08010144 (2) CITY
BUILDING DIVISION PERMIT y.€CO1tiITRACQRI1 'OTLMt1,TI(3N
fis$ 'a�W'"h. ah C.T"kl�§`Y/'e,h'�+d'kS -h �r°•x
BUILDING ADDRESS: PERMIT NO.
10055 CRESCENT RD CONDITIONED AIR 08010144
NER'S NAME: PERMIT ISSUE DATE
ELERATH JON G AND DEBRA A 1701 LITTLE ORCHARD ST' 01/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTIEC rENGINEER: BUILDING PERMIT INFO
REPLACE EXISTING FURNACE/AC BLDG ELECT PLUMB MECH
l� O D O
u o 0 LICENSED CONTRACT'OR'S DECLARATION
K I hcmby affirm Nat 1 me licensed under provisions of Chapter 9(commencing Job Description
with Section 700)ofDivWon 3 ofthc Business and Professions CLolorant my license is
I.full force end.flan. y U Z
L�? Lkcnte Clan Lk.N
a Date Contruor
ARCHITECTS DECLARATION
U I understand my plans slWl be used as Public sounds '
twD Licenced ProfassiarW
OWNER-BUILDER DECLARATION
i<S 1 heathy aRrm that I am exempt from the Conu uctaea License Law far the
COO following moon.(Section 7n31.5.Business and Profession Cade:Any city or county
$ which mquims a permit to convect,slot,improve,demolish,or repair any sauetum
prior in its issuance.also mquims to applkam fersuch permit to rile asignedsuament
g < that he I.licensed Foresail o tea provisions of the Comments's Limnsc Law(Chapter 9 Sq.Ft. Floor Area Valuation
�y mf-8 (commencing with Section 70ri0)of Division Sof the Bushmmand Professions Code)or
.,
that he is exempt therefore and fix basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fa a permit subjects the applkam to a civil penalty of APN Number Occu ane e
not mom Nun Ove hundred dollars(SM. P y n'P
❑I,u owner of Me property,or my employees with vile;as their sok eoagwasa m,
will do the work,and Ne structure is rounded or offered for sale(Sec.711/0,Businw
and Profession Cada:The Ccnuactors License Law does net apply in an owner of Required Inspections
property who Milds or improves therann,and who dors such work hbnself m through his
awn employees,provided that such improvemems am act Intended or offered for We.If,
however,the building or Improvement is said within aro year of completion.the owner.
builder will lase De burden of povinl that he did nat build or Improve for purpose of
sale.).
❑1,a teener of the pmPenY•w nciusivelY cumulating wide Haunted m
eonuactoa
.mtroct the mojem(Sec 7060.Band.and Pofaulen Cade:)The Contractors U.
cense Law does not apply u an veru of pmpery wba builds or improves Demean,me.
who eonvau far such projects with.ca.mOm(s)licensed Forecast to De Ccomer 's
License Taw.
❑I me exempt under Sec .B At P C for this mann
Ter
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury an of the following declan0ans:
1 ham and will maintain a Ceri ficau of Lament in self-Wum for Winters Compen.
ation,as pmvided for by Section 370 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑I have and will maintain Workers Compena0on incomes,as required by Section
370 ofte Labor Code.for the performance clubs work for which this permit is issued. '
My Waimea Compensation Insurance arra and Policy number are: -
Carrier. OU.QluPY` ea• Policy No.:-77J��F5�{S'O('
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Inch sxom need mthecorepleted ff ft permit is fortune hundred dollen(SIM)
or leu)
I unify Not in the performance of the work far which this Permit is issued,I shall not
employ any person In any musette as o became subject to the Warken'Compensation
Laws of California Data
Applicant
NOTICE TO APPLICANT.If, for making this Certificate of Exemption,you should
become abject to the Workers Compensation provisions of the Labor Cade.you mot
O forthwith comply with men provisions ar this permit shall Mem
deed mocked.
r�~.rCONSTRUCTION LENDING AGENCY
I henby.M.That them lex couvucuon lending agency for the perform..of
Ci > De work fur which this permit Is issued(Sec.3M.Civ.C.)
GGI Landers Name
z Lenders Address
U O 1 amoofy that 1 have mad this application and suits Da tiro above let..exon is
{xm E cohrecL I.lrec to comply with all city and county enticement and cute laws misting o
.0 building convection.and hereby authorize repmsrsutivrs of this city in enter upon the
gal .hove-mentioned property for Inspection purposes
C (We)agree to ave,indemnify and keep harmless Me City of Cupertino against
rat IhMilidesjdgmenu.tato and apmues which may in My way Amur agalnaaid❑ty
V Z in canequ..of the granum of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOS REGULATIONS. 4&
—IL-W./11 4 -�S I OB Re-roofs
Srg of Applinn onuacorT Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
MII the applkam err future building mepaol.mre or Nndle hauAous material
as&Ind by De Cupertino Municipal Code,Chapter 9.11,and De Health and Safety
Section 25532(.)7
oe
❑Y � All roofs shall be inspected prior to any roofing material being installed.
a
Will De applicant or future building c ttpant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasfdnus air.ntamin.ts as defined by the Bay Arta Air Quality Management all new materials for inspection.
D amt
❑Yat ab Ae-
I have mad the hasrd.s materials requirements under Chmter6.95 oftheCatifor-
nit Hal"SafetyCdc,Sections,25505.25533 an125534.1 moderated!Medusa building
dos not currently have a lotam that it h my responsibility a muly de occupant of tic
requimmenu which muss Whet Prior o' orf.Certificate oroacurpanq. Signature Of Applicant Date
O -
All roof coverings to be Class"B"or better
Ovine thariasd mem '
Dau
CITY OF CUPERTINO
FURNACE/AC
�CUPEkTINO PERMIT APPLICATION FORM
Oho/v� �
APN # Z� / Date:
Building Address:
Owner' e: Phone#:
Contracto - Phone#: al �- 2Z
V---)41 r Fax#: Z
Contractor License#: Cupertino Business License#:
Contact: Phone#: ;l v- vC,�1
��tJL>l Fax#:
Building Permit Info:
Elect Plumb ❑ Mech
Job scriplltion:
-
ll
Residential Commercial LJ
For Residential Installations:
Attic ❑ ]' floor ❑ 2nd floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
Strapped ❑ On Platform Bonded New Location Replacement
Valuation: J 000
/Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
FURNACE/AC
Cl F
CUPER,TINO FEE SCHEDULE
FURNACE:
Qty. if
Applicable Fee ID Fee Description Fee Grou Permit Type
MCRAA Furnace M FURN/AC
MCREPALT Commercial Mech Repair/alt/add M
MCSUSHTR Commercial Suspend Wall/floor M
Heater
PGASCOM New Gas Piping System 1-4 Outlets P
Commercial
BSEISMICO Seismic Commercial B
/ MRRAA Residential Mech Repair/alt/add M
MRSUSHTR Residential Suspend Wall/floor M
Heater
BSEISMICRE Seismic Residential B
MFLRFURN Install/relocate Floor Furnace M
MECPLNCK Mechanical Plan Check M
MFR=<100 Furnace Syst<100k BTU M
MFRN>100 Furnace Syst> 100k BTU M
MRAIRHAN Comm/Res< 100k BTU M
/ EPERMITFEE Electric Permit Fee E
MPERMITFEE Mechanical Permit Fee M
BREMRECEPT Electric Receptacles E
PGASRES New Gas Piping System 1-4 Outlets P
Residential
BPGAS Gas Piping System 5+ Per Outlet P
TRAVDOC Travel Documentation B
BUSLIC Business License B
• CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng:' Sub: Blk: Lot:
APN . . . . . . . . : 32616070. 00
DATE ISSUED. . . . . . . : 01/25/2008
RECEIPT #. . . . . . . . . : BS000003775
REFERENCE ID # . . . : 08010144
SITE ADDRESS . . . . . : 10055 CRESCENT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ELERATH JON G AND DEBRA A '
ADDRESS . . . . . . . . . . : 10055 CRESCENT RD
CITY/STATE/ZIP . . . : CUPERTINO, 95014-1050
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
---------- ----------- ---------- ---------- ---------- ---------- ---------
1BSEISMICR VALUATION 14, 000. 00 1.40 0. 00 1.40 0. 00
1EPERMITFE FLAT RATE 1 . 00 4,0;79 0. 00 40.79 0. 00
1MPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40 .79 0. 00
1MRRAA UNITS 1. 00 61.19 0. 00 61 .19 0 . 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
---------- ---------- ---------- ---
TOTAL PERMIT 184 .96 0. 00 184 .96 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ----------- --- --------------------
CREDIT CARD 184 . 96 VISA
---------------
TOTAL RECEIPT 184 . 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
Community Development
1 `/+
Cupertino
CA95014
Telephone(408) 777-3228
n C�T I A I O Fax(408)777-3333
�U
rC 1 '�I Building De artment
JOB ADDRESS: PERMIT #
00ss elwoe?nk C U D OE 6 ( o
OWNER'S NAME: e PHONE # CLke$ E• Z2
GENERAL CONTRACTOR: FAX # ZZZ-H
I am not using any subcontractors:
Signature Date .
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LI SE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental SheqA4eta1
Painting/ Wgfpaper
Paving
Plaste g
Plun,6ing
R ofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
5 �0
er/Contractor Signature Date