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06090097 (2)0C Z. U L2I � Ian, G ani UC OE �r C U< CITY OF CUPERTINOh •s"' •ti'��'*"�"' ��``°' ° '�"� gCO1�i'ICRA.CTOI2IFIF„�U,RMA'I'IQN" - DUILDINC'dIVIS10N PERMIT 43 iI L'tl_.RYY'd.A•.'4'TY=.WAS e AIR QUALITY HEATING & AIR BUILDING ADDRESS: ""°'06090097 10943 NORTHSKY SO OW NER's NAME: PERMIT ISSUE DATA ELFVING ELEANOR S 714 NORTHR NE! SANITARY NO. CONTROL NO. (408)293-7138 ARCH17ECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Descri tion p 1 hereby affirmal l am ns licensed under provisioof Chapter 9 (commencing N with Section 7W0) of Division 3 ofte Business an Professions Code, am my license is iofullfomeandefr 1, REPLACING FURNACE & A/C Lice an a L.ic.N .ADD Dam Contractor ARCHITECTS DECLARATION I understand my plans shall bo used as public records Licensed Polecat m..I OWNER.BUILDER DECLARATION 1 oreby aftres that 1 not exempt from the Corm acars License Law far Ne following reason. (section Rn 1.5, Business and Profession Cade: Any city of county which regnim, s permit to cnnsuun, slier, improve. Material. or repair any wrxture.97250 prior to its iuuam',, also requires the applicant farsuch permit to rite a signed statement Canvactms Liters, Law (Chapter 9 Sq. Ft. FloorArea On that he is licensed pursuant to tie provisions of the (commencing with Section 7010) of Division 3 of Ne Business and ftirchimes Code) or / O that he Is exempt therefrom and the basis for the alleged exemption. Any violation of er 9ccupa y Type Section 7031.5 by any applicant for a permit subjects the applicant Ins a civil penalty of not more than five hundred dollars (5500). / ❑ L. u owner of the property. m my employees with wages as their sole eumpens.timn, Required Inspections er p will do the work and Ne stsunure is not intended or offered for salo(Sec. 7044, Busnev and Profeaiom code: The Contactor. License Law does noapply to an owncr of q property who builds or Improve theeson, and who docs such work himself or though his owneroployees, provided Nat such improvements art not inteMN ora@red fm sales If. however, Ne Wilding orimp co ment Is sold within one year of wmple ime. the ow an. builder will have pipe Wrden of proving Nat he did nat Wild or improve for purpose of . ale.). ❑ I. as owner of the pmpeny, am exclusively convening with licensed contractors to construct the project (Sec. 7044, Business and Professional Cade:) The Contractors Lb terse Law does not apply to an orover of property who Wilds or improve demon. and who contracts for such prejeen with a toms dons) licensed pursuant to Ne Characters Liam. law. ❑ l can cmmp... det Sec B A P C for this mason Owner Date WORKERS COMPENSATION DECLARATION 1 thereby air.. under perWty or perjury we of ere fmllawing d xWmmns: I havesend w01 maintain aCertiBesre of Consom to self-laum far Workers Compen. anden, as, provided for by Section 3700 of the Labor Code. for Ne ponformana of Ne work for which this permit is mooed. ❑ 1 have and will maintain Worker's Compensation Insurance. m required by Section 3700 of the Labor Code, for the performance of Ne work for which Nu permit is laum. My Workers Compensation Insurance tunic lid Po e• numbo_r�e�I�S�^- Carrkr.��AC�1Cr,3vl]Sttf— CEFICATTEE OFF EKEMPI70N FROM WORKERS' RTI COMPENSATION INSURANCE (This section need her W completed if red permit is forme, hundred doBan (SIM) or lea) 1 certify Wert in the performance of Ne work for which this permit is Wood. I shall not employ any person in any manMrsa as to become subject in the Workers' Comp,madan Laws of California. Date Applicant NOTICE TO APPLICANT: IL alter making this outiftate of Exemption, you should become subject to the Workers Compensation provisions of the labor Code, you must forthwith comply with such provisions or this Permit shall W deemed revoked. LENDING AGENCY _ MaiCONSTRUCTIONMorris agency for dm perfurmuwa of 1 bor Nat Vert u a construction which Mu . Cing ' Ne work for which Orta Permit ts iaved (Sas. 309'1. Civ. C.) Lenders Name Lenders Address I exrtify that I have read this application and sum that the move information is ' correct. l agree he comply with all city and county ordinances and stale laws relating to building convection. and hereby author! re representatives of this city to enter upon the above. mentioned Property for imcetnm purpmcs. j (We) agree to save, Indemnify and keep harmless the City of Cuperllno against i liabilities, judirmcniscoscs and expenses which may in any way acsuc against saucily v incansequenceafNegrantingafth4lpCTMIL APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NO POINT Issued by: Date ,� b ' SO%'/�� RE�GhO IONS. O4 Re -roofs Signature/0- fAppbe�p sprat o��C / HAZARDOUS MA;dALS RE Type of Roof will Ne applicant or future Wilding acoupoot sham lir Wrblc handsaw material as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety Code, section 35532(.)7 All roofs shall be inspected to any roofing material being installed. CYes IQDq prior If a roof is installed without first obtaining an inspection, I agree to remove Will ted applicant or future Wilding occupant use equipment or devises which emit hamrdnw air contaminants a defined by Na Bay Area Air Quality Management all new materials for inspection. Gimlet? ❑ Yes I have read Ne haxardrau mareriab oxp ftw fro underCop tr6.95 ofthe Califon nix Health B Sarely Cade. Secd.25505,25533 and 25534.1 understood Matrix, Wilding does ncr currently haw a amount, Nat II Is my responsibility In notify Mc occupant nr mgmirer0gnuwhio mmo met poorwoaance ar aceninwmc arGgfJ,ja/Bs��ncy`!D Signature of Applicant Date All roof coverings to be Class "B" or better / ' owexit, i. a nt Duns! ,aClOF �UPEkTINO E • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: /Uorih Sk S u.a,,-e. PERMIT�D f �( OWNER'S NAME: fj o n ; e f— L v) i noj= PHONE # i�p$ - RS -a — 030 GENERAL CONTRACTOR ' r ; V FAX # I am not using any subcontractors: A -M 4 � q�� Signature U Date Please check applicable subcontractors and complete the following information -v�a1.A Owner/ Contractor Signature Date 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 -v�a1.A Owner/ Contractor Signature Date !m 1 of 1 CITY OF CUPERTINO laDTTM4ww406)DoCap 9 Sec: Twp: Rng: Sub: Blk: Lot:' APN ... ..... : 31640050.00 DATE ISSUED.......: 09/14/2006 RECEIPT #.........: 36036 REFERENCE ID # ...: 06090097 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... 10943 NORTHSKY SQ CUPERTINO ELFVING ELEANOR S OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: AIR QUALITY HEATING CONTRACTOR .......: MATTHEW FARBER LIC # 22791 COMPANY ..........: AIR QUALITY HEATING & AIRCON ADDRESS ..........: 714 NORTHRUP ST CITY/STATE/ZIP ...: SAN JOSE, CA 95128 TELEPHONE ........: (408)293-7138 �EE ID UNIT QUANTITY AMOUNT BREMAIRHAN NO.UNITS 1.00 10.26 BREMFURN NO UNIT 1.00 14.31 BENERGY PERMIT FEE 1.00 34.86 BREMRECEPT NO. OUTLETS 1.00 1.20 PPERMITFEE FLAT RATE 1.00 38.37 BSEISMICRE VALUATION 8,000.00 0.80 EPERMITFEE FLAT RATE 1.00 38.37 MPERMITFEE FLAT RATE 1.00 38.37 TOTAL PERMIT : 176.54 PD -TO -DT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS REC 10.26 14.31 34.86 1.20 38.37 0.80 38.37 38.37 176.54 llAkfw2 "-&" 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- CHECK ------------ 176.54 ------------------ 52600 TOTAL RECEIPT 176.54 VOICE ID DESCRIPTION VOICE ID -------- DESCRIPTION -------- -------- 301 ---------------------------- ---------------------------- ROUGH PLUMBING -------- 303 ---------------------------- ---------------------------- ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 0 4 CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN #) I' n_� ` , 50 4' v�J�J Date: G� ) a Building Address:. 109 3 NorkskvS C CrA ! Owner's Name; I v Ilio i e e7)Is'v1 Phone #: 06-QS5�-030 Contractor: Phone: 198- o't93- r//3$ R 6 License #: %l0 9 w6p A; r- 0 LA -0-A I±q BREMAIRHAN Contact: Phone: Cupertino Business License #: a� a✓,fie✓' -moo - a93� I/as as Building Permit Info: BSEISMICRE Bldg ❑ Elect Plumb 0 Mech Job Description: Residential LCommercial ❑ BUILIDNG Foridential allations: Attic I' floor 2°d floor ❑ Elec Permit Issuance Adhere to min set back requirement9p MPERMITFEE For Commercial Installations: 'Replacement same weight ❑ Additional weight (structural calcs) ❑ MECHANICAL Structural Calculations required for new installation ❑ Plumbing Permit Issue New installation Planning Approval Required BPERMFEE Cost of roj c, Type of Construction: Occupy group: BPLANCHK Plan Check Fee Strapped On Platform Bonded Sq.Ft. Floor Area: ❑ Er PLUMBING New Location Replacement Business License Qty. if Avvlicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin 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 PPERMrrFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING