06030182z
z°
h
a>_
1 Q
az
UO
OF
U
F�
�z
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
INFO
,CONTRACTaR �MATIQN
BUILDING ADDRESS:
PERMIT N0.
10736 PINOLE CT
'ER's NAME:
PERMIT I5SUE DATE
SIEVERT KIM R ET AL
1701 LITTLE ORCHARD ST
03/31/2006
PHONE:
SANITARY NO. CONTROL NO.
(408)291-2220
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Ct� 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby afford that 1 am limed under provisions or Chapter 9 (commencing
with Section 7aghrf Division 3afde Business and Professions C/n_dc..,and my liccnx is
REMOVE & REPLACE FURNAC
Lf�coscoC mdeff t. ,
N - g 'd
I (VALE ®
Co.
Dau /Aft Con.,. Ai
ARCHITECTS DECLARATION -
-
I uMersunJ my plans shall be used a public rtenrtls
APR
^• " �X-Z006
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby ,(nerd Liccnu law far de
n I am exempt from tW Csaimns
(Section o
followingmoon.comma]fl3LA BusinessandProfcaium Calc: Any city orrummy
75
jai III
which uyuima a permit m i, slur, improv, m sig any swcturt
the h Permit t e a
prat m its issuance. also (moves in he the applicant for such permit m Ole a signed statement
marrommang wit pursuant of the (Chapter
Sq. Ft. Floor Area I Y
7")prodaiom
eBn,i....d Code)
(commencing with Section ]000) of Division 3 of the Buinua and Professions Cnde) or
that he is eumpt therefrom arM the Ensu for dm alleged eumption. Any violation of
3
S ection]031.5 by any applicant for a permit subjects be applicant to a civil penalty of
W umbel Occupancy YP Occn anC Type
mor meal than Five hundred dollars($500).
1, as owner of the property, or my employee with wages as their sok Commandant,
will do me work. and be motion, is not intended of offered for sale (Sec. ]04th, Business
and Pmfesaions code: The Coneasnors License sew does Out apply to ac owmr of
Required Inspections
pmpeny who Wilds in improves demon, and who doessuch work himselforthrough his
Own employona, provided that such improvements art not intended oronered for We. It,
however, be building or improvement is sold within one year of completion, the owner.
builder will haw be banker of proving that he did not Wild or improve ft purpose of
salt.).
1, as owner of the property. am exclusively contracting with licensed convectors to
construct be pmjem (sec. 7044, Business and PmfcWma Code) The Contractor's U.
come Taw docs not apply man owner of pmpamy who Wilds or improves themon, and
who contracts for such projects with a contractor(i) lienttd purawnt in the Corturbaors
Liccnu taw.
❑ Ism exempt under Six. . B & P C far Nis mason
Dau
WORKER'S COMPENSATION DECLARATION
I hereby alfiom under penalty of perjury arc offt following declarations:
I haw and will maintain aCenifiex of Conent tout( -insure for WohersCompcn-
enion, as provided for by Section 3700 of the labor Code, for be performance of On
work for which this permit is moved.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
37W of the LoWr Cade, for be performance of the work for which this Permit is issued
My Workers Compenatimn Ins.unit anftltPali, number art:
q.
Carrier. AYYr k^%Civ ( re i PNr, No, rat OOO IEFI.IS –
CERTIFICATE OF EXEMPTION FROM WORKERS'
.
COMPENSATION INSURANCE
(This Section aced not W completed iDhe p .it I$ ter me hundred dollars ($lam
or It.)
I certify that in the performance of the work for which this permit is issued, l dull not
employ any permit in any munerw a to become Subject o the Workers Compensation
Laws of Califomia. Data
Applicant
NOTICE TO APPLICANT: If, after making this Conifcam of Exemption, you mould
become subject to the Workers Compensation provisions of the Late Code, you must
forthwith comply with such Provision or this permit stun he deemed mnlum.
CONSTRUCTION LENDING AGENCY
I hereby .f firm mat mem is a construction lending agcacy far me performance of
the work for which this permit is issued (Ser. IDB], Civ. C.)
London's Name
Lender's Address
I certify mat 1 have read this application and mux that me above information is
cOOerL 1 agree to comply with all city and county on inaness and aux laws relating to
building construction, and hereby authorial rcpreentativm of Nis city to enter upon the
Shrivo-memtioned property for inspection purposes.
(We) ague to sive, indemnify and keep hamrle s On City of Cupertino .,slat
liabilities. judgments, cuts and expenses which may in any way accmc against mid Cityin
uenm of be
of
APPLICANT UNDERSTANDS AND ND permit.
COMPLY WITH ALL NON -POINT
�(
Issued by: Date
SOURCE REGULATI,ONNS. , p�
313fp°
Re -roofs ��---�
Si'"nrA�pplicamuco" �ramor-,
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant store or handle haeur oto material
m defined by be Cupertino Municipal Code. Chapter 9.17, and the Health and Safety
. Stcuom 25532(.)?
❑Yes - Q�kNu
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
Smit hayartlous air contaminants as dichncd by the Bay Area Air Quality Management
all new materials for inspection.
Disrict?
❑Ycs =9 No
I have mad me hvardous materials uqumcb m s under Clupur 6.95 of the Califor.
ria Health &Safety Cale, Section ZiM5,25533 and 75534. I undemand the if be, Wilding
does not currently have a xnanl that it is my respomibility to notify the occupant of de
rc ruwhichmostbemmprirrmiss eenr,cenihempraapaney.
Signature of Applicant Date
,t �13t 106
All roof coverings to be Class "B" or better
o mer aurhonu ,sent D,x
2 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36934020.00
DATE ISSUED.......: 03/31/2006
RECEIPT #.........: 33809
REFERENCE ID # ...: 06030182
SITE ADDRESS .....: 10736 PINOLE CT
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: amyw
COPY # : 2
OWNER SIEVERT KIM R ET AL
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4425
RECEIVED FROM ....: RICHARD READ
CONTRACTOR .......: RICHARD READ LIC # 22334
COMPANY CONDITIONED AIR
ADDRESS 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95125
TELEPHONE ........: (408)291-2220
•
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
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
4,175.00
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
---------- ----------
164.78
0.00
---------- ----------
164.78
0.00
METHOD OF PAYMENT AMOUNT
-----------------
NUMBER
------------
OTHER
500.18
------------------
VISA
TOTAL RECEIPT
500.18
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
301 ROUGH PLUMBING
303
ROUGH MECHANICAL
304 ROUGH ELECTRICAL
505
FINAL ELECTRICAL
507 FINAL PLUMBING
508
FINAL MECHANICAL
•
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
1 ()-4. G P'mC)\ 0A
PERMIT #
060-��
OWNER'S NAME: , rr-\ S i o V n o
PHONE # @5 3- 9 yG
GENERAL CONTRACTOR:
FAX 8 G t - -�) 9(9 (-{
C
I am not using any subcontractors: ./D� 3 h l /Q G
Signature Date
Please check annlicable subcontractors and rmmnlPta tha fnllnwinv infnr niinn-
7*�00wner/Contrktor
Signature
gI,I()6
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental SheetMet
Painting / Wallpap
Paving
Plastering
Plumbing
Roofing
-SeptipTank
Sheet Metal
Sheet Rock
Tile
7*�00wner/Contrktor
Signature
gI,I()6
Date
OF
SCUPEkTINO
r
CITY OF CUPERTINO p(p p30ia9,
FURNACE/AC
PERMIT APPLICATION FORM
APN #
Date:
Building Address:
rcc viuu
BUILDING
MECHANICAL
l 1-3(� P, c� C�t��,r,d
cYa Rely
Owner's Name:
I �
Phone #:
�s3- �y69
Contractor:
License #:
A/C Units <= 10, 000 cfm
MECHANICAL
Contact:
Mc
Cupertino Business License #:
Rec tl, Switch & Outlets
22
Building Permit Info:
BSEISMICRE
Bldg ❑ Elect Ly Plumb C5/
Mecham❑
Job Description:
Qerv,o Va
EPERMITFEE
MPERMITFEE
PPERMITFEE
f olaCor
t1C,z—
Residentialx(-1 Commercial ❑
BPERMFEE
For Residential Installations:
BUILDING
Attic ❑ 1" floor -2-2 nd floor ❑
BPLANCHK
Adhere to min set back requirement ❑
BUILDING
For Commercial Installations:
BUSLIC
Replacement same weight ❑ Additional weight (structural calcs) ❑
BUILDING
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project:_ Type of Construction:
Occupancy group:
14 '1
Strapped ❑ On Platform ❑ Bonded ❑
Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable
Fee ID
FPP r1PCl�TIl�fi nr
/
BENERGY
BREMFURN
Ener
Furnace
rcc viuu
BUILDING
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
MPERMITFEE
PPERMITFEE
Elec Permit Issuance
Mech Permit Issuance
Plumbin Permit Issue
ELECTRICAL
MECHANICAL
PLUMBING
BPERMFEE
Bld Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING