06090043 (2) CITY OFCUPERTINOr.3si'm �` °' e
-BUILDING DIVISION PERMIT CONTRA b,R1V RMA"Ctf,!N
BUILDING ADDRESS: SAN JOSE AIR CONDITIONING PERMITND.06090043
10736 LINDA VISTA DR
OWNER'S NAME: PERMIT ISSUR DAIS
Ah PADILLA ROBERT JR 1045 N 10TH STREET
NE: SANITARY NO. CONTROL NO.
(408) 286-2047
ARCHITECUENGINEER: BUILDING PERMIT INFO
BO EO PLUMB MEOCH .
op LICENSED CONTRACTOR'S DECLARATION IOM Description
hareby arRrm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 7M)of Division 3 of the Business and Profession,Code,and my licenu4
�a inrallraauwerr«L INSTALL AIR CONDITIONER ON EXISTING FURNACE
Z Liam Clue Lic,11
Dass Contractor
q ARCHITECT'S DECLARATION
i a I undermnd in,Plan shall o used as public rimed
i
' Licensed Professional I7 /
s y Oat I am exempt
DECLARATION
ay I hernial,affirm that 11. ,Bumps from du Centred Co e:My C law for me
O O following masa. panda i 7U31.5,Business and posme.de oli Cade:Any city Of county 5/L
S9 which uquea Issuance.pmmit to cnnmum,all«.ht for sac de ermit t nr repair any mumu 4 7 6 0
prior m its eased elmhl Of Oe du applicant for such Permit m file a signed Cha mem
-ZPr�d
Out he is licensed purman,to lha provision of No Cantrocturs Liadsu law(CMptom9 Sq.Ft. Floor Area Valuation
1€O (comme eml wish Section 7000)of Division 3 or the Business and Pm(essian Code)or
Nat he is comp,Nesefmm and the basis for the alleged eakeepdan Any violation of
Section 7031.5 by arty applicant far a permit subjects the applicant to a civil penalty or MR,14merOuOccupancy Type
not mom than five hundred dollana(5500).
❑1,as owner,of the property cur my employees with wgn as theh tole compensation,
will do the work and the ssaucsure is hat mounted or offered for asle(Sec.7044,Buairmas Required Inspections
and Professions Code:The Conl,ctor's License n e Law donot apply to an owner of q P
property who Wildsarimprov Nemon,and whodoessuch weak himselfarduough his
awnemployess,provided Out such improvements am not InundeC u,affertd for sale.If,
however,Ne building or improvement is sold within ane year of completion,the Owner,
builder will hew the burden of proving dist he did tot build or improve for purpose of
scale/),
cr L u owner of the property.am exclusively contracting with licensed«nuxmn to
ceutun the project(Sec.7044,Business and Profnsian Code:)The Contractors Li.
cones Law don not apply to an owner of Property who Wilda or Improv Nemon.and
who contracts NO such projeeu with a contrumrts)licensed pursuant to Ne Contactors
Liana law.
❑lam
Ownerrtic tOn�4",Sec. .B R P C for Nu rev/on
.A//H tide Ware y�7�aG
�dKER9 OM ON DECLARATION'/ /
1 hereby aRret underpesWsyorperjury mai following doelsntimsn
❑I have and will maintain aCeNBnmor Canunt to selFlnum for Workeh Compan-
ution,as provided fur by S«tion 3700 of she Labor Code.for Ne performance of du
wort for which this Penni,u issued.
❑T have and will maintain Workers Compensation Inu ante,u acquired by Section
3700 of the Labor Code,for the performance of the work for which this permit is lamed.
My Workers Compensation Tawrarue carrier and Policy number art:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ste don need Im,ocompleud If IW permit is foranc hundred WHO,(SIM)
or less.)
1 certify shat in the performance of the work for which this peinth s Iss«d,I shall not
cmployanyporseninany mm rya tEr mbj«I toth.Wo ,' don
lawn of Caliromia.Dau c" � /
Applicant PPL
NOTICE TO APPLICANT:IL after making sh CenlRcau of crept n au ahuuld
become mbj«t to the Workcra Compensation provisions of 0 labor you mon
.,O forthwith comply with such Provsion or this Permit shall be demand revoked.
r r~N. CONSTRUCTION LENDING AGENCY
E~ I hemby alfbm Nat dere is a construction lending agency for me Performance of
IY >
the.,it for which shs Permit is issued(Sec.3097,Civ.C.)
W�Q Lenders Name
r7 z Lenders Add.
U O 1 century that 1 have mad this application and sou that ale move information is
Uy F confect I ag,a to comply with all city and county omfnardv and sae laws relating to
O V Wilding eonsuuction,and hereby aumodre represemtiws of this city to enter upno lW
l7d above-mentioned property for impecuon purposes.
y (We)agree to saw,indemnify and keep ha mlen the City of Cup rtino against
rTA liabilid4fudgmen0.cussandexperrami which may in anyway acme atimmssud City
U Z in consequence of the granting of On permit 7
ww APPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE�R rULAT N . 02 11 �
�./ ../a �4 d G Re-roofs
Sdgneto bean nlr7Data
HAZARDOUS MA ALS DISCLOSURE
Type of Roof
Will On applicantor(inure Wilding e.ChapUmu2.and O hmaNan mamdal
as deRned by Ne Cupenim Municipal Code.Chapter 9.12.and de Health and Safety
Code.Simian 255324)? All roofs shall be inspected prior to any roofing material being installed.
[DY., P1110Will do applicant cur fuum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha'nNaas air comeminans u de0ned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yus
I haw mad On hazamdous mamdals,qui,nuns under Chapter 6,95 of the Caliror,
..Health&Safety Cada.Scetioas 25505.25533 and 25534.I undimmed Out if Ne Wilding
dao not currently haw a unant met it u my eapamibility to notify du occupant of the
myuircmc wMeh at met maar4Cem0cam OCpwuy. Signature of Applicant Date
ti` "T dG All roof coverings to be Class"B" or better
Owncr dfmtWrbxd agent Dsu'
Community Development
Sim
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
GVUPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONED / 3 2—
GENERAL
GENERAL CONTRACTOR: -.,,/ ~ FAX #
I am not using any subcontractors: 06
Signature 6ate
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . : 35608018 . 00
DATE ISSUED. . . . . . . : 09/07/2006
RECEIPT # . . . . . . . . . 35938
REFERENCE ID # . . . : 06090043
SITE ADDRESS . . . . . : 10736 LINDA VISTA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PADILLA ROBERT JR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ROBERT PADILLA JR
CONTRACTOR . . . . . . . : WILLIAM JENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1045 N 10TH STREET
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 286-2047
•FEE 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 4 , 760 . 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 . 93 632
TOTAL RECEIPT 161 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
CITY OF CUPERTINO UON pQL�
Q' FURNACE/AC
11 0
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
0L.,fT /t
Own 's Name: �- Phone#:
M> 7 L 6eo - L
Contractor: Phone: License #:
N d le7473
Contact: Phone: Cupertino Business License#:
�1`O 8• G -�a�7
ui mg Po6nit Info:
Bldg ❑ Elect 8' Plumb G;P� Mech I
Job Description:
Residential ' Commercial ❑
For Residential In llations:
Attic EJIs` floor 2nd floor❑
Adhere to min set back requirement
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required El
Cost of Type of Construction: Occupancy up:
42 Tzv— 0— o
—
Strapped LJ On Platform 64� Bonded 07 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
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 Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING