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06090088'wC tie 1� nhu :y— sree ?yL F i<3 :OC yse .I ice. 45. CITY OF CUPERTINOisa�wawR C0NTRACTQ,I2IATIO.�N BUILDING DIVISION PERMIT BUILDIrvc ADDRESS : CONDITIONED AIR PERMrt rvo.06090088 19397 PHIL LN OWNER'S NAME: PERMIT ISSUE DATE KODE RUPALI 1701 LITTLE ORCHARD E: SAMTARY NO. CONTROL NO. (408)291-2220 ARCHI'IECf/ENGtNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACT'OR'S DECLARATION Job Job Description 1 hcmby affirm Our I am licensed under provisions of Cnaptcr 9 (commencing with Section 7") of Division J of the Business and Professions Code. and my lice se is Umen.seomeclamnd.rrest G� REPLACE FURNACE AND. ADD A/C LicLLL.g D2N %1y� Coal': CI.A A ON 1 understand my plans shall be used as public records /a, N Licensrd Pmfcssional DECLARATION Oat / I hereby affirm I am exempt from Law for Ned 1 am, usin fare Nr Cosions C's e: Any c o703 Any city or county fallowing mason. (Saito RD1.3, Business and Professions � ore any twcture which rcyuimu permit Imes alter, improv., h. at 8 8 0 0 sa signedstatement ! Issuance. r ft h pomiil t a sig inensed also require ftapplicant for sucContractor'sLaw Sq. Ft. Floor Area Va alfe ontra tor'lLice (Chapter (comm I$ licensed pSectiou0do pmvisionsat theeeBuincounceme Ourhe Section ] of D the Professions alis for th alleged l of Net he u eumpl tMmfrom and the Ensu for Ne allegetl e.empuon. Any violation of ththeio(commencing owner, and } U U Occupancy Type Section 7031.5 by airy applicant for a permit subjects the appl¢anl m a Civil penalty of net marc Nan five hundred dollars (S500). 1, as owner of the property. or my employcu with wages as their sole compensation. e Required Inspections will do the wank. and treatmcwrt u not intended m cdImed for aale(See. Tao. Business and Prefessiam Code: The Conmcmes Lu use Law docs not apply m an owner or q P Property who builds or marrows, thercon,and whodoessuch work himselfor through but own emDlayce. provided that such improvemens art not intended orolfcted forsale If. however, Ne building or improvement is sold within one year of completion. Cite owner. builder will have Ne burden of proving that he did not build or improve for purpose of afloI 0 I, as owner of the property, am ... luaively contracting with licensed Lonm mm On consumer the project (Sec. 90o4, Business and Professions Cade:) Tire Comencmr's U. come Law, doe or apply to an owner of property who tails or improves fla eon. and who concocts for such prakes with a emuactor(s) licensed pumrant m the Conmutor's License law. ❑ Iamesemprunder Sec .Bk PCfor Niarcaen Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under pemlty, of perjury, one of Ne fallowing declautions: t I Inwood will maintain a Ceruficateof Consent to ulGinsum forWorker's Compere union, as provided for by SecOm 3700 of the labor Code, for the pert amr. of do work for which this permit is issued. ❑ 1 have and will maintain WorkeYs Compensation Insurance, as required by Section 3900 of Ne labor Code for Ne performance of the work for which this .it is issued. My Warkeris Compensation Insurance carrier and Policy number am: p Carrier. r 4Nir'yYit Ll.•ffICV rPolity No.: n IQ()Lyt-pE 4t'ast C TIFF OF EA ITMON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars (SIM) or less) ' 1 certify Out in N. performance of Cite work for which this permit is issued. I shall not employ any Noon in any manner so a In become Subject o the WOekers' Compcmmon Laws of Caltromia. Dam Applicant NOTICE TO APPLICANT: If, Cock making this n of Exemption, you should became subject Worker's Compensation s of Labor of the labor Coded you must provisions oc ' y id Or$provisions forthwith comply with such Provisions or Nis permir shall be deemed rewkcd. j CON .is. c10NLENDtNGAOENCY I herby annm Nat Nem u a construction nn lending agrnrcy, for Cine perfurtnance of ' the work for which Nis rennin u issued (Sec. 3091, Civ. CJ (So,. lender's Name r Lcndefs Addrcsa I certify that 1 have mad this application and stare Nur the above information is ' torten. I agree be comply with all city and county eminences and sou laws relating to building comuuction. and hemby authorise mpresentatives o(this city to enter upon the above mennoncd progeny for iusacuon purposes. (Wed) agree to save, in entri fy and keep harmless the City of Cupcnino against j liabilities,judgmcas, costs and expense which may in any way same against said City ' in c.=q.c.c of Ne grunting of this permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO RCE REGULATION . Re -roofs �Zf Type of Roof ,z. A rt 9- 13 o-6 g'parmtfAppb DateHAZARDOUS MATERIALS DISCLOSURE Will thr applicant or future Wilding occupanluore or handle hmamoaa material as dcMed by the Cupenin, Municipal Cade, Chapter 9.12, and dm Health and Safety Code. SC Y., 25532(a)? ❑ Yes I.&Nt All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will Ned applicant or fortis building Occupant use equipment or skvies which emit havanums air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection. District? ❑Ye Ota No I have sad the hanrdous materials nequiremens under chapter 6.95 of the Caft(M. nice HcalNk SafcryCaM, Secuom 23503.25573 and 25534.1 undcrsmnd thssifdm building does not currently have a meant, Nat it is my responsibility be notify the Occupant of the requirem uwhich ..athcmcrprionytssaancearaceninemaraLtpaney. , Signature of Applicant Date _SLA. • i Q 13 - O All roof coverings to be Class "B" or better Owner rhori.ctl ascm Oam' D Community Development S(T_ 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 4UPEkTINO Building Department 171 JOB ADDRESS: PERMIT # Gl Ah•, I Ln.. 060 moo �,:f--- OWNER'S NAME: PHONE # 9s3 •33 35 GENERAL CONTRACTOR: FAX # (• I am not using any subcontractors: Signature Dat Please check applicable subcontractors and complete the followinginformation: C9.1,% -o6 Date SUBCONTRACTOR BUSINESS NAME BUSINESS MANSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Me Painting / Wallpa r Paving Plastering Plumbin R Roo ' •c Tank heet Metal t. Sheet Rock Tile C9.1,% -o6 Date om 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37505032.00 DATE ISSUED.......: 09/13/2006 RECEIPT #.........: 36024 REFERENCE ID # ...: 06090088 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: •FEE ID UNIT QUANTITY --------------------------------- BREMAIRHAN NO.UNITS 1.00 BREMFURN NO UNIT 1.00 BENERGY PERMIT FEE 1.00 BREMRECEPT NO. OUTLETS 1.00 PPERMITFEE FLAT RATE 1.00 BSEISMICRE VALUATION 9,000.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : 19397 PHIL LN CUPERTINO KODE RUPALI OPERATOR: amyw COPY # : 2 RICHARD READ RICHARD READ LIC # 22334 CONDITIONED AIR 1701 LITTLE ORCHARD ST SAN JOSE, CA 95125 (408)291-2220 euolfflwl 10.26 14.31 34.86 1.20 38.37 0.90 38.37 38.37 176.64 PD -TO -DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS REC 10.26 14.31 34.86 1.20 38.37 0.90 38.37 38.37 176.64 NEW BAL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 METHOD ----------------- OF PAYMENT AMOUNT NUMBER OTHER ------------ 176.64 ------------------ VISA TOTAL RECEIPT 176.64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • r `UPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN #Date: 3-+5 - 6 Energyj ci. 13 -o 6 Building Address: C 9cso I '' k otL BREMACOVER Owner's Name: Ko d R Phone #: a s - $35 Contractor: Phone: C40$ License y 4 516 O ELECTRICAL BSEISMICRE Contact: Phone: ��YYI Cupertin Y Business License #: Building Permit Info: j BUILIDNG Bldg ❑ Electc� Plumb L' Mech Elec Permit Issuance Job Description: Q)IorfalopCe MPERMITFEE Mech Permit Issuance II(' Residential,-] Commercial ❑ Plumbing Permit Issue For Residential Installations: ❑ ❑ ❑ BPERMFEE 2nd floor Attic 1" floor BUILDING Adhere to min set back requirement®, i For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ BPGAS Structural Calculations required for new installation ❑ PLUMBING New installation Planning Approval Required ❑ Business License Cost of Project:Q BCD_ Type of Construction: Occup 6, i' ou� Strapped 0 On Platform El Bonded EF Sq.Ft. Floor Area: New Location ,B— R lacemei i Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energyj BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recpfl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial j BUILIDNG EPERMITFEE Elec Permit Issuance j 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