06090124 CITY OF CUPERTINO s �' y `
BUYLDING�D;y1SION PERMIT ON' .RA. TAR IN' l7. A'Y'Ypl� ,
T—
BUILDING ADDRESS A PERFECT CLIMATE PERMIT"0'06090124 -
7507 MO
OWNER'S NAME: PERMIT SUE DATE
GONZALEZ ROBERT 10570 S DE
NE: SANITARY NO. CONTROL NO.
(408) 86119545
ARCHITECTIENGINEER: BUILDING PERMfriNFO MECH
BLDG O PLO O
top LICENSED CONTRACTOR'S DECLARATION - Job Description
:iF I hereby arfinn Net 1 am Ilmared under pmvwoa of Ch$Pter 9(mmmcneing P
re tri Sadon7OQO)of Dividon5ofthe Buri a vAProfeuiom Cadc.arul mIt eenmis
lorutlroraaMUfnk ADD A/C AND REPLACE . FURNACE
tvgZ Liceam Cl ca O lJc.a a`-Z S
i h- Gate '1. L�'• 0 6 Conlnne e c e c "M e,
ARCHITECTS DECLARATION
i U I uMersund my plana MW W sexed As public mounds
A.
G Licensed Propmom al
OWNER-BUILDER DECLARATION
I I bomhy eRrm
that I em exempt from the Contractors Ueensu Law for the
c D O fallowing mason.(Sm6on 703 LS.Businns and Professions Cade:Any city or county
which mquire•permit he construct,aunt improve.demolish,or Wrath any amacture $8896
-i 82 prior As ins issuance,also require the applicant forsueh permit to Nm
e a signcdaWccnt Valuation
used he is lkcnsed pursuant to the provisions of the Contractor's hecto law(Chapter9 Sq.F[.Floor Area
e� (commencing with Section7")ofDPision S of Ne Businessand Professions Code)w
Nal he m I. Nemfmm and the seem for ma alleged exemption.My violation or
Section 7031.5 by any applicant for a permit subjects the Applicant n a civil penalty of ASIN IsIlValftir Occupancy Type
not mom Nan R.hundred dollars($.100).
❑i,w awws of tiro pmpeny,w my employee with wscs u Nehsolecompemdon,
willdo Newark and the aimclum m notemended"offered forsam(Sec.7014,Busiam Required Inspections
and Prafmians de:CaThe Contractors Liam Law doe tat apply man owner of q P
Property who builds ver improve human.and w ho dons auch work himself ver through his
ownemployas,provided that such Improvements am not intended aro@cod formic.If.
h"vevc.the building or Improvemant is sold within one you of mmpicuan,the owner-
builder will haw the burden of proving that he did ant build or Improve for purpose of
sale.).
❑1,as owner of the Pmpeny,Am cochdively cmoaning with licensed conuecmm to
consbua tite projea(Sea 7044.Bnsiness and Profedans Code:)The Contractors Li.
cern law done not apply m an owner of property who builds or improves thereto,and,
who cantraN for sues Projects with a conhsemr(s)licensed pursuant to me Commutes
Liam law.
❑1 am eempt under See. .B it P C fon this reason
Owner Dam
kWORKERS COMPENSATION DECLARATION
1 hereby alrrm under porosity of perjury me of Ne following decleratians:
ham analwill mainW n a Cani6eo ofComnt to self-Wum fon WorkersCmnpcn-
m,as provided for by Secdon 7700 of do labor Cade.for W performanm of the -
work fon which Nis permit is issued. ,
21 have arM will maintain Workers CompemWon Inswan¢,a nequlred by Semon .
Mar the lessor Codo,fon the pMarmaace of the work fon which tiffs permit is awed.
My WorkersAC R�• m artier and Policy number ase:
Cartier. Z7 SnTU Policy No.:I$4BiY001
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thor section need mtbucampicted trust permit Is form hums ed dollen(5100)
or loss.)
I certify mot in the performance of the work for which this permit is Wood,I shall n"
employ any person in any mannerm As At became subject to tie Workers'Compemdon
Lawn of California.Dam
AppllmdL
NOTICE TO APPLICANT:IL aner making this Cenificam of Exemption,you should
West subjea to the Worker's Compensation provisions of the Labor Cade,you muff
.J O forthwith comply with each provisions,or Nm permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[–, 1 hemby.Tran that Nem Is construction ims ing.gamy for the Performance of
�i > the work for which this Permit Is Lewd(Sm.3197,Civ.C.)
Win~. Lenders Name
a z Lenders Add.
U 0 1 certify that I have teed this application W Nte Nu the show Information m
U, (~ correct.I agree to comply with all city and county ordinance and erne laws minting to
O C) building conswction,and hembyauthorine mprescmniva of this city to enter upon the,
> 4 ahmc-mentioned property for irupecdon purposes.
(We)Aetna to save,indemnify and keep harmless Ne City of Cupertingains
o at
„F„rq ImbilWe,judgmenb.mm and expenses which may In my wry acme aSalnnwid City
U Z in consequence of the governing of this permit. ��
ti APPLICA UNDERSTANDS AND WI L OMPLY WITH ALL NON-POINT Issued by: Date l a.
SOURCE EGULATION _
Re-roofs
Sign7lure of ApplicanInCoulrecutr If Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ito Applicants or future building aaupantnwe or handle hmardous material
as darned by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cede.Smile.25511(.)7 All roofs shall be.inspected prior to any roofing material being installed.
0 ❑Ye
Will the applicant or future Wilding medium,um equipment w deviw which If a roof is installed without first obtaining an inspection,I agree to remove
mit 119erdons air emuminsnu AS deRwd by the Bay Amo Air Quality Management all new materials for inspection.
District?
❑Ye No
1 hes read the MmNrwmamrmmmquimmcnu wed rClupter6.95 oftheCalifm-
nuHu1N&S.fmyCede.Smuwu25705.25511a 25534.1" mandthnifdo building
dors not currently sero a maanL this It u y mspowhiliry m maty Uo aaupant of ties
tnqul w ami h m me .w d a c 'ficate ver Signature of Applicant Date
r o te All roof coverings to be Class"B"or better
ownen"aatharbada ant
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36230033 . 00
DATE ISSUED. . . . . . . : 09/15/2006
RECEIPT # . . . . . . . . . : 36060
REFERENCE ID # . . . 06090124
SITE ADDRESS . . . . . : 7507 MOLTZEN DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GONZALEZ ROBERT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : A PERFECT CLIMATE
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 86119545
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- - ------ ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 8 , 896 . 00 0 . 90 0 . 00 0 . 90 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 176 . 64 0 . 00 176 . 64 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OUPE(�TINO
Building De artment
JOB ADDRESS: PERMIT #
- 507 h �-I-z 6(2`f
OWNER'S NAME: an'2&l eZ PHONE # (o - '
GENERAL CONTRACTORec} FAX # 161 9 "eb
I am not using any subcontractors: �L» S,� c
Signature Date
Please check applicable subcontractors and complete the following information
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN# 34- -30 -033 Date:
Building Address:
S0-7 M U
Owner's Name: Phone #:
eco G,ovzoklez a5-5 yu
ContractorPhone: License#:
a Col - y
Contact: Phone: 9Sys Cupertino Busin s License#:
U��',r 4sbl a31S
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: n 4ol A / G e C /� �
C
Residential H Commercial F1 }
For Re idential Ins allations:
Attic E 1" floor lJ 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structuralEl calcs)
Structural Calculations required for new installation
New installation Planning Approval Required
Cost of Project: Type of Consstrrlction: Occupancy group:
4 7N
Strapped On Platform Bonded LJ Sq.Ft. Floor Area:
New Location Re lacement�
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy I BUILDING
( BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 ciin MECHANICAL
ERE4 RHAN A/C Units <= ]0, 000 cf n 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
Ak PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING