05110093 CITY OF CUPERTINO -
.BUILDING DIVISION PERMIT CONTRACTORANFORMATTON a.
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BUT
ADDRESS: A PERFECT CLIMATE PERMIT NO.05110093
1032
DW NER'S NAME: PERMIT ISSUE DATE
HEDY HERR 10570 SANITARY NO, CONTROL NO.
N77� MATT)
ONE:
(408) . 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT TWO
BLDG ELECT PLUMB MECH
ioo LICENSED CONTRACTOR'S DECLARATION `b Ill {I
asC 1 hereby affirm Jul 1 am licensed under IrMisims of Chapies 9(commencing Jab IresCn ren_NA
tj
iiW with
Section 7000)Of Division Sof the Business and!Profeuiaas Cods.aM any liccoseis it N 9lly .,
inm11farreloyaoearfen .� g a?,i5$ REPLACE FURNACE
p—.z DaenLie w t.l\l11W DEC /o
i F p Da¢_� —Consncbr 2005
7W ARCHnECTS DECt.A ATION
f 1 understand my Plats shall he used u Public recoM
4 to U
Licensed Prufcssional p
OWNER-BUILDER DECLARATIONt 11,, �
I hereby alum that 1 am exempt from The Convacmts License Law for Ne \Y�
00 following maxed.(Section 763 1.5,Busimess and Profen i..Cods:MY city ar County
m which squima a peril to ennamee eller.impose,demnlW,or repair any strvmum $1998
pd.,to its issuance.also mquims Ne applicant for such permit to Ill..signed ausmcm
-�i that he is licensed putwant to tic pmvisiom ofthc Cordrxsfs Ldced.s Law(Chapter,9 Sq.Ft.Floor Area Valuation
eFG (commencing with Section 7000)of Division 3 oftho Busineuardl Pmfessium Code)or
$
that he is exempt Ncmhom and the basis for the alleged exemit My viola lan of
Sermon 7031.5 by any appliant for a peril subjttu she appicant N a civil penally of er Occupancy Type
our mom Nan fico hundred dollars(35(10).
❑I.asowner offs ryaperry.mmy wploym with wagaasJsa seleemnpewum,
will do Ne work.and Ncstrixrue is nal NUMed orolfemd mrsals(Sm.Toa,Business Required Inspections
and Professiom Cade:The CanmcNh Liame Law dao Out apply N an owner of q P
own enywW Wildsmimpmmch improvements
eta daessuchwde hivuelfmNmsahhf.
own howwwa.theebuip building
or i That such impmwments art not ear ofd oro@rod Tarsale.r-
wilder ill Wilding orimprownml ,blaheold iiina build whopro ,forgon. owty- ,
builder will kw Js WNm of proving Nat k tlitl nambuild m improve fm puryaxe of
.til[.).
❑1,as owner of the property am exclusively contracting with licensed mnuusors N
construct the pmlect(Sec.70a,Business and Profeadom Cade:)The Contractor's V.
«me taw dam out apply as an owner of prnpam rwhe builds or improves Jsmon,and,
who comm.for such projects wish a cim.,s)Beamed punusm to Js Contractor's
License La-
0 l am exempt under Sec .B d P C for this reason
O
wner Dae
WORKER'S COMPENSATION DECLARATION
I bereby afEr under pemity of perjury eta of this fallowing decluaJam:
I haw and ml maintain•Caufuam of Cement w self-insum for Wm4YsCompcn-
ion,as provided for by Section 3700 al the labor Code,for the pedace.of Ik
rk far which this Permit is Issued.
have and will maintain he No er Compemation Id.wrsna,h m s perm by Secuon
yJus Corn,o4.for Nepcdaranccof d wwkfm which Nu perituissuedy Workeh Compenution Inwrame&mer and Policy num nertier.�'r� Poliry No.:
CE Fl IgPRON FltOM WORKERS'
COMPENSATION INSURANCE
(Thu sartm need not k completed if Ne permit is fmonc hundred dollars($I00)
or less)
I cutih that in the performance of the wart for which this permit u issued,I shall not
employ any'penon in any muusr as oma a mus Wortrn'Compemauan
APPlican��/ sew
NOTICE APPIJtI�i ILIO Commaking n p Ccnins;o of EAcmptioq you Nauta
baome stumi N the Wahcfs Compensation provisions;of Ne labor Code you mus
.JO foMwishcamplY with such pmvialom mNu permit shall kdccmed ncwkctl.
Z" CONSTRUCTION LENDING AGENCY
(~.�. 1 hereby dor Nar Nem is a consuuctinn ld ulu,agency for the n
e perfurmue of
E
> tk wort for whim Jds peril u Wood(Sec.3097,Civ.C.)
Lander's Name
gl�
.7 z Lender's Address
U Q 1 anify that I have read this application and soon that Ne&hove inforadun is
LL F comer.I agree m comply with all city and county ordinances and sus laws relating to
0 building construction,and hereby authorize representatives of Nu city in enter upon the
r a ahow-menudgin Pts.cc for Inspection wpurposes.
ex.
(We)agree 19 save,indemnify and keep barrel.Jus City of Cupertino gaunt
F'r/1 incoiuequeric of
grenaMof this&which may in any coyacerin &..I said City /fir
(„)z A consequence of Nc RSTA t of Nu D WILL
Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
f �
Signuum of ApplimData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the is Cupertino
m forum Wilding aceupant srom 2.handle Heallom massial
as defined by Ne Cupertino Municpal Codc,Chapmr 9.12.and the Health and Safety
Alkodo.saJm 25s3zU1? All roofs shall be inspected nor to an roofing material being❑Yoe 1a P P Y g g installed.
will the. reanr or future Wilding aero If a roof is installed without first obtainingan inspection,I agree to remove
PP t pant six ea Air u or @vias which P g
Front bvardom air cvnuminanu u fined by the Bay Area Air Quality Management all new materials for inspection.
Distrix?
❑Ym u
1 have mad the ha>ardms masdals requirements underCkpsr6.95afthe Calif.,
niaHgl"Safery Cao,Sauw25505.n533and2553C.ItutJasund Nuif Ne Wilding
does I cmndy new a snanl t it u my reapomibility u notify ds occasyyyant of the
1kWaigmn hi mtmkmc rtuLuu aofaCcniOrssafLk�pahey. 0 / Signature of Applicant Date
f7� S All roof coverings to be Class"B"or better
0 er or auNomed agent Data' '
t
am
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
U3> v ' Of. OS//,,70 `C
OWNER'S NAME: IAe,4Cq PHONE # 46 —
GENERAL CONTRACTOR: 4 - C11 FAX # �— S
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
APN # 3f / 3j 12-
Date: /Ulz�.
Building Address: Mailing Address (if different from building address):
(D iso,
Owner's Name: Phone#:
er M= -.91 ? ,7
C tract License #-
ontact: Phone: q(o f-9<S1•f r Cupertino Business License#:
:7 h If Fax: (01 -9S4,6
Building Permit Info: � Garke._CC- -
Bldg ❑ Elect nl� Plumb Mech
Job Description-
Residential �" Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Co of Project: Occupancy Group:
00
e of onstruction: Please check this box if the project is a
second-story addition: ❑
Project Size: Standard D Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax -Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
3977
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` . CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING.
BPERAIFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPIIdTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCK.ADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUAIBING
BPSEWAGE Sewage Disposal PLUAl[BING
BPSEWER Sewers PLUAIBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTOR 4 Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER. Install/Alter Water Pie PLUAOING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/CUnit> 10,000 cfm AAECHANICAL
BREMAIIZHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways_ ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREM FURN Relocation ofFumace MECHANICAL
BREMg'URNOV Relo Furnace> l OK btu MECHANICAL
BREM FMAT Heater Installation MECHANICAL
BREAE HOOD Installation of Hood MECHANICAL
BREIVMSC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BRENIPOWER Power DeAce/Apparatus ELECTRICAL
BREAIRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Re air/Alter Heating MECHANICAL
BRERg SAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM '
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd1 Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSI IM Swimming pool BUILDING
BTENIP Temporary Power ELECTRICAL
BTEN11PPERM —Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERIYIITFEE Elec Permit Issuance ELECTRICAL
MPERNTEE Mechanical sq. foot MECHANICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERNIITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot I PLUMBING
PLLONGRNGC Pjan]ainq LR Comme/ Multi-Faro PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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