05120014 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT UNsTRACTQRiTl�''U�'IAx'I N:
EUILDINO ADDRESS: A PERFECT CLIMATE PERMITNo.05120014
1634 JAMESTOWN DR
- OWNER'S NAME: PERMIT ISSUE DATE
RICHARD SUTTON 10570 S DEANZA BLVD 19/119 /200S
NE: SANITARY NO, CONTROL NO.
(408) . 861-9545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EIFA.7 PLUMB MECH
t�
i 0 o LICENSED CONTRACTOR'S DECLARATION IOb DCsc On
l 1 hereby affirm that 1 am limned under proritimf of Chapter 9(commencing /p�
with Smtim 70(11OWDivluon 3afde Sammons and Pmustioa Code.and my license is C/t/(/(v���
„ tutu0romeana ey • B REPLACE FURNACE
��z Lkem CI Lt.• p
p Dau Can DECLARATION'
�
7W -ARCHITECTS
mai DECLARATIO
1 1 mdersuod my Ptsmx NII he used a public records
a
Licensed Pmfessionl 2Q
OWNER-caump ER DECLARATION
Conte ON
0 i 1 hereby.(rico this 11. exempts an me ConinssCo Lkem city
O for ere /prjV/•J{t! s
Al
po following rem n. emtim 7onstr Business and wi.demolish.
Coke:Any em errmuum
3$ which acgNaca.permit re cores go alter.htrmw.demolish.fie a sig any mens $2327
zY pAYrmits iimusid"neo equina tion applicant retrench pcmitu Ok augrcd ser¢mat
th.,heeltemapYmYwto the provisions of dm Communes Limns,Law(Ch Sq.F[. F7Dor Area ation
5 9 (commencing with Schon 70001 of Division J of the Business and Pmfeuions Cram)or
C — Nn he u exempt thersfmm ndi the basis for the alleged exemption.My violence of
IJVSection 7031.5 by my applicant fees permit subjects the.ppltm,to aa.E Penalty of t Oce_ ancy Type
not more than nve hundred dollars(5500).
❑1.Y M'ler Yf dM pmptlty.IX my CmplYyetl with wagCa 4111eir cot MnpeneBm,
wig do the work and the smmurs is Out Mended bro@md forWe(Sec.7041,Businau Required Inspections
and Projections Code:The ConwcmlY License Law does.1 apply b m owner of 9 p
propertywho builds IX lmpmW Museum.Ndwhodueeaueh work hlmaelfor dMYgh his
Ywnemployrn,provided that such imp,mvocou ars Out intended oroEered(msale If.
however.the building or impmwment is sold within one you Ncomldinim,the awner-
Wilder will sam du burden of proving that he did not Mid in InMprow per purpose of
tele.).
❑1.u owner of me property,un elusively conacting with germed conusmom in
cootmer am pmjea(Sec.7044.Bwbea and Pmfesdm Code:)The Contractors U-
cense law dos not apply to an owner Npmpenynodm builds orimpmw,thereon,and.
who contracts for such projects with a con mmus(G licensed pursuant to We Conuutors
License Law.
❑lamaemptmdasec. ,Ba PCfurthtsmaaa
owner Data
7301LWORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury as of the following dalarWons:
I have and will maintain•Certificate of Consent u e1r.1m.for Workers Camper.
I
m,u provided for by Section J7m N Me labor Coag.jm the pedomame of Me
rk for which this permit is limited.
1 haw arta will maintain Workers ComprnWon Insurance,as acquired by Seim
0 of the Labor Code,for the perfammee of ere work far which Nu permit ts Wood.
Worker ampewNon Inamos cam and PaIII numbertier. PNty No.:
C CATS OF EXEMPTION MOM WOMEM' ,
COMPENSATION INSURANCE
(Thu minim need tmtheeonpleud'dthe permit is faronchundred do1W(3100)
or lest)
I«nify that In the Performance Nam work for which this permit Is issued.I ahll not
employay person in my marcrwuto oebject to the Worken'Cammaaaon
Laws of Calif Dam
Aa nam
M e=sTOcttoAPPLICANT.es after making this Geminate NE AW Cod you should
Me=subject y it Workrta Cmopcwdan previsions of de Lahr Coda you mute
.,O forthwith comply with such providaa or Nu permit shall he tleemed acwked.
zCONSrRUCr10N LENDING AGENCY
F 1 bromy aRim cut them ts a coatrmdon thing agency for the Performance of
C ,>„ Me work for which this permit Is housed(Sec.3097.CH.C-)
lit Q Lenders Name
az Lmumes Address
U0 1 codify Mtn I ban read this afapiksim and situ mm dm above information ts
Ecored I agree u comply with all city and comty onilmmss and sum laws mlating m
(0 building eomWction•and hemby aumoda repraonuawa ofmis City W(NOW upon me
E
LP7 abow-mentiorcd pmpeny fm Inspection purposes
Ly,G (We)ague to an.indemnify and keep hamlets the City of Cupertino against
p) liabilida•Judgmenu.cons and expenses which may in my my some agYa,said City
CJ in coaegrcme of the granting of cols pmmiL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z,2i D
SOURCE REGULATIONS.
Re-roofs
Signature of ApplimnOCom,amor Dam of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the appliam a fulum Wilding occuplltalore of handle haallow co erial
Id'oes
s dellrcd by lie Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
ede.Section 25532(4)7 ��/` All roofs shall be inspected prior to any roofing material being installed.
❑Yw (yno
VIII the applicant or future buildingoccupant use equipment or devices which If a roof is Installed without first obtaining an inspection,I agree to remove
it haardoes air conumianu u m by the Bay Atha Air Quality Managemm, all new materials for inspection.
District?
❑Yw tBGyyllfifi
I hm mad the NaNmsmaunaurequimmenu under Clupmr&95of me Cagier.
ia HealmkSautyCom.Sttvms25515.25537 and 2553/.l untenund mmifdm building
not currently thaw a means.ma,it ts my responsibility u notify the occu us,mf this
gmrcmenuwhichmustbemetpriortolaanceofaemracateofcccuprmy. Signature of Applicant Date
wner Y,militarized agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
9 �'/ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building De artment
JOB ADDRESS: PERMIT #0. 2 �0417vv�� o h -��
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
. aTYOF
i 6 FUR10 ACE/AC flZ
CUPERTINO PERMIT APPLICATION FORM
APN # b 6 1 cD JGr Date:, Z
_3 Z 0
,b a
Building Address:
I(r,3 Jawt �cst,✓v, r.
Owner's Name Phone #:
I ,t c,6, c�� 5k oh �{o a5S-3�F6 3
Contractor:eLicense #:CI k vv c0_:�-e 7 3
Contact: Cupertino B siness License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Re.
Residential Commercial ❑
For RgsicJential Installations:
Attic is` floor ❑ 2nd floor❑
. Adhere to min set back requirement❑.
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cos of Project: Type of Construction: Occupancy group:
_� 3:k7 .0 3
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN 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 Plumbin Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING