00110089 C
ITY OF CUPERTINO '
Eot,c otvtsuxa PERMITCONTRACTOR INFORMATION:
ADDRESS: I'LiRh111'No2.1. 113 PATRIOT WY CONDITIONED ATR 001. 10098
1WNERS NAME: AI'PIACAI'ION SUB DA[H
WALN,UP GARDNER W 164 B GIL—MAN AVE 1.1./17/2000
PIIONF: SANITARY NO. CONTROL NO.
(408) 374-631.1
GIWIZ
ARCHITECIAiNGINEER: BUILDING PERMIT INFO
BLDG [LIiCI' PLUMB MCCI1CONIRACTOR S DFCI A I Chav Job Description Ibmebvafhrnitrtl B - r 1 In,Co )( a se
f—a with Sed intelan)effect. nn 101 the Nm .and Path„a Gdc,and my
a i,in full farce and effcn.
z 0 z u License Clan C”N
x°`� u:,te sI)EclA FURNACE CHANGE OUT OF A 100 000 G STAGE I
to%a.0 y nRaurECrs uEclARnnoN z
5 E u,^ I understand my plans shall he useJ o.public recnN,
w Sn O O Idaemed ProEs%im,w
OWNER-BUILDER DECLARATION
1 herby affirm that 1 am earnpt Earn the Conamen is I-peen„Law dim the
CZ following reawn.(Section 703 L.5.Business and Pamsnion,Cade:Any city or county
o which myuims a permit to constnln,alter,improve,dear o(ah,or rcpuir any mallome
Iu, prinrto its isnuan,c,also recuirc,l heappliamt hooch pennil in Elan signed aat,mant
that he is licensed personal to the proknor,of the Contmator,Liaeme l,uw(Chapter 9 Sy. Ft. Floor Area Valuation
(commencing with Section 70101 of Division 3 of the Business and Prafnsions Cede)
or that he i,exempt thercl rum and the basis for the alleged exemption.Any violation
A f Seanion 7111.5 by any uppiman Boa pts at subject,the applicant m u civil pamulty
of m,I mone man five[,injured dollars o5an. APN Number OCCup$4SY'ryipe
01,a,owner nfhe pmpeny,army employees with wage,it,their rode aompcnsaBon.
wig do the work, and the mmctum i,net intended or offered fill sale(Sec.70afal,
Bn,mes and Pafervios Coda:'Ilie Cammamr,oeen.e Law doe,nm apply m as 32653055. tR@quired Inspections '
owner of property who builds or improves thcrom.and who does,uch work outwit
through his own employee,.provided that such improvements arc not intended or
nRered Iia ole.If,I ox'm'er,the building or improvement i,,old within one year of
ennplcdon,meown+-hu,Id,rwiehave the burdenofpmvmgthatliedid not huildor 301 — ROUGH PLUMBING
improveou're'l,wol.'ale.) 303 — ROUGH MECHANICAL-
0 1.as owner othe papartamendusivelyconnecting with licensed contractors tn 304 — ROUGH ELECTRICAL
onftmct the project(See.7034.Bootless and Profusion,Cede:)"The Contractors
aen.eLow doe,aor
t npvy ,,an owneroprnperty who hoimF or mpruae hereon. 505 — FINAL_. ELECTRICAI—
;and who contracts for such projects with u wnvaetor(s)licensed personal ,the
Callm, ',LiameLaw. u 507 — FINAL PLUMBING
01 am emnipt under Sec. .B k P C for hi,rtmnn
owie, Dale 508 — FINAL_ MECHANICAL
WORKER'S COMPENSAIION DECLARATION
1 hereby affirm under penalty of ryujory one of the following declaration,:
. ❑ 1 have and will maintain a Certilieae of Corwin In.mil-inmost for Worker's
Compemulion. as provided for by Section 37M of the Lebon Cede. for the
pmdcaream,of the work far which this pe.,it ix i,sued
❑1 have and rill non :air Worker',C'nmpenoetion hum. e,:o nquhed by Seam i
3710 of the Latin,Cede.for the hcouro untt of the work for which his permit is
sued.My Worker',Compensation Insurance tamer and Policy number are:
Carrier. Polley No.:
CERTIFICATION OP EXEM LHON FROM WORKERS'
COMPENSATION INSURANCE
flhiv.,at need act he nmtpen,iifmais,rll.it is forone htdualdollar,
o 100)or les,.)
1 cenify that in the performance of the work fur which this pemjit is issued I
shall not atploy any pawn it Ilny tanner so as to become subject to the Workers'
Compcnotion Low,of California.Dam
Applicant
NOTICE TO APPLICANT.If.uher traking this Cer ilica,of Faa rni.a.you should
become ecoe object to Ili,Worker,Compensation provi.iom of he L m
bas Cede.you ust
Q Q loon all.imply will,such In... we,re Ihi,Perm[,shall be cleaned revoked,
F Vi CONSTRUCTION LENDING AGENCY
C 71 herehy affirm that them is a nmatmmin.lending agency Buff, mmn
unn,perfoce
W of the work for which Ili,pennil w i..ued(Sec.30iR,Co.C.)
0. Q Under',N:nna
.Z Lender'.Address
U O I cenify that I h:ne mad mi,application and state that the above infoajation is
GL F.I cnrrwl.I agar to comply with all city and aomny anBrar,a,and x ala law,relating
U mhoilding rumination.and heathy authorim rcpm,emaivas od this city h,enter upon
} R] he above-nicationeal property for inspection parfx„o.
F., 0. (We)agree losevee indemnify and keep humdess the City of C.,mTm l against
Vi liabilities,iudgmem..cants an I espen.ms which may in xn,way wane agaium.said
V 2. City,. ur,vWawv,,t the....aongol tbonpermit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. Y'
Sigaan:molnppfi,oavconlmmol Dat, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building ncupem more or handle h co deus material Type of Roof
a,defined by he Cnpenino Municipal Code.Chapter 9.12,and the Health and Safety
Code Seen 1255321:07
0 Yes 0No All roofs shall be inspected prior to any rooting material being installed.
Nilo the applicant nr future balking necupant use taImpmem lar devices which If a roof is installed without first obtaining an inspection, I agree to remove
nit hazardous air cummrjinanu as defined by The Bay Arta Air Quality Management
D'wm�,t7 all new materials for inspection. Applicant understands and will comply with
Cl Ye, 0 N all non-point source regulations.
1 have rend the[,emanon,material,mi,oirem,nt,under Chapter 495 oflhe
C.I,t ria Ileum,.Salary Code,Section,25505,255331md 25534.I t dewmndmut
if the building dva,nut currently have a tenant.that it is my resmnj.,ihillty to nmily the
e,ccupnnt of the mamma mrts which mot M me,prior m i,suamr of a Cenidicae of
Ocuum ". Signature of Applicant Date
Ow net or audmriatal:Igen, Dal. All roof coverings to be Class `B" or better
OFFICE
T`IOV.16.2000 4:12PM NETCLERK INC NO.368 P.1
TO:EPERMITS
720 Dubuque Ave., South San Francisco, Ca. 94080 Permit
Government Services: 888-330-1777 Application
Fax: 877-846-5888
4 w..Y4n'WMIJ 'iul.u..J r,N'E iY Ww41W9.Yn iJ•�uul.Jvf1.
ool�oo F�
Email
TO:Cupertino Permit Handling Instructions
Building Mail
City Hell 10300 Torre Ave The approved permit will be mailed to you.
Cupertino
CA 95014
4087773333
Contract or I n f o r m a t i o n
Company: CONDITONED AIR ASSOCIATES Worker's Camp Carrier: Zirich American
Address: 164 Gilman Ave.#B Worker's Camp: WC2978779 Exp. 02/16/2001
City: Campbell State Contractor's License:445162 Exp. 08/31/2001
• State/ZIP: CA 95008 Exp.
Phone: 4083746311 Exp.
Fax: 4083746314 Business License #:22334 Exp. 08/31/2001
Email: conair95008@yahoo.com
Credit Card Information
Credit Card Number: 5474975000004944 Visa:
Expiration Date: 12 /2002 Mastercard:
Card Holder Name:Kimberly Gentile Other:
N o t e s
Pro-reg: YES Attachments:
Payment MASTERCARD WC[]✓ SCLQ✓ SASE❑✓ AAR]
Agent Authorization:YES Permit Type:
ORG❑ NOT❑ FV.O Permit ID: 66020
Project Address:2113 Patriot Wy.
Comments:
•
'NOV.16.2000 4: 12PM NETCLERK INC N0.368 P.2
CITY OF CU PXCRTW O CONTRACTOR
VMDINC xo ✓ loN INFORMATION:
. HTJILDINO ADDHL-55: PL'I3MIP NO:
2113 Patriot W . CONDITONED AIR ASSOCIATE
OV/NPA'S=Z
APPI3C MON SDH DAT-
g 2 Gardner Zu 164 Gilman Ave.#B
,h. PHONH- S.WITARY NO. CONTRQL NO.
o 408.446.3324 Campbell 95008
¢� nCHrtHOT/ffi�`QINla13h: H[m.DiNO PDILaa1T N1P0.
t'a 4083746311 H[73 T PL 9 ]a¢OIi
tg8J t dolt'IIEOCVNaral ..C'p'uuciaon, of
. y" I 6mehy eDlrm that I sen licaoea unaes ao.ieimt or Cnopae 9 (mm,mmmp Cob Dearipda¢
h J .gh 5"" 70M of"n""" 3 of eta Rwhese end 1'mfineew Cede, ad my IiaaK
Lic.>445�1-�62' Furnace change out of a 100,000 2 stage furnace
Sr m,a: 11/15/2000 oaarro.-^e^t 41--
Y�Y 3 n¢clDrecrs DECL.alt.anoN'
�M' �YDmee lhnn be pad wpuhlio nroms
00
g ,. Nn,y,ynel
IMON
OWNER-exe pt he. ft ontme
L � I !alone einem inn I w exempt bpm of Cm4naode, LA,K ty nor me sly FL lel00[AICA Vp1W0011
"e.;rla amen, (PCmpe 1m err eat W w lf0m er cad.. min ay m spear,. $2,150.00
w which sgwrw rs permit b mmbcy plies, i1, s, ,mean w eepin my emmae
prier to w iNu..eq ober wain be eppl'vm% mr %uh pmmit a rtie a!omen tmmnw APN Number Occupancy Typal
d d atm re u gcnma p,m.ct m Lm ver:ti%m orale cmoear.tlaam Imw(mepa 9(aonamtiag 32653055
i wW semoa'ao07 et Die%im]Bram swim m ho¢ni.COWJ or J,w he V aevpt meeb®
r,0 the hail me me alleges 0 arab a ly f not
err then vehe by my oppusPol 0O.
Dot m- db tppkrat a a p.ab err more then Dae hundred dollen veli do
(w nxa of In peW.,m ny margo,el Zre.J.as bar as mmpwwdm4 WIII do 0.equimd IdpCCtiOd
,he app the n s Lica b npe In oor A a pllhsm o a e(Sea]Wer.Dwlmm won Pm[It[rn mad
Code:Toe d aeba r'e Liw;m Laok deer Am Apply rosette b ep obid of p"'19yrPranY who buil.a improv
,"va,and Who does s,mh ark himself foravbe e alnplpywA DroNa4 dine inch
'unµh.of se,err bvowtion,m avOLd.br Wn IC Mae
an droWide,ro impmat be di asill wifm'e
oa hep of entnpinipry me D•'asbuibtt will Mve she bard.of poring am m did ort bmM '
w bnymvt mr puyme err sdp).
4 u ower or proDe70 am emtwhMy romAPIA C ) The,:wtrwan b
wwnen< me ",m (Sea 0 a Ewiomt uta FrOproper,
atbm Coat:) in. L'I breeent
End! e, Lew dal non nppy b a Wm m pmpmy who builds a imwvwe Macon,
cad WM mfor su,JaG
e pm1Y ,tat a WnVa<w!(f) enllea lmnV4r'e to the
m
Cnnea Leenaima.Int.
I.
]am mnmm unam S. ,BOPC for oris swoon.
• Ower
WOOhm
IW.¢'S COd1DPNSn1'fOH DECLARAiIOH
I hooey ametn.m peaky of merry am of de Dellowint dwlereliaa:
❑ 1 be, or, will mlr,1`b a Cenldmw of Co. m mMicswe M Wohn
C%npaeswim, a podded Cor by Section 3100 of Ne Labor Cede, the the
I
y'e.r.�leMeaide wPor Whim orisfano,u Wud.
H/IMa and wall, deinnin a Ene1 eArIt r hvada w rICh this
by denim
33333TTTTT55555ddddd
or the Labor Code, fm the prance cnee ofd wort N,' whim my pennL is
pomd,My Worker's Cotnpenssewn Insurance Denier and Policy number arm
C.in:ZirichAmerican rplig,.:WC2978779
CER11fICAT)ON OF P% TION PROM tvORKDItS'
C0MPcgSAT10N D15URnNC6
(TDh potion nod no,be carytlned If db fecl u mr..b.dteol dollen(SIDO)er law.)
I Certify Ihu fie ibepmod,ra a of the work Cb,WDI9e bil pomi,is imued,I
mal me —play any pars. in any maser a as to temms aubuct a WC Woko't
Compeanion Lw of C's an e,
a„11/15/2000 nppgme -
NalIC]3 TO APPDCADIr: I[, ,a. Wag Wil Cenlgcme of Q,anvmn, you should
Won, "biona a wo ke". Coni nezE. promiom of the aka Coal,, Yeo mor
[enhwith amply with met,Dmvisieol or Nle permh dm0 m deemed reaeked.
06 CONSIIIULTION LWO1N'O AORNCV
r D 1 hereby e�tm tbw mem is a daemwaim Eel aganey for Or Derfomnme
K of rte woM1 Rr ankh mks pemthbfswm(S.)09'1.Civ.C.)
O
7 e lend[!a Num
V..
p Lederer Addmss
>•r t endry ata I Ince not tl;u nppliaaCion and slam rbatep We arm ,[ads W h
w,saa. I ntwe b ComplyEn Wher nu elry and eounry oniiv,mOr eM V laws relem0 .
m building omnmodro aces rherebyIHA) Atllrodw tvparemali�w o[lM1ia Clry ro wen opo
We nbono-(XVI)anm property lbs In arnify and
Jose,
(We) era,m caw,el Eep(fy Ana keDD ns:, be me ae, a N alai aywd
or
linbili4ee, JVUg o mW od eapewee Wfiim may m any way paha pDoiwl nA
CiymwmTLD of the.chap M Wierpermit
nPPDCnNT lR^^^......`D WILL CONVEY WITH ALL NON-PODJt 50fIRCD
IlsapLnnoNs,p,( 11/1512000 ac-mon
gigovure oCnpplimalGmrxaer Dona Thc.mmf
IIA do bo05MnIW O DISC.OgS
WIII she sCoa err Nmm buiWiop .:leo Or moa a hnn a EIM vol mmoialWdY Aft roof,hall be idpeeted friar co any msEDg;m.lorJ beinga w ACIA.
a ,legnd by IM1e G,p.lno Mm;kl I Dade, Cin o 9.12 ,end Ir, 1•lwlm ,end SnlNy if B loaf 1,Laldlcd wldsdut first obmitdnB en inlppetidv,l algae a amore
Ca de,S.W.2592(.)1 Yo LJ No
oU acv mnmipL for ilbpeeti0m Applioavd mMenmN and will comply with
Wtll am a isast d game beldiy^ oaappal ,ae CQDlpmm Or.ales Which ell Op�ppfv[Ipw.regolaoied.
• ®it bmmat or mnnlnlrmm �..�tDwa byt-lhee OV Ave iw palmy Mlwceew11 - - 11/15/2000
Diemen Ym No l!'1
I Nae road We bun metni.ly tequimmeou mom CUDter Coy Of db
Glifwv6 Heel@ a Seraty Cele, dealer, "195, 25555 and 25454. 1 Amend ma SignaMP of ApPlleed Dna
If mo tee tem- he,. a !mal W% it n my ,ewombNy m mail, be
mcupent e •M1 Imtse be ,m poor to mounts or, CaoifiroD at All Wf,,vcri¢I;S tube Clea"H"prballm
oeaomay 11/15/2000
otwm.Ihodxd moat D,m OPF1Cs
• CITY OF CUPERTINO
Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY 4 3
Sec: Twp: Rng: Sub: Blk: LOt:32653055.00
DATE ISSUED. . . . . . . : 11/17/2000
RECEIPT 4... . . . . . . : 14058
REFERENCE ID 4 ...: 0011009B
SITE ADDRESS .. . . . : 21113 PATRIOT BY
SUBDIVISION .... . . .
CITY . . . ..........: CUPERTINO
IMPACT AREA .......
OWNER . . . ....... . . : WALKUP GARDNER W
ADDRESS ........ .. :
CITY/STATE/ZIP ... : CUPERTINO CA, 95014-5707
RECEIVED FROM . . . . : MAIL-IN
CONTRACTOR . . . . . . . : BILL GENTILE LIC 4 22334
COMPANY ..... . . . . . : CONDITIONED AIR
ADDRESS ..... .. . . . : 164 B GILMAN AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408)374-6311
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------- ------------- ---------- ---------- ---------- ---------- ----------
BREMFURN NO UNIT 1.00 12.21 0.00 12.21 0.00
TEES FLAT RATE 1.00 35.52 0.00 35.52 0.00
TOTAL PERMIT 47.73 0.00 47.73 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -------
OTHER .47.73 VISA
TOTAL RECEIPT ... 47.73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ -----.__........_.........__
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL