05100161 CITY OF CUPERTINO A r f-- stens.'� '3%X�' rm t k
BUILDING DIVISION PERMITCO "I'RAC'rURI1V'. I�RMt1.TIi" .
• BUIL INC ADDRESS: AIR QUALITY HEATING & AIRc6r NO'05100161
OWN711 QAK MRAT)nW ("T
ER'S NAME: PERMIT ISSUE DATE
NE: SANITARYNO. CONTROL NO,
(408) 293-7138
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
O 0 PLUMS
MECHO
M
LICENSED CONTRACTOR'S DECLARATION JobDescri tion
I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing p
with Smile.7M)of Division 3 of the Business and Professions Code,and my license is
.A full farm ad off _-2 Lkg -71at?4o' NEW FURNACE HEAT PUMP, INFINITY ZONE SYSTEM
License Clues
Dem f Conlnnor a UQ s '/ Q
PA .
ARCHITECTS DECLARATION
1 undenund my plans.hall be used As public records
U
4 Ori Licensed Professional
u,3 OWNER-BUILDER DECLARATION
i f I hereby
oRnm that I am exempt form the Contractor's License Law for the
O O following reason.(Secdun 71131.5,Business and Prafessiom Code:Any city of county
$ which requires a permit t0 construct. It Improro.demolish.nr reput,any structure
prior to its I=&=.Alan requires the applicant for such permit to file a signed statement
< that he us licensed pursuant to live provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of tM Bainessmtd Professions Cnde)or
$ that he la exempt therefrom and de,basis for the alleged exemption.Any violation of
Section 7031.5 by any Applicant far a permit subjects the applicant to a civil penalty of 3 A012 61f A&r 0 0 Occupancy Type
not mom then 0w hundred dollars($500).
❑I.as owma of tion proprsry,m my employee with wagm ast sairsole Compensi don.
will do the work.and the structure is not intended w0llemd for see(Sec.TON.Bina vaa,
and Preledons Code:The Convector..License Law dues Amt apply m an owner of Required Inspections
propenyloyms,who provided
am nouchwwkhimmlrculforor hhis
ownver,th building or
prssehimprowmantsare not inuoddoroRered for ask.if. ,
however,mebuildingorimpreromentissold within am year of mproe fu the owner-
builder will have the burden of proving Net he did not build or improv for purpose of
tile.).
❑1,as ower of six property,ire exclusively and conussiins with:)The
nsomme, to
construct the project(Sec.70th,Business and property
who ns Cade:)The Commmon.Li- aw/
come Law dans nes Apply m an with
a of property who builds orimprow Cordae and
whocontractsLacLL for such prejecv with a eontrsemrt0limmed pursuant to Ila ConuuTor's O
License law.
❑1 Am eAempt under S. ,B&P C(or Anis reason 6
Owmr Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of dm following declinations:
I have and will maintains CmJficauof Cement to self-Insure for Wor sCompcn-
.ation,as provided rot by Section 3700 of the labor Code,for Ren performance of tic
work for which this permit is issued.
❑I baro and will maintain Worker's Compensation buurance.As required by Section
3700 of the labor Critic,for tM performance of the work for which this permit is Wined.
My Worlues Conermmadon Inmost=
��ane, Policy number are:
C.mer: FZV`VKL✓'S L+F,"1Ai i RcyNo.:A IQS7G3 a3
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thtssection mail not M Completed if the permit H for one hundred dollar,(SIM)
or tesA)
I mmfy that in Ne performance of the work for which this permit u issued,I Nall ret
employ any person In any Manor an as to became subject to tion Workers Compensation
Law.or California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifiate of Exemption,you should
become subject to the Worker'.Compensation provisions of the Labor Code,you most
.J O forthwith comply with such provisions w this permit shill be decreed revoked.
z tiCONSTRUCTION LENDING AGENCY
fv Thereby aM,m that there 1.a construction lending agency for the perfirmence of
a ti
one work for which this permit is Wined(Sec.3097,Civ.C.)
0.Q (antler's Name ,
z Lender's Address
U O 1 cemry that I haw red Ws application W sum that the move information I.
If.Ecomm 1 agrm to comply with all city and County ordinauxs ad sum laws relating m
Wilding construction,and hereby Authorise repmsenutiva of this city menu,upon the
W i Mve-mentioned Porosity for impeetion purposes.
tY (We)agree es save,indemnify and keep harmless the City of Cupertino against
ti liabilities,judgmenst,cast andexpenses which may In my way accrm Against said City
t.),'Z in consequence of the granting of this permit.
'•" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGU ONS.
C�Lta.�if.Tia� to/�o/e3 Re-roofs
Signature of Applicar onvantor I Dm
HAZARDOUS MA LS DISCLOSURE Type of Roof
Will the applicant or fumm bulMing occupant store or handle huardoa material
at defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cade,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
0Yes
Will the applicant or mem wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haraNna air contaminants as defined by lM Bay Am,Air Quality Management all new materials for inspection.
L anis@
[3 yea - Nu
I have mad the haallou,materials requirements underCImpmr 6.95 Aide,Califor-
nleliealth&SafmyCedc,Sections 25505,25533 and 2553/.1 undcramnd thin lfthc building
does out cuncnit,have A tenant.that It u my M"omildllty to muff the mupant of the
�aqui enlswhk Imbemm riarMWuanccoraCeni111 upanpy. Signature of Applicant Date
A,a�n�d ge t (6lD All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36626008.00
DATE ISSUED. . . . . . . : 10/20/2005 -
RECEIPT #. . . . . . . . . : 31676
REFERENCE ID # . . . 05100161
SITE ADDRESS . . . . . : 7733 OAK MEADOW CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DE LEON, ARNOLD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5201
RECEIVED FROM . . . . : AIR QUALITY H & AIR
CONTRACTOR . . . . . . . : MATTHEW FARBER LIC.# 22791
COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON
ADDRESS . . . . . . . . . . : 714 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408)293-7138
41E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00
BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BSEISMICRE VALUATION 12,900.00 1.30 0.00 1.30 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 166.78 0.00 166.78 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --------
204 UNDERFLOOR UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
•
Community Development
10300 Torre Avenue
s' Cupertino CA 95014
Telephone(408)777-3228
PIINO Fax(408)777-3333
U
Building Department
JOB ADDRESS: PERMIT #
11 -D O vL Cf. o A 950 51&1zx(-
OWNER'S NAME: PHONE # -77 l 2
GENERAL CONTRACTOR: { , k G FAX#
I am not using any subcontractors: �a4, o e�L,a644 Iv 20 vs
Signature 0 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
lb 2e )�5
Om�5er/ContraqG Signature D to
06' 100141
• J CITY OF CUPERTINO
OUPERTINO PERMIT APPLICATION FORM
APN# 3Z,1 2 L o,0 8 Date: LO1�2-6Ltl�>
Building Address:
Da Y- Mao-c G+. Uk vkvi o- CA 9 5D t
Owner's Name: Phone #:
Ay Ylo1 J De -ca 408 777- �3z
Contractor, License #:
Y katt A c \vac • 7(,2R 44
Contact: ,--
Cupertino Business License #:
k2tA tzr mer 22291
Building Permit Info:
Bldg ❑ Elect Imo' Plumb ❑ Mech--fg-
Job Description:
YV-W Y Vj Ct
Residential 19F Commercial ❑
For Residential Installations:
Attic ❑ 151 floor 0 2"d floor ❑
Adhere to min set back requirement
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural cales) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required El
Cost of Project Type of Construction: Occupancy group:
Strapped LJ On Platform LJ Bonded 0 Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of 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
MPERMITFEE Mech Permit Issuance MECHANICAL
! PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
IP ,1