06030119 (2) CITY OF CUPERTINO i rte' h'rd �. �� • *w, pz a
BUILDING DIVISION PERMIT COIVTR C-°,TO�INFORMMATION �,
BUILDING ADDRESS: PERMIT N0.
7559 NORMANDY WY
NER'S NAME: PERMIT ISSUE DATE
STUART SALTAR 1701 LITTLE ORCHARD ST 03/22/2006
PHONE: SANITARY NO, CONTROL NO.
(408) 291-2220
ARCHIT ECTIENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o m
+oLICENSED CONTRACR'S DECLARATION •Q/�1�
m 1 han 7 )of Nm 1 am licensed under And
ofChapterCode. n(commencing IO � NLE D O
with Salon IDflll)nm that
A3 of.licensed
and Professionshapter 9(c Ikerueis
k mllfr. ad elf y REPLACE FURNACE
3 Z Lima.
se Cluse Contractor
ARCHITECTS DECLARATION
a1 undersand my plans shall he uscd a public meads APR 1- 2006
6
gpt; Licensed Pmfcssionel
3 Oat I am am.pu from
m DECLARATION
iI I he."affirm Nm 1 am exempt form the RATIOar'l License Law for the
C09 fallowing naso.(Sccdon 1031.5.Business and Pmfeadorm Code:My city or county $2450
1$� which requires a permit w cmuuucl,alar.Improve.dcmolbh,or repair any swmum BUILDING
_jt, prior to is issuance.ales requires theapplteanl far such Permit to Okasigned rnmmeal
< that heblicensed pursuant tothepmvehmaoftheCanus<ur'sU..Law(Chaim,9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 700G)of Division 3 of the Business and Profession,Code)or
�.- that he is exempt themfmm and the bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to A civil penalty of APR Number Occupancy Type
not mate Nen five hundred dollen(5500).
0 I,As owner of the pmpeny,or my employees with wages a their sok ampenwtion,
will do the work and the structure is not intended m offered for Asia(Sec.7044,Buutm,
And Pout eaims Cade:The Committee,License law does ant apply in an Owner of Required Inspections
pmpeny who bui Ids or improves Nemo,and who des s och work himsel f w through his
awn employes,provided thatcmh improvement,are net intended oraffered for Asia If.
however.the building or improvement is veld within am year of compleUm.the owner.
Wilder will have the burden of proving that he did nm build or improve:for purpose of
Asia.).
❑I,as owner of the property,em exclusively connecting with licensed contrwtons to
convect the pmject(Sec.701,Business and Pmf a lam Cada:)The Commences Li-
come Law time not apply as an owner of pmpeny who builds or Improve,Nems.and,
who contracts for such projects with a conummor(0 licamed pursuant an the Convector's
License Law.
❑I am escape under Sec. .B&P C for this mown
vertu Date
WORKERS COMPENSATION DECLARATION
I hereby affirm on&,pemlty,of perjury me of the following declared.
❑1 haw and will maintain a CeNficam ocarmat W self-Imam fm WorkoesCompen-
Asllon,As provided for by Section 3700 of the labor Code,fm the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insunnm,As mquimd by Section
3700 of the labor Code,for the performance of the work for which this permit Is issmd.
My Wmkefs Campemadon 1 nes cartier and Polity number am:
carrlcr._NA-00-f 1 1�(t Y?allcy NO.; (910001136-15-261
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA71ON INSURANCE
(rhb mala mod nut N completed If de permit is froom hundred dallam(SIM)
or leu)
I certify that in the performance of the work for which this permit is issued,I shall not ,
employ any person in any manner an As in become subject to the Worken'Compemnion
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If,after making Nb Ccnificam of Exemption,you Mould
become subject in the Worker's Compensation previsions of the Labor Code,you most
forthwith amply with such pmvidnm or this permit shall he dcemcd revoked.
,z.tO CONSTRUC ION LENDINGAGENCY
[..t I hereby sffinn that Nm eis•aw
nmila.lending agency far the performanm of
a shework for which this permit b issmd(Sec.3097.Cin C.)
�W Q landae.Name ,
r7 z Larder's Address
U0 1 mrufy that 1 have mad this application and sum that the above Inrmmadm Is
W F correct.l agree to amply with all city and county on inames and suite lave misting to
0 building convection,and hereby authorise mpresenalives of this city to enter upon the
shove-amminaml pmlerty for inspection purposes. -
It-^y a (We)agme m save,indemnify and keep hm
sdu the City of Cupertino against
liabilities.jurlgmame,eats
and expenses which may in soy way marc against said City rj
U 7 in moegmnce of the granting of this permit.
'7 APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATION�9.
tr?r6 ,a 31art /'o° Re-roofs
Siyw Applieanr/Can Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum building occupant store orhandle haardous mamriai
As dc0ned by the Cupenino Municipal Code,Chapter 9.11,and the Health and Safety
Code.Became 15532(a)? All roofs shall be inspected prior to any roofing material being installed.
ED Yes
Will the applicant or future building occupam use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air contaminants As dermad by titc Bay Area Air Quality Management all new materials for inspection.
District?
❑Yus wjavu
I have mad the haaaolaus matedals mquimmenu underChapmr 693 of the Caller. -
nia Health&SafetyCo&,Smitions 25505.15533 uW 25534.1 undersuiM that if the Wilding
does ret currently haw a meant.thu It is my nesporwhility to mufy the occupant of the
requlrc cnuwhich in mpdar muana
etafacertinesmafocaparey. Signature of Applicant Date
JAA O'D/0 6
o er oaths sed agent Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
2 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # : 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36611154.00
DATE ISSUED. . . . . . . : 03/22/2006
RECEIPT #. . . . . . . . . : 33671
REFERENCE ID # . . . : 06030119
SITE ADDRESS . . . . . : 7559 NORMANDY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STUART SALTAR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5222
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 7, 000.00 0.70 0.00 0.70 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 164 .98 0.00 164 .98 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ________-_____--__
OTHER 341.42 VISA
TOTAL RECEIPT 341.42
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
• r
10300 Torre Avenue
Cupertino CA 95014
It
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #a�
-10,1501 N-60r-n-Anr
OWNER'S NAME: v } V PHONE #
GENERAL CONTRACTOR: FAX # q -
I am not using any subcontractors:
Signature Date
Please check applicable subconowing information
SUBCONTRACTOR BUSINESS NAME BUSINESS ENSE #
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
tlie Date
CITY OF CUPERTINO
FURNACE/AC o �d30
• CUPERTINO PERMIT APPLICATION FORM
APN# -366 Date:
Building Address:
255 IJ o m an'l', o C9 TZ-04
Owner's Name: Phone#: c")
r r 9009
Contractor: License #:
Cbn6,,-�- 0n <N Ali 44516%
Contact: Cupertino Business License#:
S�f1%r t a -* C15-09- 5ZLI
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech OU
Job Description:
9,Pmocm Sy,6 Re pka.act Owl,ria0f
Residential P9 Commercial ❑
For Residential Installations:
Attic ❑ 1" floors-2"d floor❑
• Adhere to min set back re uirementj�j
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: Occupancy group:
OG
Strapped [] On Platform ❑ Bonded Z Sq.Ft. Floor Area:
New Location 8 Re lacement4a—
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cftn MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfrn 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