04070083 (2) clTv BUILDING cuPESION 6 NT kT'6R INFORMATI,
BUILDING DIVISION PERMIT
BUILDING ADDRESS: A PERFECT CLIMATE PERMIT N904070083
1192 CRESTLINE DR
OWNER'S NAME: FERMIT ISSUE DATE
LARRY & LISA ARONOVITZ 10570 S D
E: SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION I heJob Description
mby affirm Nat I am licenud antler provisions of CTapmr 9(commcneing 0
b nion7M(oof Diviai
C wish Scan3of NC Businccs end Prufcsainns Codc,and myliccnsc is
._cm in full force arta cf(ccs. n a�
�z Lben.Class Lk.«
INSTALL CENTRAL A/C
=—soAUG
Data Co..., GG
y ti ARCHITECTS DECLARATION ,i 2004
Y I..&.,and my plans shell themed as puhlm rentil, �.
u Limmad Professional Six
Int
e0� OWNER-BUILDER DECLARATION AVJ���
.� E 1 morhy olfirm Nat I am exempt from tW Consorter',License Law far Nc QJVG
00 following mason.(Section 7031.5,Businus and Professions Coin:Any city or county
K$ which Montreal a Permit to construct.alar,impmw,demalLsh,or.,.I,any atmcture 750
prior m its issumm.also requires the applicant for such permit to Glc a signed statement
Fx< tha,W ix liccnscJ pursuant to the provisions of NC Cantncmr's Liana Law(Chaper9 Sq. Ft.Floor Area Valuation
€0 (commencing with Section 70M)of Division 3 of the Business and Professions Code)or
M Nat he is exempt dmrefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any appliant for a permit subjects the applicant to a civil penalty of 3e 0 Occupancy Type
oat mom Nm five hundred dellen($510) v
❑1,as owner of But pperty,or my employees with wages as their sole compensation,
will do the work.and memoriam is not intended or offered for sale(Sec.1014.Business
and Profesdons Code:The Conuactnra License Law does not apply m.n owner of Required Inspections
property who builds or improve Nemon,and who docs such work himself or through his
own employees,provided that such improvements tie not intended or offered foraale.if,
however,the building or impmvement is said within one year of completion.the owmr-
builder will have the burden of proving that he did not Wild or improve for purpose of
I,as owner of tW pmpennsm
y,am exclusively contracting with licensed contractors
on wct the project(Sec.7044,Business and Profusions Cade:)The Condacmr's Li-
emse,Law isnot apply to an owner of property who Wilds or improve themon.and.
who con for such projects with a contractor(s)Iiunsed pursuant o the Cormactots
Liccvc w
❑1 am e a pt er Sec B&P for Nts tion
Ow Dam
WORKER'S COMPEL SAT/ NDECCMyT7pN
I e by dEnm under pcmlty of ury one of Nc folTOwing dedenuons:
have and will maintain a Certificate of Consent.self-insure for Worker'sCompcn-
7cz
n,u provided for by Section 3100 of the Iabor Codc,far the pier... a of the
for which this permit is issued.
have and will maintain Worker's CompcnsNon Insurance,as"dimd by Section
of the Labor Code,far Ne pertormance of the work for which Nis permit is issued.
Workees Compensation Insurance artier and Policy number me:ier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTh section reed nor be completed Bthe permit is for..hued ed dollars(SIM)
or leu.)
I ttinfy Nat in the perfnmmnce of the work for which this permit is issued.l shall nut
employ any person in any manner m as to become subject to tW WorkersCompcw0on
Laws of Califomia D.
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
neconm subject to the Worker'a Compensation previsions of Ne Labor Code.you must
.JO Forthwith comply with such provisions or this permit shall NO deemed revoked.
Z CONSTRUCTION LENDING AGENCY
Ihe.bYRMIM that Nert is a construction lending agency for the perforrnance of
the work for which this permit is issued(Sec.31191,Civ.C.)
U3 Q Lcndcr' oil
d Iendeis Addreas / 1
V me
Q 1 I mcertify the 1 have read this application and,taro that Nc above information is
IL F' correct.I agree N comply with all city and county aNinanm and Stam laws relating re
V Wilding construction.and hereby auarim represenu mivof Nis city to enter upon the
r� i have-rom ianed property for inspection Porpoises.
4. (We)agree to save,indemnify and hap bmmlem Ne City of Cupertino against
rF.Vl liabifi ,judgments.candcapcnsca which may in any way accmc against said City
(J z in ca u<nce of Nc go"',aning of this peon,.
APP 1 UNDERSTANDS AND ILL COMPLY�W-yI ALL ON-P INT Issued by: D
SOU DL DN g i6
Re-roofs C7 t
rt of Apphe ndContrador
HAZARDOUS MA IALS DISCLOSURE Type of Roof
Will on,applicant or Into.Wilding occupant mom or handle haemi material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Calc.Second 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
(]Yes No
Will the applicamor future Wilding occupant use,equipment ordeviccs which If a roof is installed without first obtaining an inspection,I agree to remove
t havardous air contaminants as defined by the Bay Amar Air Quality Management all new materials for inspection.
rstrin?
[:1 Year Nu
1 dreadthe Wsndous mmcdals mquireacn8 under Chapter 6.95 of the Califon
nice Hcal & a&ty Codc,Sations25515,25533and25534.1undcnundthatiHW Wilding
does not a mly have a i mol Not"is my m,mrs ldit y p notify the Occupant of the
require i um he am,Pool oi awdafaCerti careof 'cep Signature of Applicant Date
own r r aamoriaca sent , I D„ All roof coverings to be Class "B" or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rug: Sub: Elk: Lot:
APN . . . . . . . . : 36224036.00
DATE ISSUED. . . . . . . : 07/16/2004
RECEIPT 4. . . . . . . . . : 26320
REFERENCE ID # . . . : 04070083
SITE ADDRESS . . . . . : 1192 CRESTLINE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LARRY & LISA ARONOVITZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5035
RECEIVED FROM . . . . : LISA ARONOVITZ
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 861-9545
%E 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 3,750.00 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
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -__--_________---_
CHECK 161.93 3519
TOTAL RECEIPT 161.93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
.d Community Development
10300 Torre Avenue
�✓ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDR//'�SS: PERMIT #
d, Cr Cpe-USHInDI2Cee_
OWNER'S N ,C.i� Itr-ovtp„i PHOW# 'G$ , 461 . 9
GENERAL CONTRACTOR: FAX #
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
ern or Sign e Date
CITY OF CUPERTINO
� '- FURNACE/AC o yD�Ol�g�
CUPERTINO PERMIT APPLICATION FORM
APN # r 0 Date:
Building Ad ress: I
CYCby 11 VC
y1IJC 0q- ��tr
Owner's Name: Phone #:
bi Lsc. Awh4\Jc-tt 408 — 861 — 9 `iso
Contractor: License #:
e r
Contact: Cupertino Business License #:
Av
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: II 00nn p 1
h S't� C� Gl.i✓ can cLr�nnvf
Residential 5QCommercial ❑
For Residential Ins allations:
Attic 13 Is` floor 2nd floor ❑
' Adhere to min set back requirement Q`I
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required F1 z
Cost of Project: 3 ;fid Type of Const Occupant gr "
Strapped 0 On Platform K Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qt 'f
A Ille Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
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 BUILDING
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
BUSLIC Business License BUILDING