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05070133 CITY OF CUPERTINO ��' �• " -- '� ' ' BUILDING DIVISIONPERMIT ' Ci�NRAGTC1Ii IN�'t�'�vIATIO: ' n z F :1: e^ xc BUILDING ADDRESS: ALP4INE CUSTOM PAINTING - PERMIT NO.05070133 10833 NEWS NAME: PERMIT ISSUE DATE WAGNER KATHY 16580 RUSTLING 5 NE: SANITARY NO. CONTROL N0. (408) 779-9626 ARCHITECTIENGiNEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH O �0o LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing with Section 70010)of Division 3 of the Business and Proflessfa s Code.and my Become is a in fullforeeadeffa REPLACE EXISTING FURNACE AND A/C Lem. Clw Lic M ns. Dau Contactor ✓ q ARCHITECT'S DECLA A 71UN ooZZ I undcnund my plana&hell he used as public rcenrds G Licensed Professional OWNER-BUILDER DECLARATION <f I hereby affirm that I am exempt from the Contractor's License Law for the $ following mason.(Section 7031.5.Business and Profexsims Code:Any city ar county which requires a permit to construct,elect,improve,demollah,or repair any structure $4280 412prior to its issuam,alas mquirm me applicant forsuch permit to file a signed suumem —fifimat heuthelncu licensedpursuanttoprovisionsofNeConr'sLicenseLaw(Chapter9 Sq.Ft.Floor Area - Valuation (commencing with Section 7")of Division 3 of me Be.!..and Professions Code)at '� .. that he u exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects me applicant to a civil penally of r U U Occupancy Type not mom Nan five hundred dollen(5100). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the swctom is nmirmaded ar offered for side(Sec.7044,Became Required Inspections and Professions Cade:The Communes License 4w dors e trot apply to an owner o! q P property who builds munitions thismon,end who does such work himsel f or INough his own employees,provided thatsuch Improvements me not intended oro0ered fm We.if. however,me building or Improvement is and within one year of impletion.the Owner. builder will have the burden of proving that he did Out build or Improve for purpose of t ask.). ❑1,u owner of the progeny,am exclusively contracting with limited eatnetors to construct tit,pmjcct(See.7001.Business and Professions Code:)The Contractor's LI- crna law does rot apply to an owner of pmperly.who builds or improv themon.and, who contracts for such projects with acontrumr(s)licensed pursuant to me ContractoYs License Lew. &FINALE® ❑lam exempt under See. B&P C far this recon O'tlig'._w �t Or Date WORKER'S COMPENSATION DECLARATION I hereby a(Bne under penalty of perjury one oftite following declarations: I h �g 0 ham and will mountain a Certificate informant in selfdnsum for Workiies Compen- ��� VY 2005 sedan,as provided for by Section 3700 of the Labor Code,for me performance of the work for which this permit k issued. aa� ❑I haw and will odejon he performance er or Compensation Insurer=,ss required it Section �'9 3700 oath and will maintain marker's Compensation work faer=,a thiapred by issued. (� fddp My Worker's Compensation Insurance carrier and Policy number are: t Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mir ire m,need not be completed ifthe permil Is f rronc hundo ddollan($100) or less.) I«r ify met in the performance of the work for which this Permit is issued,I shall not cotployanypenminan marncranssto beco rvb' Lto tie Worken'C ;;Nfion Laws of Cslimmia AO0GCE NOTICE TO AP m Work L after me in,the cess of Exemption,o d you mould become subject to it Worker's Coons or this provisions Of de oned rCada,you muss z foMwim comply with such provisions or this permit shall to dermad¢yoked. 'Z'O CONSTRUCTION LENDING AGENCY t;-i nom+ I lummyalrirm met mem ts•mnstmcim.lendinga,mey for the pedarrOar of he work for which this permit is issued(Sec.3097,Civ.C.) {Ta Q Lender's Nam. , Z)Z Lender's Address V p I certify met I have read Ws application and suss met me above information is I,Fcorrect.I agree to comply with all city and county ordinances and suss laws relating m - C�)- building convection.and hereby audience representative;of his city to enter upon fie F Wahoy-mentioned property for WpemOm purposes. ve LL (We)agree to a ,indemnify and keep Imposes the City of Cupertino against i.y rA liabilities,judgments,eau and exporters which may in any way me.&,&lost aid City („)7 In consequence of me graniing of oris permit. F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Datev7—Z/-- SOURCE .TONS,_,, _/ -7A11 ps Re-roofs (43 'SAt'-L� Signature of ApplianUCont actir Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ter fumm building occepritstme or haadlc haardous material as defined by the Cupenino Municipal Code,Chapter 9.12.and the Health ad Safety de,Section 25532(x)? G� All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will tits applicant or future building«eapant as equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air conumin ems a dcftted by the Bay Area Air Quality Management all new materials for inspection. District? [3 Yes W" I have readthe haamdnusmaterials requirements under Chapter 6.95 of the Califon nice Heald gt Safety Code.Sections 25305,25533 and 25530.1undenund mu lithe building docs not currently haw a tenant,mut It U my responsibility to notify he occupant of he rmuhemcnts mm bcoi o vanseafacertincamafaapa.y. Signature of Applicant Date Owner or aumanced agent Date All roof coverings to be Class"B" or better INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 20408003 . 00 INVOICE DATE. . . . . . : 07/21/2005 REFERENCE ID # 05070133 SITE ADDRESS . . . . . : 10833 NORTHFIELD SQ. SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WAGNER, KATHY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CONTRACTOR . . . . . . . : JOHN STEENHUIS LIC # 26949 COMPANY . . . . . . . . . . : ALPINE CUSTOM PAINTING ADDRESS . . . . . . . . . . : 16580 RUSTLING OAK CT CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 • TELEPHONE . . . . . . . . : (408) 779-9626 FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE ------------------------ ------------ --- ---------- ---------- ---------- ENERGY 4119 A 34 . 86 0 . 00 34 . 86 BLDG PERMIT FEES 4116 P 115 . 56 0 . 00 115 . 56 A/C UNITS <= 10, 000CFM 4117 P 10 . 26 0 . 00 10 . 26 SEISMIC FEE RES 2013 P 0 . 50 0 . 00 0 . 50 BUSINESS LICENSE 4063 A 102 . 00 0 . 00 102 . 00 ELEC PERMIT ISSUANCE 4117 P 38 . 37 0 . 00 38 . 37 MECH PERMIT ISSUANCE 4117 P 38 . 37 0 . 00 38 . 37 PLUMBNG PERMIT ISSUE 4117 P 38 . 37 0 . 00 38 . 37 ------------ ------------ ------------ 378 . 29 0 . 00 378 . 29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 WPEI�TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT# 0T3,a S41'.40 697070/3 OWNER'SNAME: (,(,a PHONE # ©8 ,5'yyl'79?9 GENERAL CONTRACTO : ' FAX # / I am not using any subcontractors: ✓� 7 � O 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 o S�7,o� 33 SOL CITY OF CUPERTINO FURNACE/AC E R,T OF •CUPINO PERMIT APPLICATION FORM APN# 21,084 g D o3 Date: D Building Address: Regkrdet4CeI o 833 N ,e pC Sat- Cope,(. f,r 4d CA Owner's Name: Phone #: Contractor: pc License#: (93(073 r Contact: Cupertino Business License#: Building Permit Info: r ' I (��� 4 � u� (:3CI$1`r� j�v✓ice '(' !'1l✓ Co+.�c�• 1' Ou cam' Bldg ❑ Elect ❑ Plumb ❑ Mech 210� Job Description: Residential Commercial ❑ For Residential Inst ations: Attic ❑ 1" floor Inst floor❑ Adhere to min set back requirement❑ For 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: Occupancy group: ! 2&7 wp, Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement 091�— 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 cfrn MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING