00110060 CITY OF CUPERTINO
inuu.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AD9990 MANN DR PHOENIX HEAT AND AIR Pr:RMITNO00110060
OWNER'SNl M D ET AL 1725 RODGERS AVE APPLICATIO r� �UU Y..:rATE/2l?LTU
PONE' (408) 487-0390 SANITARY NO. CONTROL NO.
G m Z ARCHITRCDENGINEER: BUILDING PERMI'I'INFO
mp
O HLUG ELECT PLUMB MECH
I—I I=1 1_I I.I
yard
zva I.IC[NS[UCO,ensed unOR•ti DECLARATION Job DCSCllpllon
I FcrcM xflirm tM1m 1 am liamal ander Pnrvisinns of Chap4•r 4(commennng
`-` whh s.i�ln,n rik)I,,,rD':: r Che un.m�..�n<rrr„Ie..innecnJ,:.end my rein. FURANCE CHANGE OUT
a ior Lie.. aw
O w O 1 tell
Contra r yr
3 u!' ARCH]IHC'I'S DECLARATION
(= O I undersl:nul my plan,.hall W u,ed m puM1e rceadd., '
ce�p O LiccnseA Pmfcssiunal
E: OWNI?R-IIUBD
. HPDliC1.ARA'IION
X
o a, I hereby allino that I am exempt Ilona'
rom the Commucmr's License Law for the
1-i e following=son.(Section 7031.5,Budw%,and I'mfessions Code:Any city an county
`2n wM1M1 rcquit, tmscl,alt ,prose.dentaltd,arispairy,ounure
i 3 Pols I le y :Ill 'III' ll I p 'II y d:Imcncnl _
Ina be ba,mcJp : t, the p m l'the Contractile,License La (Chapter9 Sq. Ft. Floor Area ValuatignD
e
(commx ng eah Section 7000)of Division 3,f the Ru.n d Pr f: ns Cole) T VJ
or that he is exempt Ihereforn and the ba,iv For the alleged exemption.Any violation
of Seclinn 7031.5 by any up..licanl for a pcm,il suhjeds the applicant to a civil Ixnolly �y ,,,},�
of no,more than lire hundred dollars(S500). AP.�N�t-u `+Y7�4. Q10 Occupancy Type
J�.,4
❑L d owner of the and
he y,m my employer,let cs wire wages xs a dr....1.(Sea 7094.
will do the work.ono Ill seacroft C WI i ttandcd ere Law for snot(Sec.71W4.
owner of and property
Who
ode:The cant therss,and w Law does u nm apply Io an 30 L — ROU6Hq Uii°ns
onr of property W nn bouts per;minae,Ihaccn,and who Joss such work ni ed or
o...Ifo,his awn,,play,'.provided thin such impmc eoldu inormayearo 303 ROUGH MECHANICAL_
oRcmd Ino sale 11,however,the M1uildng or Ilnprnvenanl is old within one year of •-) '
iellpletinirde -.v,Nildsrstill false thehrdcnofprovingthat hedid no[build or 304 — ROUGH ELECTRICAL
mprove for purpose of sale.).
❑Lasawmnoflhepmped'.oto,xdaslod,a'imeor,with har. mseecomoacun,tu 505 — FINAL ELECTRICAL_
Lae,nmthe p,,,jc l(sea.I(ua.Business and Prof—i....Carl The Canleer'% 507 — FINAL PLUMBING
ie<nse Law does not apply to an owner of pn)pery who builds or improves thereon.
and who contracts for such pmjecl,with a(onlranry
on.o licensed puuant to the 500 — FINAL MECHAN I CAI_
Comme,no's Liven,.Law.
01 an,exempt under Sec. .B h P C for this rcasun
Owner Dat,
WORKHR'S COMPHNSAT]ON DECLARATION
I ne,by affirm muter Penalty of perjury one of the following declarations:
1
ha
va and will maintain a CaMlicale in Consent to self-imam for Worker's ,
omped
. on. ass plan sided for by Swtlon 3700) of the Labor Cole, for the
perfoream ee of the work for which this permit is issued -
❑1 huv will maintain Worker's Cumpcn.anion Innnrance,as required by Section
37 it the Labor Cole,for the pcdoom...a of the work for which Nis permit is
.ad,My Worker's C"mpemaion liscreara currier and Policy number arc:
Gorier: rtJ( ,. —policy No.:A19/30231
CERUFICA ION OF EXEMPT PON FROM WORKERS'
COMPENSATION INSURANCE.
(Thi,union need not be v... flencil if the permil is fm one hundred dollars .
(51 0(11 or less.)
I candy(hal in the perlldmance ol'the walk for which this Ixrmit is Issued,I - -
shall not employ any Perron in any inunner so u,to vaccine subject to the Worked'
Compensation Laws of California Dare
Applicant
NOI'IU?'1'0APPLICAN'1:It,olicrnmking Ibis CeAOcane of Cxco,non,you should -
lxunc subject the Worker's Comrynwtion Prov sine'of the Labor code, no most
O Qa
foMwill,comply with such Provisions or this permit shall h deemed revoked.
z CONS'I'RUCI'ION LENDING AGENCY
71 M1etehy affirm that there is a construction lending agency for the performanca
W of the work for which this permit is issued(Sec.3047,Civ.C.) -
Iy G]
[.code,s Name -
7 Londa',AAJ'cs
U O I calmly that 1 nave read(his application and ,are Nm the olive information is
fs. correct,1 agree m comply wit,all city and could,ordinances and nate laws,doing
O O holding mmmdnion,and hereby aoa1owreprescnlxtivcs of lhi,ally m enter,on
iy ry the abve.mcmioned property for iospecdon purposes.
We)agree tsave.innd cxvxmW keep ihamnless mayinthe City ofcopartner
against
said
N Cnst
i,v;tics,judgments,caps and expenses whish may in any way acme against said
U 7 City'm ml au,mc of the grunion,of dM1....n on. .
ANN UNUBRSTANDSAND WILL COMPLY WITl1 ALL NON1'OINT Date
IsSUedbY'
NCE.RCGIyJ�IONS. /� �
signanlleorApnp.nwcolmneaal Dam
Re-root's
HA%AHUOUS MArER1AtS UIgCLOS handl
Will sax eppucert or stun:Ladling e.chant moan,,and
handle Head,an material Type of Roof
a.defined by the 32m)?nu Municipal sole.Chapter 9.12,ane the Health and Safety
G,Jc,Section 25532(u)'!
O Yes LINet All roofs shall be inspected prior to any rooting material being installed.
Will the apprc:onorromrebmldmg,wanpan,use cyinproarit dosce,wh1ch If a roof is installed without first obtaining an inspection, I agree to remove
emit nma,doos alruodaminnntaan defined by the Bay Amo Air Qunllly Managcmem
metr all new materials for inspection. Applicant understands and will comply with
0I'e` 0 N all non-point source regulations.
I have rend be Imm,dous mammal,vae,oamolocaux order Chapter 695 of the -
Califrunia Health K Safe,,Code.Section,25505.25533 end 25534.1 understand the,
d the hila; ado[ or I currently have a tenanuhat it is my respomibility e,mafy the
occopmn be rcyuirAan'cnks which nest be ,le prior or issuance of.Ccrdhcnfa of
O<ev pee).
Signature of Applicant Date
d
-owner„malltodaed agent All roof coverings to be Class ”B•'or better
OFFICE
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY # 3
Sec: Twp: Rug: Sub: Blk: Loe:32645009.00
DATE ISSUED..... . . : 11/13/2000
RECEIPT 4... . . . . . . : 13994
REFERENCE ID # . . . : 00110060
SITE ADDRESS .....: 10390 MANN DR
SUBDIVISION .......
CITY ... . . . . ......: CUPERTINO
IMPACT AREA . . .....
OWNER .. . . . . . . ....: MAPLES M D ET AL
ADDRESS . . . .......:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1141
RECEIVED FROM ....: DAVE S
CONTRACTOR .......: LIC # 21379
COMPANY . .........: PHOENIX HEAT AND AIR
ADDRESS . .........: 1725 RODGERS AVE
CITY/STATE/ZIP . . .: SAN JOSE, CA 95121
TELEPHONE ........: (408)487-0390
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMFURN NO UNIT 1.00 12.21 0.00 12.21 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
---------- -------- -__
PERMIT : 47.73 0.00 47.73 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 47.73 2913
TOTAL RECEIPT 47.73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---.----------------- ----- -------- ----..................._....
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
i