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06050049CITY OF CUPERTINO/-� BUILDING DINUISION PERMIT BUILDING AoOaFss: A PERFECT CLIMATE Phd"NO'06050049 7481 HEATHERWOOD DR OWNER'S NAME: PERM" ISSUE DATE BRAD BLACHLY 10570 S DEANZA B NE: SANITARY NO, CONTROL NO. (408).861-9545 ARCHI7ECT/ENCIKEER: BUILDING PERMTT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION - Job Description I bunchy af0rm that 1 am thousand under provisions of Chapter 9 (ormmewing with Section TOM) ofDivWon3of the Business end Profcesiuns .and mylkunxta mthSrwaarwm L. REPLACEMENT OF FURNACE �'��® Licen Lit. Data Contractor - ARCHffECI-S DECLARATION' s shall be used public m s I understand my padu mrd /p�a-a JUN - wwg, 2006 Licensed Professional OW NER-BUILDER DECLARATION 1 hereby affirm that I am commit Imre the Commences License Law for the fallowing mason. (Section 7131.5, Business and Prorauions Coda: Any city w county ,7'59 which nat a permit to conswn, eller, Improve. demullsh, or repair any IU9eture Sq. Ft. Floor Area alua son prior m as iauence, also requires the applicant for such permit to file a sithad statement Contractor's L.i¢om❑w(Chaptar9 licensed puuant u the provisions of ase that he b u (commencing wish Semon 7000) MDivision 3af tes Business Lad Professions Cade) of tut he is aampt therefrom and the bub fee the alleged eampdm My violation of —tjPRjqV#6VrT U Occupancy Type Sermon 7031.5 by any applicam for a Permit subjects the applicant in a civil P"uhy of not mart tun five hundred dalhm (5500). ❑ I.uawoerof Ues Pmpeny,wmyemployaswlthwagau Nehmlecompeuadon, Required Inspections will de the wade and theslmmambmtimmeadwaReredferrule (Sm.7W,Someone I apply an an Owr of and PlaramON ran u CaOYxtaA License Law dads MM 9 C property who bulldsorimproms dumon,and who doessuch work Mmxlfw WeaN his awn employees, provided that such improvements are not intended aroRerel forsale. It. however, Ne building or improvement Is sold arms. aro year of mmpleyw. the 0. builder will have the, buNan of proving that am did Out build or improve for Purpose of aim.). 1, an manner of the property. am exclusively contracting with BttNed comb ebm to covuucl the project (Sec. 7016. Business and Profurstm n Code:) The Consumers V - cove law does not apply an an ower of property who builds or improves, thereon, and. who contracts for such projects with acoommmrtm licensed Panama relit, Contractor, License Law. ❑ I am aempl under See . B d: P C for Lou ream Own" Data WORKERS COMPENSATION DECLARATION ' I hemby,nim under penalty of perjury ave allies fallowing dalmWana: ❑ I have am will maintain aCeniBou oreonsent to self-inum forworkees Campen. sedanp as provided for by Secson 3700.1' the Labor Cade, for Loa pesfarmanoe of the work for which this permit is issued. ❑ nave and will maintain Workers Compuvatina Insurance, as required by Section 3700 of the tabor Code. for the performance clubs work fwwhkh Nb permit b issued. My Workers m war n insumem ami" and Policynumber are: tinier: Policy No.: CERT FICATE OF EXEMPnON FROM WO ERS' COMPENSATION INSURANCE v (This section need not M compktad flux Perron Is for enc hundred muse ($1001 or mass) I certify that N ter perfamanee of ter work for which this pammll is bmesd. I shml not employ any pecan in any mannerse as in became subject an the Workers' Compensation Laws of CmlfomiL Dau _ Applicant NOTICE TO APPLICANT. If. after muWng Nis CeniRcata of Esemption. year should become subject in the Wadmea Compensation provisions of the labor Code you moan faMwith comply with such provisions or this permit that) be domed revekad. CONSTRUCTION LFloD1NO AGENCY I hereby affirm that Nemis its a construction lending agency for ter perfurmana of ' the work for which Woe permit Is laved (Ser. 3097.civ. C.) s ' Lenders Name lenders Addmm 1 sonify Loaf 1 have read We appikWan md state that the above information Is . ' comma 1 agme to comply with all city and county ordina er, and sum laws relating to building construction, and hereby sumorim representative of this city to enter upon the alive-mentamd property fon Impaction pagpxa (We) agme to ave, indemnify ad keep haretcat the City Of Cupertino against j IiaEilita.ludgmenu,cosu and vp. which may In any way amus against said City In consequence of the granting of this permit. APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON- INT Issued by:9100Date 0� ) I Re -roofs - Type of Roof Signature of AppllaMContructor Use HAZARDOUS MATERIALS DISCLOSURE Will the opplicamor fulum building mlerme stem orhandh haaNeds mamdal as defined by rho Copartner Municipal Cade. Chapter 9.12. and the Hahh and Safety Cede. section 2-5332(a)7 - Ya O ❑� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the appfiant of for= building occupied ax equipment or dcvias which ,.it haaNnv air umu olmote as defend by the Bay Arca Air Quality Management all new materials for inspection. District? / ❑Ya aB 1 have mad the hnallous matariabrequirementa underChapur 6.95 of des Callfor. nLa HulNkSafciyCodeSeetau25705.25533 md25531.l u demand thelfNe building dos ml cum lily haw a b my naihility N Ootly the weupant of the be n kh uehcnest ld r"anof �� Signature of Applicant Date All roof coverings to be Class "B" or better 0 crwathameda em D,m ' ' f CITY OF OCUPEII;TINO • • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: `% I U. PERMIT # ®60 Sa o OWNER'S N �Q SUBCONTRACTOR PHONE #. -� GENERAL CONTRACTOR FAX # _S, I am not using any subcontractors: Signature Date Please check avvlicable subcontractors and comvlete the followine information � K owner/ Contractor Signature 5 q S10 6 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 � K owner/ Contractor Signature 5 q S10 6 Date !em 2 of 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35926049.00 DATE ISSUED.......: 05/05/2006 RECEIPT #.........: 34270 REFERENCE ID # ...: 06050049 SITE ADDRESS .....: 7481 HEAT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: BRAD BLACHLY ADDRESS ..........: CITY/STATE/ZIP ...: , Nil OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: A PERFECT CLIMATE CONTRACTOR .......: SMITH, BYRON E LIC # 21144 COMPANY ..........: A PERFECT CLIMATE ADDRESS ..........: 10570 S DEANZA BLVD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE .........: (408) 861-9545 •FEE ID UNIT QUANTITY BREMFURN NO UNIT 1.00 BENERGY PERMIT FEE 1.00 BSEISMICRE VALUATION 4,975.00 PPERMITFEE FLAT RATE 1.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 14.31 ---------- 0.00 ---------- 14.31 ---------- 0.00 34.86 0.00 34.86 0.00 0.50 0.00 0.50 0.00 38.37 0.00 38.37 0.00 38.37 0.00 38.37 0.00 38..37 0.00 38.37 0.00 ---------- 164.78 ---------- 0.00 ---------- ---------- 164.78 0.00 VOICE ID DESCRIPTION -------- ---------------------------- ----- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • VOICE ID DESCRIPTION 501 FINAL ELECTRICAL ENERGY r OCUPEI,TINO CITY OF CUPERTINO 00050OL FURNACE/AC PERMIT APPLICATION FORM APN # 2 9q � w � O� j� Date: Building Address: BREMFURN Owner's Name: Phone #: r-4 A/C Unit > 10,000 cfrn Con ctor Phone: �61 License #: ?,731�S_Y e G a Contact: Phone: Cupertino Business License #: Building Permit Info: Rec tl, Switch & Outlets Bldg ❑ Elect El— Plumb LT-- Mech Seismic Fee Res BUILDING Job Descriptio tie v Seismic Commercial Residential ET Commercial ❑ EPERMITFEE For Residential Ins Rations: El 0 ❑ ELECTRICAL Attic 1' floor 2"d floor Mech Permit Issuance Adhere to min set back requirement ❑ PPERMITFEE Plumbing Permit Issue PLUMBING For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Bldg Permit Fees Structural Calculations required for new installation ❑ BPLANCHK New installation Planning Approval Required ❑ BUILDING Cost ot Project: Type of Construction: Occupancy group: 7S o� .,3 Strapped On Platform ❑ Bonded Sq.Ft. Floor Area: New Location ❑ Replacement a Qty. if >:PP m Fee Description Fee Group A 11M4V1Y BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin 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 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