04070181CITY OF CUPERTINO -T1'R
•� '�
CONAG'T-OkINF10i "UTI,
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
A PERFECT CLIMATE
PERMIT N%4070181
10500 MADERA DR
OWNER'S NAME:
PERMIT ESE DATE
GAIL ANDERSON
10570 S D
ONE;
SANITARY NO. - CONTROL NO.
(408) 861-9545
ARCHITEC (ENGINEER;
-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
b Descri tion
Chain., 9 (comencing
d unr provisions of Chapm
1 hemby affirm That 1 am lianxde
p
�r
with &clan 70110) of Division Sof the Business and Professions Code, and my license is
in full Tome and c" tZ6 (5g'
LiceoO Clna �..a�� Lic. p
REPLAY iE A/C-
Dem f
I ARCHITECTS DECLARATICittrAUG
p/
I understand my plans shallbe used as public records
AUG •O�
Licensedsional
OW NER-BUILDER DECLARATION
I herebycrchy affirm that I ore exempt from the Contractor'sLiccnnc Law far thefallowing
BUILDING
mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to coronet, altar, improve, demolish, or mpair any structure
prior as its issuance, also requires the applicant for such Permit to File a signed lu ement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant o the previsions of dm Comment's License Law (Chapter 9
(commencing with Section 7110(1) of Division 3 of the Business and Professions Code) at
and the s. for the alleged eanmpllme. Any vWlialon of
that he Ice exempt Ih irelmm bas
.3 4VN*Q"Egr0 0
Occupancy Type
Section 7031,5 by any applicant fora permit subjects the applicant to a civil penally of
n I marc do. hundred dollen ($5W).
❑ I. as owner of the property. in my employees with wages as Noir Ole compensation,
Required Inspections
will do the work, Bad Neslmm es is not intended ar offered for sale (Sec. 7044. Business
and Professions Code: The Co mento r'a License Law does not apply m an owner of
property who builds or improves thereon, and who dos such work himself or through his
own employees. provided that such Improvements are not intended aro@red forsam. If.
however. Ne building or improvement is sold within oo year of completion, the owner -
builder will have Ne burden of proving that he did not build or impraw for purposes of
sale.).
❑ 1, as owner of the property, am exclusively connecting with licensed contractors to
consumer the project (Sec. 7014. Business and Professions Cade:) The Connectors Li.
cents law dors not apply to an owner of property who Wilds or improves Ihemon. and
who contracts for such projects with a commatif(s) licensed pmaaam to the Contractors
License Law.
❑ l un ewrap, under Sao ,B&P C for this mown
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby grim under penalty of perjury one of the following declarallans:
I have and will maintain a CerJBcam of Comenuo alFimmic for Worker's Compen-
sation, is provided for by Section 3700 of the labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insumna, as required by Section
of the Labor Code, for the performance of the work for which this permit is issued.
My Work nm eused Insuran-c carrier and Policy tuber e
Carrier. I Policy No,:
CERTIFICATE OF INN FROM 0 KER '
SAT(
COMPENSATION INSURANCE
(This swoon need not be completed if ine permit is for one hundred dollars ($1 00)
or las.)
1 anify, that in the performance of to work for which Nis permit is issued. I shall not
employ any person in any manner so as in become Object a the Workers' Compensation
Law. of California. Date
Applicant
NOTICE TO APPLICANT: Jr. after making this Ccnifca a of Exemption, you should
become subject m the Weak.,'. Cmalmosatlon previsions of fm lahnr Code, you must
foMwith comply with such infoutsions or Nis permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 thereby affirm Nn there is a conmmctinn lending agewy for dm performance of
the work for which this permit is issued (Sec. 3097, Cin C.)
Lenders Name
Lender's AJdmss
I anify that 1 have mud this application and cute that the above information is
correct. I agree to comply with all city and county mobnanees and sum laws relating In
building construction, and hereby influence mpmsematives of this city to color upon the
abovcmentiuned property for inspection purposes
(We) agree to save, indemnify and keep barmlen the City of Cupertino against
I
liabilities. judgments, costs and expenses which may in any way accme against said City
in consequence of the granting of this permit.
APPUCA NDE STANDS AND WI OMPLY ITH ALL NO POINT
Issued by: Dale`
SOURCE U AT NS
Re -roofs
Type of Roof
Signe o pp Iant/Comraclor to
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding ec,iqu nu smrc or handle hvardoua materiel
M defined by Ne Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
1
CoJc, Section 25332(x)?ri
All be inspected to
Yea
roofs shall prior any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Tut re building occupant use equipment of devices which
Omit harardous air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Dixnicl?
❑Yes
I have mad the harardnus materials requirements under Chapter 6.95 of Ne Calific,
nice Health & SafetyCeam, Sections 25505, 25533 and 25534.1 undersand Naz if the building
Jars e u cumentl have a tenon', Net it is my spos¢ibility w notify Jm Mention, of Nc
rc u' n hm.a .1 daft ' a0 fcamaf DLC, C
cJ �� ®
Signature o Applicant Da
�`�
All roof coverings to be Class "B" or better
�' T
Ownc Odr.dred agent m
r
CITY OF
#UPEkTINO
E
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Buildine Department
JOB ADDRESS: PERMIT #
/-b5oo 1�'l A A DvvJ& I CNOo 0)\x1
OWNER'S NAME: i 30✓` I PHONE # Cf O$--- 0,(6 — %1W?
GENERAL CONTRACTOR: P-eA e o a A- ( :) t iM rte . IFAX#
I am not using any subcontractors:
Signature
Please check avvlicable subcontractors and cmmpleta +ha Fnllnwino infnr m -i n -
D
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
EEE
1
i 1
CITY -OF
UPEkTINO
low
I
CITY OF CUPERTINO
PERMIT APPLICATION FORM
APN # n
Date: Z� �
Building Address.-
ddress:Owner's
BREMFURN
Owner'sName:l
Phone #:
Glr Io
MECHANICAL
s 2 G
Contractor.
MECHANICAL
p � Phone:L cl /
UL
License #: 723 / S g,
Contact: Phone:
Cupertino Business/ License #:
Building Permit Info:
BUILDING
/
Bldg ❑ Elect L5 Plumb ❑
Mech
Job Description:
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
Residential Comm rcial
Meeh Permit Issuance
For Residential Installations:
PPERMITFEE
Attic El 1" floor 02"d floor ❑
PLUMBING
Adhere to min set back requirement ❑
Bldg Permit Fees
or Commercial Installations:
BPLANCHK
eplacement same weight ❑ Additional weight (structural calcs) ❑
BUILDING
Structural Calculations required for new installation ❑
Business License
New installation Planning Approval Required ❑
Cost of Project: '_ Type of Construction: p Vg
GC
Occupancy group:
Strapped El On Platform 11 Bonded LJ(
Sq.Ft. Floor Area:
New Location ❑ Replacement. ❑
Qt if
A lioal@e
Fee ID
Fee Descrintion
FPB C;rniin
BENERGY
Ener
BUILDING
BREMFURN
Relocation of 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
I Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMITFEE
Meeh Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
2