05080108 E'_U, D
TY OF CUPERTINO
BUILDING DIVISION PERMIT baCQ)NTRACTOR INFORMATION `.
INGADDRESS: PACIFIC COAST MECHANICAL PERMIT ND05080108
0so MC CT.RT.T.AN PT)
ER'S NAME: PERMIT ISSUE DATE
WALTER S . HOEFLER HOE637 MINDY WAY OR /12/2005
E: SANITARY NO. CONTROL NO.
fN!
.
(408) 365-0284
ARC HITECrfENGiNEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
°Oo LICENSED CONTRACTOR'S DECLARATION
wF 1 hereby affirm mm I am licensed under provisions of Chapter 9(Commencing lob Description
Zw with Section of Division 3 of the Rusinav and Prolmiuns Code.and my licrose is
iicenseClara Lic.N
and err«L
p L full force REPLACE 3 A/C UNITS W/ 1 UNITS
g?
I;,p Date Co.(.,---
ARCHITECTLA
S DECLARATION
z< I understand my plans shall E used u LA records
tau
s o GLicensed Profcssionsl /
`y:1 �, out I..OWNERexempt R DECLARATION
<Y 1 hereby.(Tete on I am exempt
from the Colons CM :License law for the ,
i.
00 following reuoa Perm(t ](nsu Business and improve,
demolish.
Cale:Any city or county S
$ which requires a peanit re cores Um alteq nt for
demolish,tie a sig any is men $7500
-¢i priorm its issuance.also requires the applicant for such permit to tilt aaigneJ suleme I
S
< IhatW is licensed pursuant o the provisions of live COnlracxrf Li,xuc LAW(Chapter 9 Sq.Ft.Floor Area Valuation
EH S t(commencingheisexempt
Section 7000)of bastson 3 or NC Business eaxe m t Prorouson.Any vi Code)of
Nal he is exempt Therefrom and or bur for bj alleged exemption.Any violation of
Section7031.5this five
any applicant for a permit subjects the applicant w a civil penalty or Occupancy Type—
act
mt,m than R.e wnamd dollars
P Y
❑I.As owner of the Property,or my employees with wages As their xle Compensation,
will do dm work and the structure is not intended coffered Tomato(Sec.7044,Business
and Profcssiuv Code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves Hereon,and whodocs such workhimself or through his
own employees.provided thatsach impro omen Area no,mixoded oroBeen!fmaale.If,
however.the building or improvement is sold within one year of eamplction,the owner-
builder will have da burden of proving that W did not Wild or improve for puryose of
sur.).
u..or of the props xelusivcly contracting with licensed C.00.c W.to
comwct IW prod",(Sec B siness and Professions Code:)TW CCommo 's Li-
Co.
cove law dors not sppl b er of property who Wilds or Impome,Nerem.Nd
who Contracts for such rojec i aconVazlor(a)licensed pursuant to me Convactor's
License Law.
O lam exempt on Sec. ,B&PC for this mason -
r
Data L OS _ _ _ - ..
COMPENSATION DECLARATION - _'_' ------
- -
1 hereby affirm under penalty of perjury one of the following declarations:
Into of Consent to scIf.mure for Worker.Compcn-
.ton,as provi or Ci n 37W of me labor Code,far the performanm of the
work for which this pe it' i tied.
ve and will maiarker's Compensation Insurance,u required by Section
3]00 of the labor e,f aperformanee of the work for which this permit is issued.
My Worker's Cc 6 n waranee Cartier and Policy number an:
Cartier. Poll,No.: _
E ATE OF EXEMPTION FROM WORKERS'
CO P!N ATION INSURANCE
(This section two I c m letedirthepermitisforanchundmddollau(SIIX)I
CA')
I ccoiry thne
m"in e pe m n, of he work for which Nis permit r issued.I shall not
employ any perwni any an r um Wcomcmbjccit.ft Workcrs'Compensmion
Lawson Califomia aN
Applicant
NOTICE TO APP IC ,ar making Nis Cmiticale of Exemption,you should
become 3 1 to 'speCompcvadon provisions of the lab«Code,you most
�z forthwith Comply with such provisions or this permit hall W deemed,revoked.
z y CONSTRUCTION LENDING AGENCY.
[-+ Thereby affirm mal inert is.Covtvctim I.Mingapeay for me performance of
tYi
the work for which this pert 'ter is ^d(Sec.MG.CO,C.)
(y Lenders Name lT/
r7 z Lenders Address
U Q 1 ccnify mat 1 have read this applicadon and sus mal the shore inrontroom is
gy f"' Comes I agree m CIArply with LI city and county on inaneu and sum laws relating to
0U Wilding consume hereby atomire mprCxataliK¢of this City to enter upon me
Faahovcros,juA p prig (orinspcction purpowhich way
(We) .4 ,indemnify and kap harmleas dus City of Cupco int,against
rA incoiseque m u.fos and expcnusmit. may in any way accrue against to Diry
t„)z in eonseque cc
thrJgr ling of this permit
" APPLICA D R ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE EG L S.
Re-roofs
Signuu o i UConuacmr 6.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding o tupant store a handle harardou material
As dcfincd by the Cornettist,Municipal Code.Chapter 9.13.and the Health and Safety
e. es z25532(.)'0 Yv vv....fy'''' All roofs shall be inspected prior to any roofing material being installed.
�ADu
Will the applicant or future
building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
it ofnWoonamus u defined by the Bay Area Air Quality Management all new materials for inspection.
t smiclT `J
❑Yes Tp No
Lha m Imsmwdalmryuimm"nuuntkr CMpler6.95ofthe C&iifor
ria Hexlth aft ode edov25N)5.25533am125534.1..de mdmuifthc Wilding
�0.nc,
.f "rail ape LL'nanr.mdl it IS my reapnmilliliry b noJly IW aCUparll of tet
, sew hm Wmetpooruissoanat,f.Certificateofaap.n . Signature of Applicant Dale
2 6S'
orcein Jagenl ,te All roof coverings to be Class"B"or better
CITY OF CUPERTINO
FURNACE/AC 695�?b
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
/ 3 3 g t2
Building Address:
u 1 o
Owner's Name: P ne#-
c NUE 31y -9y1
Contractor: �, v License#:
LH AFIC COW NE-CHAaiCOL
Contact: c Cupertino Business License #:
R!l vRRis� Ow�rrA �v
/tdymnrro2
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description: O 13 71Wr r
E'Pc Cr3 R c Wiirr 4.) i Py 17/c r Tour Nei,
Residential ❑ Commercial
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor❑
Adhere to min setback requirement[]
For Commercial Installations:
i� Replacement same weight ;�;, Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost f Project: Type of Construction: Occupancy group:
`4 7s v 7yPC' S I h/w
Strapped On Platform Bonded ❑ Sq-Ft. Floor Area:
/ 14'l L
New Location ElReplacement � .�6
Qty. if
A licable Fee ID Fee Description Fee Grou
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
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE RICIa Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR,INF®O_ RMATION
BUILDING ADDRESS: QUICK PLUMBING INC PERMIT NO.05080208
OWNER'S NAME: PERMIT ISSUE DATE
FATEKH VERGASOV 656 E TAYLQR - 41 OR /21 /2005
NE: SANITARY NO. CONTROL NO.
(408) 732-1220
ARCHI=ENGWEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
�Oo LICENSED CONTRACTOR'S DECLARATION
C 1 Mmby affirm Nat I am licensed under provisions of Chapter 9(commencing lob Description
b with ScCliutIM)of Division 3 of Ne Business Mal Pmfcssions Code.and my Requests
inlullImea _ �p�S2( WATER SERVICE REPLACEMENT
q z Lica. las o Lie.'
F n Dale Comuamar
ARCHRECrS DECLARATION
v1 understand my plans shall be used as public mentis
spy
Licensed Professional
S OWNER-BUILDER DECLARATION
f I Wmby aRnn
out I em exempt from the C4ttrxclors License Law for the
p a following mason.(Section 7031.5.Business and Professions Code:Any City or County
3 i< welch mquinus a permit to Construct,alcor.improve,demofim,or repair any structure $1200
prior in its issuance.also tequiru the applieanl for such penniuo file a signed smmmcut
-�<
that he is licensid pursuant to thc provisions(if the Contractors License Law(Chapter 9 Sq.FL Floor Area Valuation
Yee (commencing with Section]000)of Division 3 of the Business and Profession Code)Or
u $ Nal he u Cumpl therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicants for a permit subjects she applicant to a civil penalty of
not mom win five hundred dollars(00(f). c Occupancy Type
❑1,a owner of the property.W my employees with wages as their Cole Compensation.
will do Ne work.am the annum is not intended or offered for We(San.70th,Business;
and Professions code:TOO Contractors License law dons not apply in in owner of Required Inspections
property who Wilds orimproves th"conand whodmes suchwakhimselfor through his
own employes,provided that such improvements are not intended aroffeied for We.If.
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving Nat hat did not Wild or improve for purpose of
ale.).
❑1,as owner of the property am uClusively contracting with licensed mnoeemn to
com uct the,Project(Sec.7014,Business and Profwions Code:)The Contractors Li-
anas law does not apply to an owner of property who Wilds or improve thereon,and
who convects for such pmjeets with a cormoctor(s)licensed pursuant to the Contractors
License law.
O I am exempt under Sec. .B&P C for this..on
Mr Dam
WORKER'S COMPENSATION DECLARATION
1 hereby all under penalty,of perjury one of Ne following declarations:
1 ham and will maimvin a Certificate of Caroms to self-insure for Workers Compm.
13700of
on,as provided for by SWuon 3700 of the Labor Code,for the peAormaWc of the
k for which this permit is issued.
1 hese ars]will maintain Worker's Compensation Insurance,a required by Section
the labor Cede.for Ne performance of Ne wok for which Nis permit is issued.
WofkceC ado.mormsce cart."aM Politypyr�tpC'am:tier.�l Policy
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTissectlon need not be Completed lithe Perris Is fmrone Eundauddollars(SIM)
or less.)
1 l'Crhfv too in Inc performance Of Ne work for which this pc.it Y lamed.l shall nm
employ any person in any mammy so as to become subject to the Workers''Compenauon
Laws of Celirofnia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workers Compensation pmvisions of the Labor Code,you must
.J,Z forthwith comply with such pnviaions or Nu Permit shall W deemed mvmked.
'ZO CONSTRUCTION LENDING AGENCY
ce Ihereby stints that there u a construction lending agency for the peformmen of
C the work for which this permit is issued(Sec.3097,Ci,C.)
V4 25 Lenders Name
= Z crs Address
U Q 1 certify this I have mad Nis application sed sum Nat the above
Wve infCammUm is
LL.F COMM P agmC to Comply with all city Md county mNlNnas and slam Iowa leasing to
0U Wilding construction,and hereby authorim mpresenalives of this city to enter upon the
1 aWVC-memdonea property for inspection pmrposea
(We)agree in ase,indemnify and keep harmless the City of Cupertino against
ifA Pian"ties,"' 'innu.costs end apensea which mayineny way eccluc against WdCisy
U z A PLIC NITcUf the tr N of AND WILL COMPLY WITH ALL NO POINT Issued by: Date
URC REGU A S.
Re-roofs / 5
Sigmetre ofApplcanVCon clot Date
OUS MATERIALS DISCLOSU Type of Roof
will tic applicant W forum Wilding occupant store or handle harard.us memrial
as defined by Ne Cuponimm Municipal Mc.Chapter 9.13.and the Health and Safely
Code, 25532(a)7
ny. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occuWol use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
is hmardoms air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
inrioR "
❑Yes dy
ve mad the hvaMmu mamriais requirements under Chapter G95 of the Cal ifor
nice calth SafctyCadc, '.25505,25 Sand M534.1undcomnd Natifdre Wilding
d not C Molly hoc n a Nes it its respowbili y in notify the WCUPam or the
Coq tswmm�m 1priWto vanaoncertir,moraa Signature of Applicant Date
Owner On authomcdage D All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
k Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JO ADDRES PERMIT #
14?Z1
12.�. 00 -r-Ob=0 20 C--
OWNER'S NAME: .g4-er- e2GwS0 i/ PHONE #W- 73Z — /226
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
60 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 �x Plyh ti
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Z
Owner/Contractor Signature tate
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO .PERMIT APPLICATION FORM
APN# 3s / o / Date:
g-,23 -OS
Building Address:_2112?1
C ��
lV 2fjl
Owner's Name: ^ ` Phone #:
✓� >�eC/ Veg_6A_3o C &so - Gs- 3773
ontractor: Phone: License #:
It t. Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: (�
IAV 4Q.
Residential 71�_ Commercial ❑
Cost of Project:
e
Qty. if
Applica Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFLYTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE L Sewage Dis osaI PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
3 077
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