No preview available
06050099 CITY OF CUPERTINO --� s_ 0 M. AT -BUILDING PERMIT "��•BUILDINGDIVISION ' Id BUILDING ADDRESS: - b , MAGIC MECHANICAL SERVICE PERMITNO'06050099 10381 LINDSAY AV OWNER'S NAME: PERMIT ISSUE DATE JIM PAGE 1681 MILROY PL 2006 SANITARY NO. CONTROL NO. (408) 978-6181 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH loo LICENSED CONTRACTOR'S DECLARATION Job Description ! 1 hammy affirm Thal l am licensed under pmvislans of Chapter 9(Commencing With Section 7000).f Di,1.1.M 3 ofMC Business and Professions Code,marry license is in full fameand ette= �Z.h / 2 �j z jZ ADD ON A/C FINALED J? Licesuc°lase e Lic.P A d /�L t Dam S /1 A CHR C 5 DECLARATION 1 understand my plans shall be used as public menrN )yU Q `o0i3 Licensed Professional JUN S- 2006 OW NER-BUILDER DECLARATION �q 1 hereby aRrm Nat I am exempt from the Convenors L.ieenu law for th d O g following moan.(Section 7131.5.Business and Profession Cads:My city m coemy ee S� which mqulres a Permit m conewct,alum Improve,demnlah,or repair any structureno all prior to its issuance.also requires theapplicant for such permit m F.I.a signed statement x< mai Its isllceoad Famous to sloe provisiaut of the Contractor's Li¢mc LAW(chartn9 Sq.Ft. Floor Area I [�$ (eemmemmj wine Section 701 of Division 3a(the Buid.and Professe.Code)., r3— this he is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant w a Civil penalty of M Mrhber U Occupancy Type Out mom then five hundred dollars(ML , I,u owner of Else pmpmy,w my employea with mg=u they mleeompemWw,. anddeneewarle andx; he Conihmrs Laces LAW CIdforaapply M as Onomen Of Required Inspections pro ertyProlh lou Code:The wsthemers ndwho law uch Cot apply lf rt owmr is q p property he b.provided that exneimpoom ems me uuchwdedaraffeer tivaualt Iter Cm employees,provided Net vete improwmenta am not u of completion. aron.rcd theals.r- ' however.Me Wilding arImprowmmtlshold WithinamyouormpownfrCiteowner- builder N0 haw the bmrrden of proving Out k did no build or Mprow for purpose of able.). ❑1.as owner of the property,am exclusively contracting with licansed Conuaclars to mmmuct the project(Sec.7014.Business and Profusion on Cade:)The Ctru7ars U- cave Law dna not apply le an owner of property who builds or Improve Mount.and What contracts far such prolene with a contra uni licensed pursuant to the Cantrumrs ' License Law. [3I are exempt ander See ,B B P C(m this mum Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane;(the following declatolose 1 ham and will maintain•Cullinane of Comer In self-alum Its WorkelaCampm- War.u provided for by Section 370D of the Lothar Code,res Ne performance of the work for which this permit Is issued. ❑1 have and will maintain Workers Compeeation Irwrmce,as requirod by Section 370Dof the Labor Code,(m the perfe mous:Cruie wart fn which this permit is lasted. My Waters Compensation Inwmmas Carrier and Policy number m: Carrier. $4.txr I 'P Policy No.:16 2 If fa 2 3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA71ON INSURANCE v (Tota smtion steed Cot be completed if de permit is(roam hmtAed dollars(SIM) arta.) I certify that In the performance of the work fa which this permit is bound.l shall and employ any Forma in try mwner an u m become subject mute Warkea'Compansaden Laws of California.Dam Applicant NOTICE TO APPLICANH If,after making this Cmillnm of Exemption,you should became subject m the Workers Compensation provisions of the labor Col you mum vJ 0 forth Wine Comply with such prevision or mu permit shall W deemed mooted. z rrN., CONSrRuc T10N LENDING AGENCY [-t Ihereb1 affirm that Nem u a Comuuctim lending agency for nee performance of rL>, the work for which Unix permit Is issued(Sec.3097.Civ.C.) Q Lender's Name z Leaders Address U O I certify that 1 have mad this application and sem dal nee above in(ormatiun u ly Pcomm.l agree in comply with all city and county ordinances and some laws relating to U building Construction,and starchy sultana,represmmives of this ity to enter upon Ne 4r7 ;hove-mentioned property far inpectian purpoaca. (We)agree to ave,indemnify and keep humleu the City of Cupertino againt rex liabilhda,Judgments.casts and experua which may in any way amus agalmt said City Uz in cmaquenm of the grufing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ,� 6/ SOURCEREGULA77 Re-roofs Signature of Ap rDam,1Type of Roof HAZARDOUS MATERIALS DISCLOSURE WIII the applicant mfactum building aeeuputnom or handle Health anmaterial a de0ned by tiro CuPenino Municipal Cade.Chapter 9.12.and tiro Health and Safety Code.Section 2553x.)7 ��y/// All roofs shall be inspected prior to any roofing material being installed. [:]Y. Iy No ., Will Me applicwt or farm building occupant uta equipment or tkvices which If a roof is installbd without first obtaining an inspection,I agree to remove emit huaAn=air conuminnts as dcOxd by the Bay Area Air Quality Management all new materials for inspection. Diwin7 ❑Yes I have mad lhehuaNswsnumrialsmqu'nenems underCNPtu 6.95 of the Cali(or nix H=IthikSafely Cok Sa-tiou25505,25533 and 23534.1 mskvmwtd nese lime Wilding does Cot currently haw a goons,dint It W my responsibility m scary dm aceupmt of the mqulmments which m�um be met poor missusrmcof a CerfdOc.w of Occupancy- Signature of Applicant Date � Vex S - ! �" o 6• All roof coverings to be Class"B"or better Owner a wtharisd;gem Dam s Community Development 10300 Torre Avenue %w ,' 1 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 gVUPEkTINO Building Department JOB ADDRESS: PERMIT# o ' L'.> c/s'2. ✓. �6o Soo � � OWNER'S NAME: PHONE # o •'ZS�S= d 79/ GENERAL CONTRACTOR /L/ r a sr:r' AX # I am not using any subcontractors: or.. 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 Glass / Glazing Heating 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 �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36912013 . 00 DATE ISSUED. . . . . . . : 05/11/2006 RECEIPT # . . . . . . . . . c 34358 REFERENCE ID # . . . : 06050099 SITE ADDRESS . . . . . : 10381 LINDSAY AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JIM PAGE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . : , RECEIVED FROM . . . . : BORIS SHEDRIN CONTRACTOR . . . . . . . : SHEDRIN, BORIS LIC # 21762 COMPANY . . . . . . . . . . : MAGIC MECHANICAL SERVICE ADDRESS . . . . . . . . . . : 1681 MILROY PL CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 978-6181 4kEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BREMAIRHAN NO.UNITS 1 . 00 10 .26 0 . 00 10 . 26 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 3 , 000 . 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 161 . 93 0 . 00 161 . 93 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 161 . 93 AMEX TOTAL RECEIPT 161 . 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL • CITY OF CUPERTINO FURNACE/AC *UPERTINO PERMIT APPLICATION FORM APN # Date: - i -o 13 - Building Address: 1038 Zi H afsa, t,/- Owner's Name: Phone #: Z Pot ,,�,, Contractor: Phone: License#: 6< 0� 62�'23Z Contact: / / Phone:: Cupertino Business License#: 4. S/P all- i� �r , % oL'/Q/>C7 Building Permit Info: Bldg ❑ Elect Plumb ET' Mech C� Job Description: �r G? C� dH (!�3 . Residential Commercial ❑ For Residential Installations: Attic ❑ 1' floor ❑ 2nd floor❑ Adhere to min set back requirement, or Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required Cost of Project: Type of Construction: Occupanc oup: Sq.Ft. Floor Area: Strapped On Platform Bonded © New Location ❑ R lacement ❑ 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 BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMTfFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS I Gas Piping System Fee PLUMBING BUILDING BUSLIC Business License