06010103 (2) ho
CITY OF CUPERTINO ' A t m -.- ---xs°,r
BUILDING DIVISION PERMIT L`ONTReCx,QR INFQRMATION•
Bu1LDINGADDRESS: SCHAUMANN AC-HEATING-PLUM NO.06010103
0669 CELESTE C1.
• OWNER'S NAME: PERMIT ISSUE DATE
HIROMI KOBAYASHI 3505 THE 06
)NE: SANITARY NO. CONTROL NO.
(408) 428-0640
AR(HITEC fENGINHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uO- LICENSED CONTRACfOR'SDECLARATION JobDescri Description
dv I Mroby&from that I m licensed under provision of Chand!)(commencing p
with Stertors]000)of Division 3o(mc Businue arW Prorusinns Cogp an myliccnu is
a mmnmmamdercm4 -7 -700 6 REPLACE FURNACE, ADD A/C
�•�� Lken�lm Lic.g
OF Dam Contractor avvnavan
ARCHITECTS DECLARATION
1 understand my plans shall to used as public records
J
k G Licensed Pmfcsdanal
r7.m OWNER-BUILDER DE CLARATION
i M 0 I hereby.(Siam that 1 1. exempt from an Um Contin;Co License Law for the
M o allowing moan.(Section T(01.5, t.shun. and improve,
do tins Code:Any oily or aunty
$ which requires a Permit re cores,the altep imprrsu h permit t or mash any statement
that Mor its issuance,e,almnt to the thovisiappo s o for Contra mil m Nc se Lac(nammcm
z < (cannot n m&witpurstion7 Ncpmvivioion3ai eBuulor'anicenmlaw(Chapmr9 Sq.Ft. Floor Area Valuation
zC$ (commencing with Sutton 70W)of DivistanJ"Trim Business and Rof"alom Code)or
3—
that he is exempt Nemlmm and We bub far the alleged exemption.My violation of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penally of r U J Occupancy Type
not mom Than It.hundred dollua($500).
❑1,as owner of0m property,or my employees with wages as their sale compensation,
will do the work and theaanum is not intended oraRemd(orasle(Ses.7DN,Bud.
and ProfcWans Code:The Cammmofs License Law data sat apply to an owner of Required Inspections
property who buil&or im proves thereon,and who does such work bimaelf or through his
own employcu,provided that such Improvements m not intended ora0ered for sale.If.
however.the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did no Mild or Improve for purpose of
sale.).
❑1,a owner of the property,am exclusively contracting with Ilmu,E antractors to C7/
constmct the project(Sec.7041,Business and Profusions Code:)The Contractors U. C�
cove law don not apply to an owner of property who Milds or improves themon,and,
who contracts for such projects with aeonummft)licensed pursuant to the Cormier,
License law.
❑1 am exempt under Sec. .B&P C for this sawn
saner Dete
WORKERS COMPENSATION DECLARATION
I hereby,aRrm,under penalty of perjury arc of the following declarations:
I have and will maintain a Certificate of Contin m self-intim far Warkefa Compso-
tion,u provided for by Section 3700 of the Labor Coe,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Walter's Compensation Insurance,as required by Section
37110 of hit(aMr Code,(m the performance of the work("which this permit u inuW.
My Wortime Campe1r�a Insonna curio and Policy number am:
Carrier.�r✓LjC ,(-h S dYA/1�/6o11ry No.:� W11, �B
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This steno reed not bernmpleted time,pmmlt Is foram Warhead dollua(SIM)
or leu.) ,
I comfy that In the performance at the work for which this permit is Issued,I shall not
employ any partner in any manner sou In became mbkn to the Workers'Comp otaadon
Laws of Celifomia.Data
Appliant
NOTICE TO APPLICANT;If,aAct making this Certificate or Exemption,you should
Mcome subject to the Worker's Compensation provisions of the labor Cade,you am
,J 0 forthwith comply with such provisiou or this permit shall be deemed mocked. -
zCONSTRUCTION LENDING AGENCY
52
(. 1 hereby aRrm that Nero is a construction lending agcory for the performance of
a> the work for which this permit is issued(Sec.3097.Civ.C.)
WE Lender's Name
O z Lender'sAddmss
U O 1 aniry Wt I have read this application and atom that the above information is
ty Fcomma.I agme to comply with all city and county urdinuwes and some law relating ho
OU building consuaction,and hereby authorize representatives of this city m enter upon the
tTt above-mentioned property for Impaction purports
�"py (We)agree to save,indemnify and keep harmless the City or Cupertino against
r.t y liabilities,Judgments,tom and expenses which may in my way accrue against said City
t.)Z in consequence of the granting or this permit. f/
•"' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCy-RfsgULANSn ' v Re-roofs �i�.�
SignalUM of AAppplica tet//Cantractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
V411 ft applicant ar future building occupant nam mbmdm hauNou..most
u&fined by the Cupertino Municipal Cade.Chapter 9,12.and the Health and Safety
ode.Settlor
yer IAll roofs shall be inspected prior to any roofing material being installed.
❑ SNu
/ Will me applicant or future building occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haramou air contminants as defined by the Bay Area Air Quality Management - all new materials for Inspection.
uin7
❑Yes No
I he.mW the Wou dou.mamriW requirements undcrchapier 6.95ofthe Califor-
meHealth&SafetyCodc.Sections 25505,23533 and 25534.1 unicameral due i(dm building
does sat cumendy haw mnm4 mat It u my mapomiblOty b natlfy dm oauput of the
require which she etpdarmisaimnme nia cmtina afoemupmcy. Signature of Applicant Date
r (T-0 C. l All roof coverings to be Class'B"or better
Owner or amhorimd gens Dam �•„ ,fJL�
r5 ,rTt..
Community Development
! ' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
20665 Ce Ic- +e G`rc-1z 67� Oi o/vim
OWNER'S NAME: o BA YA S N 1 PHONE # vg 517 8A I
GENERAL CONTRACTOR: FX # o — a 3 — ?o '
I am not using any subcontractors: T-V1- 111 ,06
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
Til
4-12e
Owner/Contractor Signature Date
De Anza Forge COPY
550 Division Street
Campbell, CA 95008
408-540-5050 Fax 408-371-5130
September 29,2005
Hiromi Kobayashi
20669 Celeste Circle
Cupertino, CA 95014-0481.
REF: Architectural Application
20669 Celeste Circle
Dear Hiromi Kubayashi:
Your application to install air conditioning at your unit was reviewed and has been
approved with the following conditions:
1. Design and construction must meet the guidelines as specified in your CC&R's, any
applicable state and federal laws, and as described in the enclosed architectural
application.
2. Please obtain design approval from the appropriate local agency if necessary.
3. Prior to the start of any work please make sure that all vendor information has been
provided including insurance certificates.
4. Any damage done to the Common Area will be the responsibility of the unit owner.
5. Also, at completion of the work,please send to my attention, copies of any final
signed agency permit(s). If we do not receive these documents, we will understand
that you have contacted the appropriate local agency and they have advised you that
their approval is not necessary for the work.
Any additions or modifications to the above referenced work will require a new application.
Should you have any questions or comments, do not hesitate to contact me at 408-540-5026.
Thank you for your cooperation.
Sincerel
If `ice �......
Rangly Near
Association Manager - -- -- —
L7��JPAN
cc: Property File: 00131-2658 1 9 2006
Architectural Committee ,,,--�",,��
Board of Directors
PPL2—Architectural Application Appro�cd
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CITY OF CUPERTINO
.0FURNACE /AC 6 � ul o� ,-3
CUPEIIiTINO PERMIT APPLICATION FORM
APN# Date:
326 - Se fl G7 o 6
Building Address:
20(,(,g c +e C`r-cl-0-
Owner's Name: I- P nep#: Q
r .,; j�o6c QSkI LfOO -5Ir7 "9 V2I
Contractor, License#:
S Gl�tsi vvr.on mil ?' Or%6 003 C4C2o C3
Contact:
Applicant/Contiactor:
SC k-aU/vLC1/I
Building Permit Info-
Bldg Elect mum Mech
Job Description:
Residential: Q_ FURMNCC A--�+J A /C Commercial:
Sq.Ft. Floor Area: $/Sq.Ft :l
Architect/Engineer: Valuation: It.
Type of Construction: Occupancy Group:
•
Qty.if
Applicable Fee ID Fee Description Fee Group
/ BENERGY Ener •BUILIDNG .
BREMFURN Relocation of Furnace 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 BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERmrrFEE Mech Permit Issuance MECHANICAL
PPERMrrFEE PlumbinR Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILMNG
BUSLIC Business License BUILIDNG