06020025 TTY OF CUPERTINOn�p �r
BUILDING DIVISIONPERMIT �ONTI2 C Q INFI,# 'f 0
BUILDING ADDRESS: PERMIT NO.O 6 0 2 0 0 2 5
10541 LARRY WY
OWNER'S NAME: PERMIT ISSUE DATE
CARIS ALBERT G AND RUTH M 02/03/2006
,E; SANITARY NO. CONTROL NO.
ARCH17ECfiENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Descriptiono O
1 hereby affirm that 1 am licensed under provisions f Chapter 9(commencing
with Senion)gp)of DiW,lon of the Barlow and Profrulnn�y n
it Hemoe is
ni Luc Cleanderce KIT REPLACE FURNACE �� � ®
gz Lkenm Clea tee.
LL'fqJJ Dem Contractor
Y ARCHITECTS DECLA A
Y Cyd dun ad my phi JWl W uxtl u public recnNs
i c
Licensed Professional
RED Is 2006
a Oat I am exempt fo DECLARATION
I hereby snimm on 1 am exempt sfourn
an time Conions Co License Law far the gryry{qqq Ll Hy,
Oo whowwgmuan.�(Section 703 1.5,construct.abousa Pmfemiolih,or eAnypai cityapaunry tT}y l,l iii ltd �,Y''µ"$4 '-o,O
$ which m asses a east re restheJtec ice rove,demolish purnit t fire siren twment _-\n I' 11 `{tj
�^
prior it)its Issuance.Also requires the Applicant Tar such pennitto Rlo ulgned statement u
p-p�< that he is licensed pursuant to to provisions of the Common's Liause Law(Chapter 9 Sq.Ft.Floor Area Valh'ati ❑
rr�$ (commencing with Sado.7")or Division 3 of tie Business and Propositions Cade)or
.. that be is exempt therefrom and the bub for the alleged exemption.Any violmon of
nasi mme0tlu1.5 A"Applicant for a5mci.h subjects due applicant m a Jul Family of r Occupancy Type
❑I.u avear of the pmpeny.or my employm wish wagesu eneh tele cempemadon. .
will do the work.and die mi uue b rot Intended oranmeA forted.(Ses.7W4,Buri.
and Profewant Cade:The Contractor.License law does not apply to an owner of Required Inspections
propeny who builds or im prow Ihemon.and who docssuch work hi msel f or through his
ownemployw,provided toughen impronomema art not intended mannerist forule IL
howew,the building or improvement It sold within oro year of completion,die owner. '
Wilder will have this human of proving that he did not build or improv for purpoa,of
tele.).
❑1.u eater of the Property.am exclusively contracting when flamed c9nuaeton in -
construct Use project(Sec.7014.Business and Pmfeslone Code:)The Costumers U.
cense Taw does not apply to an owner of property-wad hull&or Improv theeon.and.
who contracts for such projects with a contramor(s)licensed pursuant to the Contractors
Lke•.-Law.
❑I am exempt under Sec .B B PC for this mason
Owner Dam
WORKERS COMPENSATION DECLARATION
110 1 hereby affirm order penalty of perjury,oro of the following deelaratiam:
❑1 hsveaM MI]main Wa a Cenifimm of Covent wolf-imm for WarkcesCmnpen•
ution,at provided for by Sudan 3700 of the labor Cade,fm the performance of the
were for which this permit is it=&
❑1 have and will maintain Workers Compemallon Imuranw,as required by Section
3700 of Ne Labor Cade,for dm performance of the wan for which this permit is issued.
My Workers amp u0an 1 mance a 'u and Policy number are:
Caller:_ = PolicyNo.:
CERTIFICATE OF EKEMFnON FROM WORKERS'
COMPENSATION INSURANCE
(Thismctku nm!not We Plemd a We permit IS fmonc hundred"Ini(5100)
in Ices.)
1 unify that in the performance of On,work for which this Permit Is Issued.I shall rut
employ any person in any meaner an as to became sobject to the Woleri Compereadon
Law,of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this CerdRute of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you most
.,O forthwith comply with men imdaims or this Permit shall be deemed mvoked.
?rrNi CONSTRUCTION LENDING AGENCY
Fw Ueeby are.We ft.I.. muuninn leading agency for tie performance of
aG> the work for which this perm is issued(see.3097,On.C.)
aO lander,Nam.
Z)z Lender,Addmae
U C 1 comfy that I haw mad this pplication and sum that the above information b
n.F suspect.I agree to comply with all city and county ordinanw and rote laws mlating to
0 U building const cdon,and hominy sunbathe mpesonutim of this chytoenterunmift
[T] .1oove-men0ooed Property far inspection purpmes.
(We)agree to tete,Indemnify aM keep harmmss the City of Cupertino Instant
CA IlibilWcs,judgment,casts and expeua which may In any way same agalmt said City
U z In comea
g of this Parrott. (� ^-t _ Cie
APPLICNDS AND COMPLY WITH ALL NON-POINT Issued by: Date s!i J
SOURC
Re-roofs
Sigmt Da
X OUS MATERIALS DISCLOSURE Type of Roof
Will the eCuperapplicant ur portion Iwilding occupantnamorand hnnan and Safety U&Rated DY Oct Cupertino Muni'pal Code,Chapter 9.11,and tie HcJth antl Safety
Cole.Section 15532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym o
son the applicant or tome w�dingaaupam sax equipment or dcvima which If a roof is installed without first obtaining an inspection,I agree to remove
...a Iso a mut,nor conuminan0 d riwd by de Bay Ama AirQuality Management all new materials for inspection.
District?
❑Yos Nu
Ihavemadt less tome mamriabrequiements under chapter 6.95 or the Calofor.
nl olNZid do troru25505.15533 and 25534.1 undcnuad thin lithe wilding
d t cu I' aw tenant,that Itpiny respomihlilty in notify the ecu i of eno
requ ich ubemupda tri umccorsCmunmmyf) n.y G Signature of Applicant Date
uanamho gam G Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
I• 1 of 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31602019.00
DATE ISSUED. . . . . . . : 02/03/2006
RECEIPT #. . . . . . . . . : 33079
REFERENCE ID # . . . : 06020025
SITE ADDRESS . . . . . : 10541 LARRY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CARIS ALBERT G AND RUTH M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2034
RECEIVED FROM . . . . : ATLAS TRILLO
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
IRE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 1,700.00 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ----------'-----"---------- --------
301 ROUGH ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO
FURNACE/AC
•,UPER,'TINO PERMIT APPLICATION FORM W,10 b?5
APN # 316 - 0a o/9 Dat • O
Building Addresl: 2-4 (
Owner's Name: cct�y,S. I y4 honS� _SS�
Contract IG S r , ` p C l Ph Gy 3�_DTI icense#: 3:7Contact: l � V f'� l Ph ` t t CupertingoBusi ess License#:
Building Permit Info: !�
Bldg ❑ Elect Plumb 0" Mech
Job Description:
Residential Commercial ❑
For Residential st lations:
Attic ❑ 1 s` floor nd floor❑
Adhere to min set b ck 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: I, Type of Construction: v Occupancy cup.-
Strapped El On Platform El 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 cfin MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL
BREMRECEPT Recptl, 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 I Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING