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06060236 CITY QF CUPERTINO BUILDING DIVISION PERMIT 4NEORMA I I ONCRACT©R . BUIL 2DING ADDRESS: , REPELLA CRAIG """"060602366 0164 NORTHWIND 90 OW NER'S NAME: PERMIT[SUE DATE REPELLA CRAIG NE: SANRARY NO. CONTROL N0. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 ca d' LICENSED CONfRAC OWS DECLARATION - Ib Description rd 1 bereby Wns anbm I 1 am licensed under provision of Chapter 9(mmmcOCSCrIP ncing Z wiNSection 7000)of Divlaion3of Ne RuunwaM Profcuium Cade,and myllceomis a mfall atroeL REPLACE FURNACE/AC �� ��� Z Lleenso.ClasClass Lk.N Dam Contractor ARCHrrECI-S DECLARATION I understand my plans shall he used as public records JUL — 2006 5yU N cad Licensed Professional 5 OWNER-BUIL.DBR DECLARATION I I hemby,film Net I am exempt from the Camractafs License Law for the t a o following moan.(Section 71131.5,Business and Professions Cade:My city or countyi goo nnm1% I pi. which accounts a Permit to oonmucL slur.narrow.demNish,or-pair any Washoo ] prior to its issuance,alm nqulws the applicant for such permit to file a signed suument that he Is licensed pursuant to the provisions of the Commctor's License Law(Chapter9 Sq.Ft.Floor Area IfiNbri >�$ (commencing withSection 7000)of Division Sof the Rosiness and Professions Cade)or — that he ts asemPt thnefrem and the basis for do alleged caempdon.My viohvdoa of Section 1031.5 by Ory applicant for a permit subjects W applicut to a civil porosity of r Occupancy Type nut mom than five hundred dollars(5300} ❑1,u owner of the property,Or my employees with warts as their sole compensation, will do the work.and dm mnsmum is at Intended or arrested for sale(Sm.7014,Business Required Inspections and PlanetariumsCode:The Canlaets lafs License Law doset apply m N owner of q P property who builds m improves therean.and who does such work himself or through his awoemployees,psoNded Naamhimprosemmuareretinu ocaRe- fmale R. however.Ne building or improvement is old within o-year of comple ion.disunion, builder win have the burden of proving that he did tot build or improve for purpose of aJl yr' ca 1,a owner of ct PrcKrty,.Business s velyam a fcssimrts with Rttued cons"W's . mutton dupronto(Sec.7061. neofsed Profession Codr:)The Cmuaufsnd cove Law does oto apply to as owner of continent who sed a r hnmosv Wsem,me, whocontractsLacca for such pmjecu MN a contranort)licensed purswm to Ne Contractafs License law. ❑lam sato ndu See .5 k P(.s r Ni/{son OwMr 46f* Dau W 'S MPENSATION DECLARATION ' I berany,lnsm under penalty of perjury ata of use fallowing dMar,daos: I ham and will maintain a CerdOmu of Conant to self-insure fa WorYeh Compon- smion,as provided fur by Section 3700 of W labor Code,fm the of the wort for which this permit is issued ❑1 have and will m,inuin Wartefs Compensation Insurance,as required by Section 37M of the Labor Code,for the performance of the work for which this permit is Issued. My Worker's Compensation Insurance esnier am Policy number we: Carrier. Polley No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE filstssect(nn nscdmillecompmud ling permit Is forum hundred dall.($100) carless.) I certify that in the prrfoman of W work fur wnic 4P pcmiit is issued.I rami not employ any person in my in rsoam esu totheCo eumim Laws of California Dau Applicant NOTICE TO APPLICANT:If.e0 nakNb in Cenincme of Emmpuon,you should become subject to the Worter'a N pcmetian provision of silo labor Cede,You muss .,O foMwith comply with such Provisions o Nu m Permit be deemed malted. „zt0 CONSTRUCTION LENDING AGENCY [-r Iha-by aRren that thens I.itomtrocdnn lending agency for No perform.of ai 7 Ne wart!ur which Nb omit is issued(Sec.3097.Civ.C.) OW.t 0 Lender's None z Lenders Address fJ Q 1 certify Wt 1 have read this application and sou that use show information U V. (~ came,.I agree to comply with all city and county aniinamcs and ants laws miming to pU building consutedon,and hereby authorise representatives of this city to color upon the shove-mentioned praporly for inspection purports. f.., (We)aloe o ave,indemnify cad loop hared.W City of Cupertino against f..t V) liabilities,judlmeau,cold cad expenses which may in my way acerbic against said City U z in conacquem-of W gnnOng of this permit. 6 Z V w. APPLICANT UNDERSEA AND WI OMP I7H A ON-P Nr Issued by: 67Date SOURCEREGULA77GINS 2/i�V- Re-roofs Signatum Of AirpliandConuanor HAZARDOUSLAXTERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant am err handle haalloos tutorial u denned by the Cupenino Munto at Code.Chapter 9.13,and W Health and Safety Code.section 35533(+)7 All roofs shall be inspected prior to any roofing material being installed. [3y. e Win the applicant or future building asupant tic equipment Or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove emir hvasdnos air conuminsnu defined by W Bay Area Air Quality Management all new materials for inspection. Disuin7 ❑Yes Nc 1 have mad the yh sand wsmau rials requirememsoukrCMpurd95 afthe Califon nulim,"Safety Could Smiau35505.35533,nd .�umkmmd t does oat c/runew,fg6Ati(esgAhhee.;unm4 an ms n to nouf the amu mt of jbc regairemen has an me nae Councamafa Signature of Applicant Date Owner or ant Dam All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CI Of Fax(408)777-3333 OUPEkTINO Building Department JOB ADDRESS: IPERMIT # Zo�6� �vac-nrwian scy D 666 �s 2.3 � OWNER'S NAME: i2A16e-P�LL PHONE # e Z Z-9 L GENERAL CONTRACTOR: FAX# 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 • /�� er Contractor Signature Date CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31638049 . 00 DATE ISSUED. . . . . . . : 06/28/2006 RECEIPT # . . . . . . . . . : 35055 REFERENCE ID # . . . : 06060236 SITE ADDRESS . . . . . : 20164 NORTHWIND SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : REPELLA CRAIG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : GREG FEIST CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : REPELLA CRAIG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : •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 BSEISMICRE VALUATION 4 , 197 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 175 . 04 0 . 00 175 . 04 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 175 . 04 MASTERCARD TOTAL RECEIPT 175 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • OWNER-BUILDER VERIFICATION 1. (Check one) I or/my immediate family (parent,spouse or child) will perform: . A. All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to be—erfc�u.ed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). a Property Owner's Signature: G/Z1�L� Date: 6 7i6 l��p job Address: 90)b 41 lVPI AI)mo -S4 Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. J..OF City of Cupertino Building Department CITY OF 10300 Torre Avenue • CU PEkTINO Phone: L4081777-322B Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper CITY OF CUPERTINO FURNACE/AC `';CUPEkTINO PERMIT APPLICATION FORM APN# 36 Date: Building Address: DJb 2 NorCrNw),le s Owner's Name: (/ eV)6 � Phone#: Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Pa--� Plumb Er/ Mech Er Job Description: p /�,E1�G/4Ct F�YGAl�9CE/A�C Residential Ey Commercial ❑ For Residential Insta ations: Attic F1151 floor 2"d 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 y�g7 b0 section: Occup y rg_oup: Strapped On Platform Bonded Sq.Ft. Floor Area: New Location ❑ Replacement 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 cfm MECHANICAL BREMRECEPT Recpfl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING