j(.0e*K-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
✓ Heating C,1-- C
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 05 0003
FURNACE/AC
CUPEI�TINO PERMIT APPLICATION FORM _
APN # 35(aDate:
- I \ - ()a C) cr. i 7, 2o�.s
Building Address:
g/8 /=:bR.T 13flKER DRivE
Owner's Name: Phone #:
RO(2 S fWE/Z (4c2) Z5-S--7-07S
Contractor: pp,9 F°5cr C L /mli f6 License #:
7Z 3 /58
Contact: Q4 045 86/-954 5 Cupertino Business License #:
AA7- VA a0N2Ab55 '-�D S, q a11�1�1
Building Permit Info:
Bldg ❑ Elect Plumb d Mech
Job Description:
REPUa(-E
Residential 2q Commercial ❑
For Residential Inst llations:
Attic ❑ 1" Floor ( 2" floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Projec Type of Construction: Occupancy group:
—
Strapped ❑ On Platform ❑ 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 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 Pennit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING