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06030179CITY OF CUPERTINO CONTRACTOR INFORMATION _: BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 20284 VISTA CT ER'S NAME: PERMIT ISSUE DATE SABES IRENE C 917 QUERCUS CT. 03/31/2006 WIDNE: SANITARY NO. CONTROL NO. (408)655-0491 ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH Al l� L! (� LICENSED CONTRACTOR'S DECLARATION I arm at I am licensed under provisions of Chapmr 9 (commencing 1 herebyff with Section 7")of Division 3 of the Bumke, and Infmoms Cade.andmylicense is REPLACE FURNACE in full force and,r_ Lican.Claza Lie[ APR X2006 Dare Gonll ARCHITECPS DELLECL A ION I understand my plans shall k used u public mmrds � I y tea.,' L® BUILDING Licensed Professional OWNER -BUILDER DECLARATION I hereby alRrm Net l exempt from the Communes License Law for my mem 1. 71131.5, Rustiness and proimprove. al Code: Any city or county $2000 whicfolloh ac mess a panto t akr, improve. ch repair my structure which permit re cores its ism n the h permit t fi thatMor toisscensed c. also pursuntto the thovisiosof for sucCmurarmiuoicense nad aw(Chtemem thatW is licensed pursuant (, Sq. FC Floor Area Valuation othe f nnd ProRLaw 70he or Division Code) or estop,th S.ctdon]000) ofD avis n3 of theeged •a,am. An,ansCNe) Oat k u exempt thcrtfram and de bats for Ne alleged cxempdon. Any violation of Oat he Is An APRMuFnEier Occupancy p y -+�� Section 7031.5 by any appliant for a permit subjects the applicant o a civil penalty of trot more than fm hundred dollars(55(sl 0 1. as owner of the ponp'rty, or my employees with wags a their stul' compensation. Required Inspections will eo the workand Onswcture is not intended or offered fount. (Sec. 7004, Basin. and Professions Cos.: Tk Comentor's License Law dos not apply b an owner of property w ho indicant imprmes themon, and who dna such mak himsel f or through his own employes, provided Nal such improvements are not intended proffered forsale. If, however, the building or improvement is sold within one you of completion, the owner - builder will base It. WNcn.( proving that he did nm build a, improve for purpose of sale.). 0 1. as Owner of doe property am exclusively contracting with licensed economists in construct the project (Sec. 704-1. Business and propensities Code:) The Cornerstones Li - come Law dues not apply to an owner of property who Wilds or improves themen, and, who contracts for such pm*a with a conuaemr(s) licenced pursuant in the Comractofa License Law. 0 1 am exempt under Sec. . B k P C for this recon u Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I ham and will maintain a Cenifiesu of Consent o self-imum for Wmketa Com ion- autun, ss Convicts fm by Section 37W of the 12Wr Code, far the Nafmmana of the work for which Nis permit is issued. ❑ 1 have and will maintain Workcls Compensation Insunince. az required by Section 37W of or Coec,ftur the performmcc of the work far which this permit is issued. ' My W c n Imuran¢ carrier end Policy number am: Cartier. Policy No: CERTIFICATE OF EXEMPTION FBO ORKERS' COMPENSATION INSURANCE Mos section need not k completed if tk permit is fortune hundmidollars (SIM) at kid.) 1 certify thvt in the p'rfnrme pf c ort. fm which this permit is issued. I shall not cmplayony permn arm, me auboa, ui weakes'Compemation Laws of California. Dau Applicant ' NOTICE TO APPLICANT. If, slier making this Cenificata of Exemption. you should become subject to the Worker's Compcnsafim previsions of the labor Code. you must forthwith comply with such paramour w thu permit shall be dcem'd revoked, CONSTRUCTION LENDING AGENCY I hereby,whoRnm that them u lending agcrrry for the performance of th, work fur which this permit is issued (Sa. 7097, Civ. C.) s ed (See Lender's Nam. � larWCYS Add. 1 certify Nat 1 ban mad this application and stare that the above information is correct. 13g= th comply with all city and county on inantts and sole laws relating to building concoction, and hereby authpme mpmsentaiiva of this city to enter upon the above-mcmioned property for inspection purposes. (WC) agree 10 a nify Nd tap harml. NC City of Cupcnino against liabilities,jusgments sts ante mea which mey in any way accrue againsuaid City in ctunxquence tuf ting a( is permit. APPLICANT UN E NDS L COMPLY WITH ALL NON -POINT Issued by: Q�( Date SOURCE REGVLA \� f Re -roofs Signawr'oMpplinDeta AZA HAZARDOUS HAZARDDOO US MATERIALS DISCLOSURE Type of Roof Will the or forum Wilding occupant more or hurdle hdrardoandSafrmaterial a Cupaa az defined by the Cupmino Municipal Code, Chapter 9.11. and the Hcaith and Safely Wc. Saturn 15531(a)? pyre ONO All roofs shall be inspected prior to any roofing material being installed. will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove 'mit haraNnus air coram mounts as defined by the Bay Asea Air Quality Manag'mcnt all new materials for inspection. District? ❑Yon ON. II've read th"Mr apkr6 II'vSafetymmn5un iftheCaldiogria Fa .de 5 .fur IuMcrstaMthuifUwUifogdoes not currently hpomrb I m rattly the meupam of the requirements whicha erdrmOeUppanry� Signature of Applicant Date �3/// All roof coverings to be Class "B" or better Coma, ormthm,=d agent D'areV • Community Development 10300 Torre Avenue Cupertino CA 95014 Telepbone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 6aP PERMIT # 0G63,9/7 �. OWNER'SNAME: SpELhJ AYAWE PHONE# yo 4S,' -o ter/ GENERAL CONTRACTOR:�I t t �Tv FAX # - 7&A- S c;7 3 4— Jlonri��roa��3 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/Contractor Signature Date I 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 I jw 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31625032.00 DATE ISSUED.......: 03/31/2006 RECEIPT 4.........: 33807 REFERENCE ID # ...: 06030179 OPERATOR: amyw COPY # : 3 SITE ADDRESS .....: 20284 VISTA CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: SABES IRENE C ADDRESS ..........: CITY/STATE/ZIP ...: LOS ALTOS HILLS CA, 94024 RECEIVED FROM ....: JIM TURNER CONTRACTOR .......: JIM TURNER LIC # 25053 COMPANY ..........: JIM'S AIR CONDITIONING ADDRESS ..........: 917 QUERCUS CT. CITY/STATE/ZIP ...: SUNNYVALE, CA 94086 TELEPHONE ........: (408)655-0491 'PEE 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 2,000.00 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 ------------ CHECK 164.78 ------------------ 11452 TOTAL RECEIPT 164.78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL --- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • •UPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM OW36 9 APN # 3�6 ,u 03a Energy Building Address: vet. BREMFURN Furnace MECHANICAL Owner's acme A dl'l JCC' lZ Ph -/V Y - Contractor: Phone: License #: . Swc` AW �a� ��oK i Yo D Contact: Phone: Cupertino Business License #: ZT µ -� v �. 62ss-o 05 Building Permit Info: BUILDING Bldg ❑ Elect 93'� Plumb Mech -Lf BUILIDNG EPERMITFEE Job Description: ELECTRICAL Residential ❑�V Commercial ❑ Mech Permit Issuance For Residential Installations: PPERMITFEE Attic ❑ 1' floor ❑-?"d floor ❑ PLUMBING dhere to min set back requirement ❑ Bldg Permit Fees Ivor Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ BPLANCHK Structural Calculations required for new installation ❑ BUILDING New installation Planning Approval Required ❑ Gas Piping System Fee Cost of Project:c9z; Type of Ca Occupcy�roup: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ R lacement 'a Qty. if Annlicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING