05100019 (2) CITY OF CUPERTINO '` ' ' %
BUILDING DIVISION
PERMIT RACTONFORMATIO
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BUILDING ADDRESS: CONDITIONED AIR PERMIT NO.05100019
642 PEACH nT,nqqnm DR
OWNER'S NAME: PERMIT ISSUE DATE
DUPERLY WRIGHT 1701 LITTLE ORCHARD T 10/05/2005
ONE: SANITARY NO. CONTROL NO.
(408) 291-2220
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I�
000 LICENSED CONIAACnderpDECLARATION lob Descriptio '
jdj I hereby 0)of that l am licensed under provisions of Chapter 9(commencing ���
with Section 7g1U)of Division 3 o(the Business and Profmiuus Code.and my license u
in full force andCftt. REPLACE FRUNACE ADA A/C
y g z Licmuc Class (1-2)0 Lie.g 4 5 �. c
car ELJ
Dauc�j' "f- Contractor `s4:"'* FTtY' Vas
eQ4 ARCHITECPSDECLARATION' OCTA
Z
e I understand my plans shall W used as public records 7r 200[
7 ser
G Licensed Professional
0 3 OWNER-BUILDER DECLARATION [[yyyy��;;sus q
f I hereby affirm on 1 am exempt from the Contractors a Lleanu Law for 1W BUILDO IrIA pr:�®
O O following rtamn.(Section].. t.a1w, and vee tknom Cade:AnY city os county IttJ N 41 J
which rtqulrus a pormit re c ires ft,pier.Improv,h permit I car epaig any atm ant 74'L0.0
-3r
poor art its issuuuc.also requires Nc applicant fee such pennant refile•signnd mtenunl
<
Valuation
Nal he Is licensed p...or to the pmvisiomor the Cumractwh License I..(Chapter 9 Sq.Ft.Floor Area
E a (commencing with Section 7000)of Division 3 of NC But.and Profmiona Code)he
that he la exempt therefrom and the basis for the alleged exempLim Any violation of
Section 7031.5 by any,applicant for a permit subjects the&wheat to a civil penalty of SON
r Occupancy Type
na more Nen Rw hundred dollars($300),
❑I,as owner of Ne property,or my employm with wage an their rale eompment
will do the work.and the stsunurt is notinundedaroaered forest,(Sex.704,sutlmu Required Inspections
and Pro(miona Code:The Comrsemr's Liana Law docs at apply m e an net of q P
propertywho holldsorimproves thereon,and whodoessuch work himselfor0uough his
own employees,provided thatsuch improvements arc not intended woaered formle.IL
however.the Wilding or impmvmem is sold within one liar of oompkuon,the owoer-
builder .will have the burden of proving that he did not Wild or Improve for purpose of '
O 1.as owner of the property.am exclusively contracting with licensed comaciare to
constmcuhe pmjecl(Sec.7014,Business and Profmiona Cade:)rat Comsecmr's Li.
muse law does not apply m ae owner of property who Wilds or improves Neuron,and.
who contracts for such projects with acomractor(O licensed pursuant m the Contractor's
License law.
❑1 oro exempt under Sec. .B&P C for Nis mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I lteroby aliirm under penalty of gaudery oral of tits rollowing dalan0ona:
I have and will an, a Cenlficamof Coment to selGinsum for Worker's Camper-
nation.u provided for by Section 3700 of the Labor Code.for the performance of she
work for which this permit is bound.
'1 have and will maintain Worker's Compensation Imuance,as required by Section
1700 of Ne labor Code,for the performance of the work for which this permit in issued.
My Warker's Compensation Insurance carrier and Policy
numa
Cartier. I PPolicy No:3f;
C?
CLI/C170NFROMWORKERS' 9
COMPENSATION INSURANCE
(Thu union recd trot becanpleud Iftbo permit is foroahre died dollars(51(X0)
or Ina.)
1 coni[that in the performance of It work for which this permit is issued.l Mail not
employ any person in any manner so as W become subject to the Workers'Compensation
Laws of Calif unia.Dau
Applicant
NGI'ICE TO APPLICANT,IL after making this Certificate of Exemption,you should
become subject to the Worker's Coopemdon provuiom of the Labor Code,yen must
O O forthwith comply with such previsions or this permit shall bo domed revoked.
CONSTRUCTION LENDING AGENCY
(+ Iberthy M.Nm titre is a construction lending agency,for the performed of
ai> the work for which this permit Is issued(Sec.3097,Civ,C.)
WM Q lender's Name
7 Z Lender'sAddmu
C)Q 1 certify that I haw mad line application aha suis that the show Information Is
comm I agree an comply with all chy and county ominanms and eau laws relating In
Q rU^ building construction.and hereby mthadu representatives;of this city to now upon Ne
I2( abow-mentioned property for impecdm purposes.
py (We)agree to ave,indemnify ad kap termites the City of Cupertino sgrinat
y liabilities.judgenemo.cwu and expenses which may In any way a..agamilmid City
(n conugusnee of the granting of this permit. ///'� j-
1 r
APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NON-POINT Issued by: Date ( V'_J
SOURCj:ARGULATIONS.
11Tj/o X esti la MOS Re-roofs
Signuwc r.
HAZARDOUS IALS DISCLOSURE Dau Type of Roof
Will the applicant w fume Wilding occupant man or handle hacom ous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
nde.Suedan 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym �Nu
If a roof IS instailed WII
Will the applicant or future Wilding occupant use equipment or devices which without SCSI obtaining an inspection,I agree to remove
It havardou air communanW as dcBad by f Bay Arta Air Quality Management all new materials for inspection.
Dlsuicl7
❑Yw
In va read the haarda smauriWrtqummenu under Cluper6.95 ofthe Califur. /
riaHalth&SafetyCau,Swdm25505.25533B 25534.1undemWndthuifNe Wilding
does not currently haw a Isom.that it is my mapomibbllly to notify ft occup m of dor /b' Q 5 .0.5
mqulmmemwhiuhmusthe etpdorm.baup ceofa CeNfcaleof Occupanry. Slgnat I, of Applicant � ,/ Date
Zlzzei. - ,/Y u, �o ooS y All roof coverings to be Class"B"or better
Owner or authorind agent Date
Community Development
10300 Torre Avenue
Cupertino CA 95014 '
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT#
7 ¢2C mC ( r / 0061 -
OWNER'S NAME: 1 ; PHONE # 6 0�
GENERAL CONTRACTO FAX #
I am not using any subcontractors:
Sign'atur& 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
Zf
er/Contractor Signa a Date
CITY OF CUPERTINO
FURNACE/AC
CUPEfZaTINO PERMIT APPLICATION FORM
APN #
Building Address:
?,ea(,k 131OSt;aYY1
Owner's Name: Phone #-
wl h% 99(v 7015-
Contractor: Phone: License#:
Ow&km 40g- a9t -aaa ggs-r (,0a--
Co�{ Et: Phone: Cupertino Business License#:
J,trlVv4e oa -
Building Pe it Info:
Bldg ❑ Elect Plumb PGF Mech
Job DescriptioW
f 10
- �
Residential Commercial F1For Residenntiaall In allations:
Attic ❑ 1"floor 2nd floor❑
. Adhere to min set back requirementyli
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:
Strapped On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of 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
BUSLIC Business License BUILDING
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