06050169 CITY OF CUPERTINO t° Z '" s
BUILDING DIVISION PERMIT C( I�.A- iTi ('1R��I„�NFU,RM,A ' + '
k'niY �!di°s^ ^L✓.x ':work#_ y t TtiN
BUILCr'Lh�`
DING ADDRESS: RESIDENTIAL HEATING AND VO-06050169
10989 NORTHSHORE SO
OWNER'S NAME: PERMIT ISSUE DATE
JON HENDERSON 65 CRISTICH L
NE: SANITARY NO. CONTROL NO.
4083774073
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:oc LICENSED CONTRACTOR'S DECLARATION Job Description
1 Nmby affirm Nn Jam imenecd mMet previsions of Chapter 9(commencing
with Section 7000 of Dlrision 3 of Ne Business aM Polesehom Code.and my license u
Ez� REPLACING FURNACE AND ADDING A/C
a< In roll term and effect
j�z Licenao❑ !Y.g —r— w
pp Oeste Contrumr
3 RC'ME cr,DECLARATION v�
f�O I undeuund my plans than bo used as public menrds ,_�y
yard Liceruad Pmfeuieal �'Q l•
m OWNER.BUILDER DECLARATION
I hereby affirm that I em exempt from the Canuacmrt License Law for the �/
o O following meson.(Section 7031.3.Business and Profession Cede:My city or county
3$ which mquims a permit nocommuter,ser.improve.demolW,or repair any Ictmum 5437
z i~^ prior at its itaarure,abut,mquima dm applicant for such permit m Jim a signed summant
€< thuNislicensed pmourn1.lfamisioaaftheConuasuresLice.Lt.(Chapur9 Sq. Ft. Floor Area luation
(commencing with Section 7000)of Division 3 of the Business and P urAmom u Cnde)car
.. that M la attempt themrmm and the basis for the alleged eanmptimh.Any violation or
Section 7031.3 by arty applicant for a permit subjects the applicant in a civil penalty of r V U Occupancy Type
not mom Nan Bw umuked dollars(5.100).
❑1,u owner of the property,car my employee,with wages as da:b MI.campema..
will do the work,and the srrucmm n mat Intended Or offered ranelo(Sec.70th.Business Required Inspections
and Pmfasion Cade:The Com mcMes Lk LAw does Out apply m an owner Of q P
property who builds m Improves thereon,and who sines such work himself a through his
own employm,provided that such Improvements ase netintermed ma@red fastl.a.
however,the Nildimgor Improvemeet Is sold within oro year afcompledon.the aamen-
builder will haw rN torde t of Proving that he did act Nita or improve for purpose of
ale I.
❑1.as owner of the property,w exclusively c rr u Laing with theoretical mnmmnam b
construct site project(Sec.7044.Business and Profession Cade:)This Comnmlm's Li-
cesm Law class tet apply in an owns orpropeny who Wilds or improves theman.and,
who contracts for such projects with a conuular(s)licensed in rmmt to the Contramors
License Law.
❑Iamaemptunda See .B&PCfmthumamn
Owner Dam
WORKERS COMPENSATION DECLARATION
I barely affirm under penally of perjury,ane of the following declaredan:
,]1 have and will mainuin•Cartiftmm car Cotrmmmmlf-mmm far Workers Campo
smlon,as Provided for by Section 3700 of dm labor Code,res the perforres, of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation InsWanm,as mqu red by Section
3700 ardor Labor Code.fm the part..mdse weak ferwhmh this permit I..."ad
my Workers Compensation Inuranm arnm and Policy number ase:
Canner. '/v�D,A,l +G_ Policy No.:L-T 00bU4S�/
CERVI'ICA E OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
musscctim acted"IN example"ifthe permit facet hunthedd m(1100)
or Ice,.)
1 Certify that in the performance of the work for which this permit Is inucd.I shall not
..play my perm.in anymanner m as In become subject to IN Workeri Cm.Pee, .
Laws of CAifomia.Data
Applicant
NOTICE TO APPLICANT`.IL afar making side Ccnificam of Eaempdon,you shouhl
become subject in the Worker's Compensation provisions of the Labor Co&you muss
3z forthwith Comply whit such pren miam m this permil atoll N decreed revoked.
Z► CONSTRUCTION LENDING AGENCY
E
E Iherebya n.that then ismmun le
a comdading sgmmYr, site faperformance or
> the work for which this permit is issued IS=.3097,Civ.Cd
14a Lander:Nunc
7 2 Lambs, Addmu
U O I certify dust I haw rad this application aM sum this site above infatmNun Is
LL.F caned.I agree to comply with all city and county mOinuues and sum laws relating m
17 V building construction,and hereby inalwAm mpresentatives of Nis city to enter upon IN
W above-mentioned property for inspection purposes.
FCy' Ly (We)agra to saw.indemnify and keep harmless ties City of Capertino a{aims
to liabilities,judgmecu.cats and expenms which may In any way a.sgaimt said City
U in caasegnenm of the{Contin{of this Permit.
APPLICANT UNDERSTANDS AND WL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. <-Il y l ol Re-roofs ��—
Signuumof AppHca MOOUsour Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building aecupantatare or handle harardoas material
as donned by site Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cade,Seale,W33(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ifo
WIII the applicant m f��F�um building ecmpant use equipment or devices which If'a roof is installed without first obtaining an inspection,I agree to remove
craft hazardous air comuminams as dermad by the Bay Amo Air Qaaiily Management all new materials for inspection.
District? -
❑Ya ANu
I haw mad the haardtxu matedabhequlrements underChapmr6.93 of tho Canfary
nia HonW&Safely Codc.Secduu21SD3,21333 and 21331.1 stxkrsund Last Bdm building
does not currently Mw a tenant that 11 m my responsibility m notify the occupant of the
requimmmmu which must Nmol prim an issuance of a CmdTicam or)<ctgmcy. Signature of Applicant Date
�`�""'c1'°� r "e- 1" All roof coverings to be Class"B"or better
Owner or authorized a cnt Dam
Community Development
10300 Torre Avenue
lk 9 Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
`UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
loctbPt . 06a ..r'-o,/� 9
OWNER'S NAME: oCN \-eXS PHONE # collo. q'3l6S
GENERAL CONTRACTOR enAj 0.\ ipq#
I am not using any subcontractors:
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
May 18 06 0929e Jon Henderson 408 996 9365 p.1
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
• Please indicate below which modification(s) are planned for your property. Provide
brochure(s), if possible, and copy of any proposals) including the contractor's license
number. Any modification not expressly listed herein, or not conforming to the
restrictions and requirements listed herein for that modification, will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for approval.
Modification Restrictions and Requirements '
Air-conditioning unit Unit will be designed for quiet residential use. Unit
will be located within the enclosed yard of the
property.There will be ne parts of the unit visible to
common areas. Installed by licensed contractor.
Replacement window/ Must be same size aperture and location of existing
sliding door window or sliding door. Any necessary touch-up .
painting is the responsibility of the homeowner.
--IQ CopFRV Installed by licensed contractor.
G e ■ Must be windowless and in conformity with general
e architectural style of the complex. Repainting to
conform to exterior color scheme is responsibility of
the homeowner. Installed by licensed contractor.
Satellite dishlreceiver Specify type and size oelow and Include sketch of
Intended location. Installation of dish in the least
type: visible location to receive signal. Cables routed inside
• size: attic, crawlspace,or wall near the dish mounting
to minimize visibility. Other guidel nes may apply.
Any damages caused to property as a result of modifications will be the
homeowner's responsibility. All prohibitions, restrictions, conditions, and rights
of the Association enumerated under Article V of the Amended and Restated
Covenants, Condidons and Restrictions of the Northpoint Homeowners
Association are pplicable to modifications contained herein. City permits may
be required.
Please pnnf
Homeowner
Name(s): kmO
Property U G9
Address: Phone;
Date of Notification: S' 6I404Date of Completion:
Homeowner has six months to complete the designated modifications and is responsible for notifying
management upon project completion,
--------------------------------------------------— --
—ofnelel uss only—
'Notification Received by: Date:
CompletiiiC �vedby�• ':i–� :�c 1i r'✓Hvt Date:.?
FCRM DOPTEDai10 @ Y
MAY J _
1 82006 ^.vsq�h�J�� 'r/✓!�� ' 9 ',/ - J;=^
CITY OF CUPERTINO
em 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31638023 . 00
DATE ISSUED. . . . . . . : 05/18/2006
RECEIPT # . . . . . . . . . : 34457
REFERENCE ID # . . . : 06050169
SITE ADDRESS . . . . . : 10989 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JON HENDERSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : 'RESIDENTIAL HEATING
CONTRACTOR . . . . . . . : CATHY HAIRE LIC # 21161
COMPANY . . . . . . . . . . : RESIDENTIAL HEATING AND A/C IN
ADDRESS . . . . . . . . . . : 65 CRISTICH LN
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : 4083774073
•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 6, 000 . 00 0 . 60 0 . 00 0 . 60 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 . 34 0 . 00 176 . 34 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 289 . 64 21721
TOTAL RECEIPT 289 . 64
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
o5o► (09
CITY OF CUPERTINO
00 FURNACE/AC
SUPERTINO PERMIT APPLICATION FORM
APN# 2i I n �yt��2t1 Date: oC-D 6
Building Ad' cae ess: ✓�J No\7r h Q
rje
Owner' Name: Phone #: gal0 a,N45
Ton \A�&Cy—son
tractor: Phone: License#:
a1 �1-I
-LAO
Contact: hone: Cupe ' o Business License#:
--Ck fn 1fZLn k ,-?
Building Permit Info:
Bldg ❑ Elect NJ Plumb ❑ Mech
Job Descriptiog�,, ,1
Residential',] C mmercial ❑ U1f�
For Re idential Ins lations:
Attic M I't floor 02nd floor❑
Where to min set back requirement R
Milkor Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Ap2roval Required
Cost of Projec Type of Cons tjon: Occup�ncygioup:
Strapped D� On Platform lel BondedeJ Sq.Ft. Floor Area:
New Location Replacement
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREM[FURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREAN A/C Units <- 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERM[TFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING