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08010030 CITY OF CUPERTINO - ' �-avxryy b;zw�>s 4 aINFO�. •'Rr T/�!,., -i BUILDING DIVISION .PERMIT eC�1N':lllARM_, '=-"'^N av p xrc . ...> , PERMIT NO. Bu1LOf1Niary�RINTW00D AVE A PERFECT CLIMATE 06010030 OWNER'S NAME: _ PERMIT I'SUEDATE ANDY ULLAH 8375 BRENTWOOD BLVD STE B 01/07/2008 NE: - SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO REPLACE FURNACE 100K BTUs ELECT PLO MO i0, - LICENSED CONTRACTOR'S DECLARATION - Jb Description w I Iemby affirm Nat I am licensed under provisions of Chapter 9(comOp mencing ;ZE with Secton7000)of Diviaion7o(the Husineu and Pro(essiuns Code,and mylkense is ! ° is full fares and.Race _ v �,r� t2Z License Cie. _ Lk.g i F p DatcTI iFzz, Conlmclar 7W ARCHITECTS OECLA-RATION i < I understand my plans shall be used az pubic,mentis fyU a o rn Licensed Professional 3 OWNER-BUILDER m DECLARATION C I M1cmhy a(Orm that 1 1. exempt from Yte Canine Co License taw for Ne -o O following reason. amnio n 1(131.5.Business and ve.doians Cade:Any city or county which mquis.a permit ac cores the alter,improv,h Permit t or repair any structure ';ED priormiu sensed e,also mquira the so roe Commorm's Licaic Lawsutemem < IhaheislicenseJpursuanllothepmvisionsofaaConlracmrSLianselaw(Chaper9 Sq.F[.Floor Area Valuation RFG (commencing with Section 7000)of Division 3o the Business and Professions Cade)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 1031.5 by any applicant for a permit subject,the applleant to a civil penalty of APN Number - Occupancy Type not mart Nen five hundred dollars(SSM). 0 1,as owner of the Property.a my employers with wages as chair sale compensation, will do the..,it.and me stsuctme is not intended of oQemd far aak(So..7044,Business Required Inspections and Professions Cade:The Commetirs License Law does not apply m e an owner of q P property who builds car improv=thereon,and who dues such wok himself or through his own employees,provided mat such impmvemenu me mommiled dragsmd(orsalu IL however.an building or Improvement is Geld within ore year afcompkdan.the maim. builder will have the burden of proving mat he did not build or improve for purpose of sale.). ❑1,as owner of to property.am=elusively contracting vim licensed conwetors m construct the project(Sec.1014.Business and Prof=sion,Code:)The Cantracmr's U. surae law does nm apply man owner of primary,who builds car improves metean,sad who contracts for such project,wit a eammcmKs)licensed Pursuant in the Conuagmes License law. ❑Ism=emptunder See .B&PCfarthuseawn Owner Data WORKER'S COMPENSATION DECLARATION " I"Baby Nem under penalty of perjury one 0,he fofewing dxlara0om: have and will resinuin a CeniE=te of Consent m self-insue for Weaker'sCompen- n.as provided for by Second 37M of lie one Coda,for me Performance of the work for which this permit is issued. i have end will maintain Worker's Compensation Insurance,m required by Section 100 of the Labor Cade.for the performance of the wark fs-which this permit is issued. My WerkC mpenutan Insursnce artier and P,*Y.V,mbcr am: Cartier: )r'o+-f t- Policy No.: (�Z �f V 0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This aced..decd net bcemapieeU if the permit is fare..hundreddollars(SIM) arts..) I certify that in the performance of the work for which this Permit is issued,I shall nm smploy myparsoo in any manner so as to become subject to IM Workers'Compaxom n Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Ceninam of Exemption,you should become subject to the Worker's Compensation provisions of the lahor Cadc,you mut, •,z forthwith comply wit such provisions or this permit am)ha dammed mwked. _ CONSTRUCTION LENDING AGENCY F-m Ihereby affirm that more is a construction lending ageriy ror the parfurmarae of Cl r>-. IM work far which oris Permit u issued(See.3097,Civ.C.) DW Q undoes Name ,7 z Lender's Address U 0 1 certify Nat 1 have mad this ap,dIc 0a and sou that the above information is a, f- correct.1 agree to comply with all city and county andinawn and auto laws mating le - rJ U building consaaction,and hereby amhorive representows of this city to cater alien me a move-memioned pmperty for inspcnion paifiieS. (Wer)agree to aaw,indemnify and keep heral.an,City of Caperton against NfA liabilifies,judgmcnu,casts and expenms which may in any Way accrue,againslsaid City C)z APPLLIs Permit. CANT UNDERSTANDS Aticracc of the odamg of tND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7—Z)i'­ SOURCE REGULATIONS. Re-roofs Signature of ApplicamCommouir Oars HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy t applicant or fumrc Municipal Cg e.Chapter a handle ha'aalloud Safety az defined by me Cupertino Municipal Cade.CTapter 9.11 and ere Halm anal Safety Code,Sceian 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Dyes Will in.epplianl or(mum building occupant sac equipment in devices which If a roof is installed without first obtaining an inspection,.l agree to remove t herr admis air conten inane as defined by the Bay Area Air Quality Management all new materials for inspection. stn Y. No I have mad ms. matee harials mequiremenu underChaper6.95ofaeCalifor- riaHcaldt&SafcIyCade.Se ®25505,25533and25534.1u,drsn dthaifthebuilding does net curtendy have a tenant,that It is my responsibility m entry the occupant of the m mcnuwhichm tbeet d Inlssaanccarscenrace. rOcapamay. Signature of Applicant Date f— i> All roof coverings to be Class"B"or better Owner or authorize n Date CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35931019 .00 DATE ISSUED. . . . . . . : 01/07/2008 RECEIPT # . . . . . . . . . : BS000003624 REFERENCE ID # . . . : 08010030 SITE ADDRESS . . . . . : 1149 KENTWOOD AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANDY ULLAH ADDRESS . . . . . . . . . . : 1149 KENTWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS . . . . . . . . . . : 8375 BRENTWOOD BLVD STE B CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513 TELEPHONE . . . . . . . . : (408) 861 9545 FEE ID UNIT-- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -------- ---------- ---------- ---------- ---------- --- --- 1BSEISMICR VALUATION 5, 562 . 00 0. 60 0. 00 0 . 60 0. 00 1EPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40 .79 0 . 00 1MPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 1MRRAA UNITS 1. 00 61. 19 0. 00 61 .19 0. 00 1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 184 .16 0. 00 184 . 16 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 113 SLAB 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL VIM . 0 Cpl a�3� CITY OF CUPERTINO FURNACE/AC �CUPEkTINO PERMIT APPLICATION FORM APN # � 5 0 Date:tolq � - _ z00 � Building Address: xeo4bjjLve Owner's Name: Phone#: U��� l zine- 410b- 73L) ,> Contractor: Phone#: Y61- -' 5 K �el`cc:4 C /,' v� G /off- /r Fax #: /O Contractor License#: Cupertino Business License#: -72 3 SSS Z /l ,// Contact:: Gre ry Phone#: Yo-0- - vrv� .S/D- VVI?-GWl Fax #: Building Permit Info: Elect ❑ Plumb ❑ Mech Job Description: �e /Jl9ce / d14C� 16foA ff/ [J Residential / Commercial For Residential Installations: Attic ❑ 1" floor 2"d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: -57-�-6 Z Type of Construction (Usage Class): Strapped On Platform Bonded El New Location El Replacement Valuation: 6 Z Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO R FURNACE/AC ' CUPER,TiNO FEE SCHEDULE FURNACE: Qty. if Applicable Fee ID Fee Description Fee Group Permit Type MCRAA Furnace M FURN/AC MCREPALT Commercial Mech Repair/alt/add M MCSUSHTR Commercial Suspend Wall/floor M Heater PGASCOM New Gas Piping System 1-4 Outlets P Commercial BSEISMICO Seismic Commercial B / MRRAA Residential Mech Repair/alt/add M MRSUSHTR Residential Suspend Wall/floor M Heater / BSEISMICRE Seismic Residential B / MFLRFURN Install/relocate Floor Furnace M MECPLNCK Mechanical Plan Check M MFR=<100 Furnace Syst<100k BTU M MFRN>100 Furnace Syst> 100k BTU M MRAIRHAN Comm/Res < I 00 BTU M f EPERMITFEE Electric Permit Fee E MPERMITFEE Mechanical Permit Fee M BREMRECEPT Electric Receptacles E PGASRES New Gas Piping System 1-4 Outlets P Residential BPGAS Gas Piping System 5+Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business License B CITY OF CUPERTINO FURNACE/AC CUPEI,TINO FEE SCHEDULE AIR CONDITIONER: Qty. if Applicable Fee ID Fee Description Fee Group Permit Type BCAIRHAN Commercial A/C Units <= l Ok CFM B FURN/AC MCRAA Commercial Mech Repair/alt/add M SEISMICOM Seismic Commercial B BREMAIRHAN Residential A/C units<= l Ok CFM B MRRAA Residential Mech Repair/alt/add M BSEISMICRE Seismic Residential B EPERMITFEE Electric Permit E MPERMITFEE Mechanical Permit M PPERMITFEE Plumbing Permit P BREMRECEPT Electric Receptacles E PGASCOM New Gas Piping System Commercial P 1-4 Outlets PGASRES New Gas Piping System Residential P 1-4 Outlets BPGAS Gas Piping System 5+Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business License B Community Development 10300 Torre Averme Cupertino CA 95014 ` Telephone(408)777-3228 C_ INN - — Fax(408)777-3333 G.Q��'' I�1 ----s - Building De artment JOB ADDRESS: Y 9 Ke t -/ wo v d 9v e PERMTr # O p� ( Q7�� 0 OWNER'S NAME: A ,, d I 4 PHONE # GENERAL CONTRACTOR r-77 FAX # sY I am not using any subcontractors: /— 7- zoo? Signature Date 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 A 1k Glass/ Glazing FV Heating e . - Insulation Landscaping Lathing / Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving . Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /- 7 Owner/Contractor Signature Date