06080018CITY OF CUPERTINO
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{IUILDING-DiVISION PERMIT �
lCONTRACTnR�INFO,RMATIgN x
BUILDING ADDRESS:
CONDITIONED AIR
PERMIT N006080018
11122 WILKINSON AV
OWNER'S NAME:
PERMIT ISSUE DATE
CHEW GLEN
1701 LITTLE ORCHARD
NE:
SANITARY NO. CONTROL NO.
(408)291-2220
ARCHIIECTWENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTORS DECLARATION
Jpb Description
affirm Nn I am under ions of C 9 (mmmensing
1 homion
(oV'{'/
Buensed
with Section7 of theand Pr ride.
eand )ofDivisianJof the Business and Profession Codc.and myliccnsc is
Lfull fearand cf(mL
ADD ASC
Liat qqus
C0-Lic.p 1
Dao: 7i'/D Q Conlr«CL
�J
DECLARATION
ARmailW
I understand my plans shall W used ss Public records
used
v/ L
Litttsmcd Pmfcssional
OWNER -BUILDER DECLARATION
V
I hereby alum 1 am exempt from the Contractors License Law for nm
fallowing moon. on 7(D 1.5, Business and ore Coot: My city as county
Moto
er it t demolish, or repair any svum
whirl, a permit to rte. do
alto. ntlfor
4 8 0 0
nt
for Commurmiuo etc asLaw(ned ummcm
its issu t. im the such
its issuance. o,a0o requires thovisio Conuacuss
ivom i«,rshwes
Sq. Ft. Floor Area
Valuation
that heor
of lW
so
and Codln9
of Code)or
(commecing wit puwanl lalM of Divisiontlon.
n3 nfthe Bed
thatnmcncingwithSrefromon
and basis room Any
that W u exempt therefrom antl Ne baso for the alleged eumpuon. Any violanlon of
er
Occupancy Type
Section 7071.5 by any applicant f« a Permit subjects the applicant to a civil penalty of
nes more Nan five baMred dollars (5500}
❑ 1, ss owner of Ne pmpeny, «my employca with vmges u
Required Inspections
Aa them.n. nldthe ale (Sele70". Busts.
mnded«cachous a4(ply 7aa,owns,
of
he, Contractorslaw rot apply lf rt pwher
and otud cede: 7Te Ce
and
q P
is
thecmrs nd who uch himmlf er tluough leis
wh and who
property who Wi
property
own employees. provided Oat suIh impo An not Come, mpllfued for sale IL
that such improvemwse are not ear
ing ori of dueow«r
year of mpove
however, Nebuilding«den
of pmrnusoldwithinot
for
builder will have the burden of paving Nal be tlitl not Wild or improve for purpose of
satin.).
❑ I. as owner of the property am exclusively contracting with licensed contractors w
construct the project (See 7060, Business and Professions Cade:) The Contractors Ll -
_
cow
cow law deo not apply to an owner of property who Wilds or improves thereon, and.
who contracts for such projects with amnuusor(s) Iicenud initiation m the Contractors
-
License Law.
❑ I am exempt under See ,B&PCf«this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby Af ire under penalty of perjury m of the following dttlaruiosls:
❑ amt will of C rum her Werkeh
by
when.a provided few e Labor Cook.
few Section
$tttion 7700 0( the Labor Cade. (or the Performance of the
37M ce of the
work(u
work for which Nis pcnnin is issued.
mi
❑ 1 have and will howmain Workers Compensation Insuran¢, as myuimd by Section
37W a( the Labor Code, to, the performance of the work for which Nu permit u issued.
My Workers Compensation Insurance carrier and Policy number art:
/�
Carrier. dEMMkn tt�.7Poil,ON No.: titRdf11SW�l'—O
'I
FROM WORKERS'
CERiI CATEOFSATIO
INN
COMPENSATION INSURANCE
,
(ITU session Iced not W Completed if Ilc Permit u f«ane, hundred dollars ($100)
or less.)
1 certify, that in the performance of the work f« which this permit u issued, l shall not
employ any Person In any mother an as to become subjecl w NC Workers' Dompentallon
laws of califomia. Doc
Applicant
NOTICE TO APPLICANT: If, after making this Ccnificate of FaempGon, you should
become subject im the Workers Compensation provisions or do labor com, you mull
comply with such provuiotu w this Permit shall W dimmed mwked.
CONSTRUCTION LENDING AGENCY
W reby af0rrn WI there us c tramuctinn lending agmtry for the perfarmanm of
the work for which this permit u issued (Sm. 3097, Civ. C.)
Name
Lenders Address
I Cerdfy that I have lead this application and mule that the above information u
1 agree to comply wit all city and county ordinances and suite laws relating to
building construction, and hereby authorize rcpresenulives of this city to enter upon the
above-mmudgm ntoncny for on poutowhich cx
(We) agree tin save, indemnify and keep harmless do City of Cusum, against
caper
and expenuswhich may in any way second against said City
ts.the
in Caitlarthen of ra
APPLLICANTCUN UNDERSof thin itermit.
TANDS AND WILL COMPLY WITH ALL NON
Issued by: �� L L
-POINT
SSOigUnuR�XofE
GpUplLicAanUO
Date r
Re -roofs
i(03 P 6
c r�i
'A
CNoS.
Datef
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicanl or future Wilding oceupantsmm in handle hadarderas material
as de0rmd by the Cupertino Municipal Code, Chapter 9. t2. and the Health and Safety
Cole, Section 25532(4)7
Ye
All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or Tutu building occupant use cyuipmrt or Jcriea which
If a roof is installed without first obtaining an inspection, I agree to remove
g P g
cmil ho'rardeus air contsminan" is defocul by the Bay Area Air Quaity Management
all new materials for inspection.
District?
❑Yea ON.
Ihavereadthehvaudeace mnalsrequimt mundcrChapmr6.95oftheCAlifor-
niaHcalth&Sofely Codc.Scetio.ZM5,25533.d255J.lunJcrsundt iftWWilding
d«a vel curren0y havea tram, Nat it u my respoesibility to notify the occupant nr do
teyui nes which vu W mel PriissuanCc of a Ce cricad, of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
o r raathnrindagent m
SAP
CITY OF
`UPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
JOB ADDRESS:
tie
PERMIT #
O 6 (Food
OWNER'S NAME: tjpPHONE
# �$
GENERAL CONTRACTOR: -()r-
-FAX #
U
I am not using any subcontractors: I � CrA �5603 IC7 6
Signature Date
Please check applicable subcontractors and complete the following information: X
caner/Contractor Si e
8.03 •dG
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINES ICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Me
Painting/ Wallpap r
Paving
Plastering
Plumbing
Roofing,/
Septiytank
S et Metal
eet Rock
T
caner/Contractor Si e
8.03 •dG
Date
46m 1 of
OA
CITY OF CUPERTINO
M'I�f 7uM�11ii�i7�FNl1�
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35617073.00
DATE ISSUED.......: 08/03/2006
RECEIPT #.........: 35502
REFERENCE ID # ...: 06080018
SITE ADDRESS .....: 11122 WILKINSON AV
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: CHEW GLEN
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: CONDITIONED AIR
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
BREMAIRHAN'NO.UNITS
1.00
10.26
0.00
10.26
0.00
BREMRECEPT
NO. OUTLETS
1.00
1.20
0.00
1.20
0.00
BENERGY
PERMIT FEE
1.00
34.86
0.00
34.86
0.00
BSEISMICRE
VALUATION
4,800.00
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
----------
----------
161.93
----------
0.00
----------
161.93
0.00
VOICE ID DESCRIPTION
303 ROUGH MECHANICAL
505 FINAL ELECTRICAL
VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL
508 FINAL MECHANICAL
OF
OCUPECIIoTIN0
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN # � - I � �
l
Date:
0DI
Building Address:
I1 as i I ns�n >�� K`�,
o y
Owner's Name:
� eP, hVecJ
P one #:
o&- saS-agCoco
ontra tor: x r Phone:O S a S a (p
License
g7
Con
ct:�{I hone:
Cupertino Business License #:
MECHANICAL
�l 40S-aRI - v
Rec tl, Switch & Outlets
Building PermH Info:
BSEISMICRE
Bldg ❑ Elect i Plumb EV
Mech Er'J
Job Description-
escription 1 ,
Q�
A&4
Seismic Commercial
Residential (}(I Cornhiercial ❑
EPERMITFEE
For Residential I llations:
El ❑
ELECTRICAL
Attic floor 2nd floor
Mech Permit Issuance
Adhere to min set back requirement
PPERMTI'FEE
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
PLUMBING
Structural Calculations required for new installation ❑
Bldg Permit Fees
New installation Planning Approval Required ❑
BPLANCHK
Cost of Project: Type of Construction:
Occupancx gro1:
Strapped ❑ On Platform Bonded
Sq.Ft. Floor Area:
New Location 6— Replacement 5�
BUSLIC
Qty. if
Applicable
Fee ID
Fee Description
Fee Grou
BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfrn
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
PPERMTI'FEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BPGAS
Gas —Piping System Fee
PLUMBING
BUSLIC
I Business License
BUILDING