06080164 (2) CITY OF CUPERTINO 14 "' "
BUILDING DIMSION PERMIT
i
BUILDING ADDRESS: AZORES AIR & HEATINGS PERMTN0.06080164
10380 FARALLONE DE
OWNER'S NAME: PERMIT ISSUE DAM
MICHAEL & SALLY WEBB 3850 HIGU
E: SANITARY NO. CONTROL NO.
(408) 234-4245
ARCHITECT GINEER: BUILDING PERMIT INFO
BLDG O ELECT PLUMS
MECH
O
o0 LICENSED CONTRACTOR'S DECLARATION Job Description
Z 1 hereby affirm that 1 am licensed under provisions of Chapter 9(cemmonsing
< with Section 70OO).fDh UI,mSof the Bust.and PmAnnsiom Code.and my licensee
in full farce and Client. REPLACE FURNACE-ADD . NEW A/C UNIT
License Class Lk.a
Ii gm� Gold ARCHITECS DECLARATION
I understand my Pain andl hused as public mads Ne
®
)yu
:p1-� Licensed Professional
OWNER-BUILDER DECLARATION ,w
I<m I hereby mlirm that I am exempt from the Contractors License Law for the PIP
.O O following mason.(Sedan 7031.5,Bmmas ad Professions Code:My city or County
which require a Penult to construct.atter,b,demon.demolish,of repair any mucmre 8546S-
.ti prior at its usuorec.alas requires the applicant for such Permit to file*signed statement
' $ that htsu
e is licensed the provisions ofthe Connector's LicenseLow(chapter 9 Sq. Ft. Floor Area �L.-6y V luatti-9n
1 (commencing with Section 7000)of Division 3 or the Business and Professions Cem)or (, IJ
�.. UIL
that he u exempt themfmm and the basis for the alleged assumption Any violation of �Y
Section 7031.5 by any appliant for a permit subjects the applicant to a Civil penalty of PYP4r Occupancy Type
oat mom than five Waded dollar(5500).
❑I.uowerarthe paprny.mmy empmym with wateastim'vsakcampens4Oan,
will On thewam."dissmmtum u ammualed a offered immie(Sec.7044.Business Required Inspections
and Professions Codi:The Contractors License law dao rot apply he an owner of - q P
property who buildsmimprow thenron.ad whadatasuchweak hisoldi ar threats his
awn employee,provided than such Improvements art mainmNad monad formic It.
however.the Wilding m improvemant uuld within ate year moompletion.me.
Wilma will have the burden of proving that be did not Wild an improve fm p,upase of
ale.).
�rl.as owner of the pmpiny,am exclusively contracting with Ocemed Contractors in
constrom the project(See.7044.Business and Frofesdam Code:)The COMUCLA s Li-
eona Law doe not apply an an owner of property who Wilds of improve them m.and.
who contracts for such projects with aeanhamo s)licaused pursuant in the ConerecuM
License Law.
❑I sur umap,unser See ,B&P_C flet this Am.
Owner �wa�+�-1a�1b Date yy�y—L
WORKER'SCOMPENSATION DECLARATION
1 hereby afs7m under penalty of perjury ane of the following declarations:
I lm.and will maintain•Cenifiam of Consent to self-inure for WorkersCamper-
cation,as provided par by Section 3700 of the Lab.Cede,far the perfarmua of the
work for which this permit Is leaned. ..
0 I have and will maintain Workers Compensation Insurance,as required by Section '
3700 of the Labor Code,for the per(ormanco or the work far which this permit is Wound. '
My Workers Compensation twomnce carrier and Policy number art: -
Camier. Policy No.:
CERTIFICATE OF EXEM PITON FROM WORKERS'
COMPENSATION INSURANCE
(Thu settle need et W<anPkled If Ile permit ufinene hundred doBas,($100)
or lea.)
I ccTd v that in the pmfarmance of the wart fm which this permit is imud,I mail nm
employmY Person in any menrrc agJ�saome ubjeetmgive Worken'Compematbn
Laws of Catifoom.Dam1 klb-�
Appsantm+eW-�v-1
NOTICE TO APPLICANT:If.afermatlng this Cenifiem of Erwpd..you should
become subject as the Warkers Compensation provisions of that labor Cod,.you most
Oforthwith comply with such pmvWam m this permit shall be d.md mwked-
Z.t CONSTRUCTION LENDING AGENCY
t--t Ihamhy sM.Out,ft.ua eouaOcOon lending agency far the Perfarmanx of
a> Oe work far which this Permit is farad(Sec.3097,Civ.C)
0.Q Lenders Name
.`D z Landers Addma
V Q I certify that I have and this application ad sum that the abuse information in
u, C~ correct.l a&me to Comply with all city and county ordmaee and state laws relating m
CU
Wilding convection,and hereby autharne remeumatives of this city to enter upon Oa
W above-mentioned pmpeny for inspccdon purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcmno against
N liabilhim.judgments,casts and expenses which may in try way acere against mid City
C)Z In consequence of the grandng of this permit.
v'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 6i Date
SOURCE REgULATIONS.- -
1,1L Re-roofs
Signalum of AppIimmAZm for Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the APPliCanl ar future building OCCopanlrmm of Mdse haaArdae material
as defined by the Cupertino Municipal Cade.Chapter 9.13.and the Hedth and Safety
Cam,Section 35533(4)7 All roofs shall be inspected prior to any roofing material being installed.
Ye we
Will the applicant or future building Occupant tax equipment or devise Mich If a roof is installed without first obtaining an inspection,I agree to remove
mit hmardnus air ccnuminanu as deputed by the Bay Am,Alf Qnsiby Management all new materials for inspection.
D LdCl?
❑Ye §LNo
I haw mW the himudmtsmamnau rtquirtmenuunmrClupmr&95ofdeCatifon
nulkalN&Safc,YCde,S MZ303,35533e 25534.IunmemdlheifOe Wilding
macs Item Cmmndy have I lenani this It u my moponsihiliey to notify Oe Occupant or Out
mquirtmenta which roup comet pdorurissuancc ofa Cmmkam at Occupancy. Signature Of Applicant Date
erdl zi I fab All roof coverings to be Class"B"or better
Owner or suthar'ved agent Dom
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT#
'Sko 0 8 d2-0� G �/
O R'S NAME: PHONE #
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
• o6
Owner/Contractor Signature Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36929015.00
DATE ISSUED. . . . . . . : 08/21/2006
RECEIPT #. . . . . . . . . : 35691
REFERENCE ID # . . . : 06080164
SITE ADDRESS . . . . . : 10380 FARALLONE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHAEL & SALLY WEBB
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3105
RECEIVED FROM . . . . : SALLY WEBB
CONTRACTOR . . . . . . . : FERNANDO VALADAO LIC # 25859
COMPANY . . . . . . . . . . : AZORES AIR & HEATINGS
ADDRESS . . . . . . . . . . : 3850 HIGUERA RD.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95148
TELEPHONE . . . . . . . . : (408)234-4245
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00
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 5,465.00 0.60 0.00 0.60 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 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 280.14 0.00 •280.14 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 280.14 667
TOTAL RECEIPT 280.14
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
47c],
CITY OF CUPERTINO
FURNACE/AC
CUI�TINO PERMIT APPLICATION FORM
APN# 36
00�1 O/S Date: li�-( 2-1 I 046
Building Address:
Owner's Name: Phone#:
Sfta 4- IktcHAe-L 1.70
Contractor: Phone: License#:
AZv e-es RSR kC i Con , 46k 2-4-4 66$2 6 yr 'l 13
Contact: Phone: Cupertino Business Lice se #:
'Z%(2►�A-1�ao VALLF}DAn do8' 234 v-2µS' p�0 �/ -/1
Buildipg Permit Info: P�io6
`— P-GPLACC*AQV +T r-%,&a Nv*fc a-
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential [ - Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ® 2"d floor❑
Adhere to min set back requirement®—
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Projec$5 y 6 .0 Type of Construction: Occupancy group:
Strapped ❑ On Platform U Bonded El Sq.Ft. Floor Area:
New Location R- Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
13REMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
f 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 1 Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING