08010035 CITY OF CUPERTINO
BUILDINGVIVISION' PERMIT ' CfliVTRACTQR 9 -
BUILDIC'G.AADREssI'IIBISCUS DR_ AAA FURNACE & AIR . _ PERMIT08010035
OW NERL'SLNALMlE: PERMIT MITE DATE
DEBRA HARTWIG 1712 STONE AVE 01/07/2008
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
PANEL UPGRADE 100 AMP BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION - Job Description
mu 1 kreby affirm thn 1 am licensed under provisions of Chapter 9(commencing p
:Zr whb Section 7000)of Divisien3ofthe Budrmas and Pra(cuiuns Code,antl mylkenseu
in full form and c
i Lineman Class, tic.N
Dem Contractor
ARCHITECTS OECL
i 1 undemand my plans shall k used as public records -
t6
o�a Liccnud Professional
s OWNER-BUILDER DECLARATION
Con Ohn
<0 I hereby mrso alum on I am exempt from IM Cmines as License Law ford.
p O following mason.(Section IID L5.Business and Pm(cssiom Cade:Any city or county
Or
3fist which requires a permit In emm muct,alter,improve,demolish,m minor my strurtum
ZY prior In its issuance.also requires the applicant former permit to file a signed statement
ZsF that
iwitpSectioNwk of Division
of NC Convector'scame mn.taw(ChaptersClk)or Sq.Ft.Floor Area Valuation
2 t-, (Commentingeased Section to the pf visions of aline Buchisand Pm,Law Cmk)or
Nat her B exempt Mountain and the basis for Ne alleged exemption.Any violation of '
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy e
not mart Nan fare hundred dollars($500). p y�p
❑I,ae owmer of the property,m my empleyem with wages m hek sole c onacca tien,
will do thcwark,and We structure Is notimmnded or offered farmic(Son.709 C,Bodnea Required Inspections
and Pmfesslons Code:The Contractees License Law does teet apply or an owner of q P
property,who builds or im proves themen,and who does such work himse If m hmugh his
Own employcos,provided Nat such improvements are not intended oroffemd resettle.If.
however,We building or improvement is said within aro year of campkdon.the awoer-
builder will have the burden of proving Nat be did mut build or improve for purpose of
ask.).
❑1,as Owner of the property,am exclusively contracting with licensed mnuacmrs in
construct the project(Sec.7094,Business and Professions Cade)The Con Wcmea Li-
cense law dots not apply m an Owner of property who Wilds or improves do eon,and
who contracts for each projects with a contractor(s)licensed pursuant to the Conuacter's
License Law.
❑I ten exempt under See ,B B PC per Was mssan
Owner Date
WORKERS COMPENSATION DECLARATION
I kmby affirm under penalty of perjury one of the following de huratkns:
have and will maintain aCurfilllmk of COnuntioself.imurt for WerkehCo rron-
on,m provided for by Section 3700 of rhe Labor Cade,her the Performance of Ne
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as,required by Section
3700 of the Labor Code,far Ne performance of the work fmwhich this permit be issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. .�/�n f� I'dat p/ Policy No.: ��
C RTI O EX PnON FRO oRKERS'
COMPENSATION INSURANCE
orms.,firm nectl oat be completed if We permit is fnroue hundred dollars(SIM)
or less)
I certify that in he Performance of the work for which this permit is isucd.I shop not
employ any person in any mamneran as in became subject o the Workeri Compeesafiar
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,error making this Cenifcac of Exemption,you should
become subject m the Workers Compensation provisions of the labra Code.you most
,J O faMrobe
with comply with Such pvisiooa or his permit shall deemed revoked. -
z(Z) CONSTRUCTION LENDING AGENCY
I-
-tIhereby affirm the here is a construction lending agency for the Performance of
a > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Undoes Name
04 z Lender's Address
V Q 1 certify Nat I have read this application aro sum het Ne ahem information is
ry Correct.I agree to comply with all city and county ordinances and sure laws relating to
OU building construction.and hereby authmire.presemutives or this city m enter uman he
Umove-mentioned Property,for inspection purpose:.
(We)agree m aave,mdemm fy and keep harmless the City of Cupenirm against
rq
liabilities.judgments,casts and expenses which may in any way accme against said City �,,�
C)z APPLICANT UNDERSTANDS ANDmetruence of the granting of WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date ,/— - ase/
SOU E REGULATIO S.
Signature a�mmc",.� 'P✓o W Re-roofs
HAZARD US MATERIALS DISCLOSURE Type of Roof
Will heapplicam or future building Occuporecor a or hurdle hmardous material
u refined by the Cupenina Municipal Code.Chapter 9.11.and the Health and Safely
Cadc,Sectiony.15533(¢)?
❑tics All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o mm.O building occupant use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
hanummus air commutable m defied by the Say Area Air Quality Management all new materials for inspection.
e?
❑Yrs �Nu
I have mad the haaakrma materials requirements underchap rr 6.95 ofthe Califon-
, ria Health A SafelyCode.Sainte 15505,25533 and 15534.I mocmund War tribe,building
does moo eumaml,have a uta mm,that it is my mmpamihilb,na at,We asupant or he
req ' mniswhehmust bemet priotorissumecare CcalOfOccupaoq. Signature of Applicant Date
c
-Owner araum i.,easenr� � -/J Dm�� All roof coverings to be Class"B"or better
CITY OF CUPERTINO
4 ITEMS OF 22 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32602023 . 00
DATE ISSUED. . . . . . . : 01/07/2008
RECEIPT # . . . . . . . . . : BS000003633
REFERENCE ID # . . . : 08010035
SITE ADDRESS . . . . . : 22115 HIBISCUS DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEBRA HARTWIG
ADDRESS . . . . . . . . . . : 22115 HIBISCUS DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0110
RECEIVED FROM . . . . : JIIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . .: AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 17.12 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)293-4717
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 4, 000. 00 0 .50 0. 00 0. 50 0. 00
1ELECINSP HOUR 1. 00 122 .38 0. 00 122 . 38 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1TRAVD0C FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 204 .46 0. 00 204 .46 0 . 00
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
® PERMIT APPLICATION FORM
APN# 3z 2 .D Z3 Date:
Building Address: J
Mailing Address Address (if different from building address):
Owner's Name: Phone#:
d w 73-32
Contractor: Phone: //o�
"nt , C Fax: 7
Contractor License#:
Cupertino Business License #: go
Contact: Phone: �j f
Fax:
Residenti Commercial
Job Description:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N kL,-e
Valuation: Square Footage:
424?421 Oe
Project Size: Standard ❑ Large ❑ Major 0
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING •
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
(� ,g1GENCOM
1BBOILERI For the installatidfi or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
113130ILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Instal lation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CG. CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1CHIIv1NEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRN Pile Foundation Driven (steel, pre- B
stressed concrete
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r
qw CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
. .Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSPIO Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDEST/BK Siding, Stone & Brick Veneer B
(interior/ext rior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<10 SF Skylight less than 10 sf B
1SKYI.>IOSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) . B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
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CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
I WINREP Replacement windows/sliding glass B
door ea 8 windows)
/ 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
/ 1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
lELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
Lwhennot overcounter hourly-stand alone
VDOC Travel &Documentation B
LIC Business License B
0
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