06070005 (2) CITY OF CUPERTINO .
-BUILDIN:DIVISION PERMIT ,X10NTRAGTORINFORMATIQN ,
FBUILDING ADDRESS: A PERFECT CLIMATE PERMIT ND06070005
1026 PENNINGTON LA
OW NER'S NAME: PERMIT ISSUE DATE
Aft GOTTWALD RUDY 10570 S DEANZA BLVD 07/03/2006
NE: SANITARY NO. CONTROL NO.
(408) 86119545
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
18o LICENSED CONTRACTOR'S DECLARATION
n I Wmby affirm that I in licamead under provision of Chapter 9(commencing Job Description
es� with Seetim7M(iiof Division Sof the Bud.and Profession Code.and my licenseis
?�N inmOfomoandcl ADD A/C
a$ License as
Lic.d
C F n DateContactor
ARCHITECTS DEC ATI
1 a< I uMcrsund my plans shall be nail u puM, cords
lyU
sofcrLicrcd Professional
3 OWNER-BUILDER DECLARATION
I 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
❑O following mason.(Section 7(131.5,Business and Profession Cotte:Any city or county
3$� which mquims a permit to eonuuct.aper.improve.demolish,or repair my structure3600
iy prior to its issuance,also require the applicant for such permit in file a signed statement
m< thmWisGanscd purmam to the provision of the Camracums Uccom Law(Chapter 9 Sq.Ft.Floor Area Valuation
z€� (commencing with Section7000)of Division 3 of the Business and Profession Coal or
y
that M is exempt thcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects use applicant to a civil penalty of Occupancy Type
not more Wit five hundred dollars(I5D(B.
t.uowtrcr of the propcny,or my uoploym with waguu their sole compewtion,
will do the wcuL and Ne swnum u ma uteMed oraReseA forsale(Sec.7004,Husintm
and Profession Code:The Conttazlors License Law don Out apply to in owner of Required Inspections
property who builds or improvuthereon,and who does suchwork himselforNrough his
awnemployms,provided that such improvements are not intended oro@rd!orale.If. y
builder,ill Wilding orimprozememuhatba mid did of year of Improve e.
the owner.
builder will have the WNcn Of proving that W did not Wild or imprase far purpose of
am.l.
❑1.as Owner of the property,am exclusively contracting with lianud contractors to
construct Ne project(Sec.700,Business and Professors Cade:)The Contractors Li.
cense Law data not apply to an owner of property who Will or improves Ommun,and
who contracts for such projeeLs with ac ummcuot(s)licensed pursuant to the Contractors
Liccna Taw.
C] I ant mempt undi See .B&P C for thismason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby a1Bm under penally of perjury on,of the following declaration:
I hive and will nu main a Ce tifiate of Consent to selfAm is for Workers Compact.
atiar.as provided far by Seeoan 3700 of the Labor Code,for the perfomance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance.a mquimd by Senior
3700 of ac labor Coda,for the performance of IIIc wart for which this permit is issued. '
My Workers nrance ation Insuca Tier and Policy number soc
Grtiu. Polity No.:
on IM-CA E�PTION FROM ORKERS'
COMPENSATION INSURANCE
mus abetlan need not W compicadi if the Permit is fomite hundred dollars(3100)
or Ins)
1 certify that in the performantt of the work for which this Permit is issued,I shill ml
employ any parson in any manner in as to became subject to the WmImri Compensation
Laws of California.Data
Applicant
NONCE TO APPLICANT:IL after making this Cemificate of Exemption,you Nauta
become subject an the Workers Compensation provisions of dm labor Code,you most
.JO faMwids comply with n such provisions or this permit shall he decreed tewked.
'ZM CONSTRUCTION LENDING AGENCY
[-+ � 1herehyaflLm Nat there iso emashoetwo lending agency Car he pcffmmanecof
Qi dm work fur which Ibis Permit is issued(Sce.3097,Civ.C.)
Q Lender's Name
2.
7 z Landers Addmv
U 0 1 mnify that 1 have mad this application and sure that the above information u
L, U cancel.l agree to comply with all city and county ordinances andsute laws behoingto
0 building conawnion,and hemhy amhmim mpresentmivos orthls city to enter upon the [ �/�t (/ ////�/7��
r [y above-m,judg d property fon inspection purposes. `
gy (We)agrtc to save•indemnify and kcep harmless the City of Cupcnina againt
h incommiumgOfthecaauandof thissnwhichmryin any w,Yattroc against aid City
U z in comegcerme of the Bantin6 of this permit.
^ APPLIC/t1a'1�UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURGIC RFIONS. '�Vty`�']
Sigtwure of Ahnnucanuactor �� Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant nom or handle hazardous material
as dcOned by thc Cu mnino Mu ici
Section Nu
put Code.Chapter 9.13.end'be Health and Safety
Code,Scon 35533(x)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes
Will toe. resat of future Wilding am ant Ito If a roof is installed without first obtainingan inspection,I agree to remove
Pp f p enrolment Mann Mich Pe
emit District' air contaminants u darned by the Bay Area Air Quality Management all new materials for inspection.
Distrix?
Ycs
I have mad the hazaNsuzmateriils rn dromenu under Chapter,6.95 ofthe Califur.
nu Health&Safety COM,S .25505,35533u 25530.1uMersun ifthe Wilding
does t c n0y
'job tenant.Wt to
my rce,of.cely c Rory do occupant of de U `�
which uubemnpriorwissuanecofaCcrtifmaeofOccupancy S6natu'rc fApphcant Date
saner mr,tmorizc semi D,te All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
/ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
�0&C-P ehNin `fry tome-
OWNER'S
oh2OWNER'S NAME: PHONE # 40 a
GENERAL CONTRACTOR: ueilp p Q ,,Vaa� FAX # 6
I am not using any subcontractor
Signature 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 ( S
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
SYpaqRock
T' e
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
06m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36203031 . 00
DATE ISSUED. . . . . . . : 07/.03/2006
RECEIPT 4 . . . . . . . . . : 35097
REFERENCE ID # . . . : 06070005
SITE ADDRESS . . . . . : 1026 PENNINGTON LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GOTTWALD RUDY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : A PERFECT CLIMATE
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 86119545
•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 3 , 600 . 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 025034
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 O(OO10DO5
cm
' FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN# Date: o f
Building Address: (p
loacp -Penn lRt��
Owner's Name: n K O� n�j Q�W Phone6.S_a I S_a�
Contracto . e� „p; I _ Phone: , rUC/ aSa�G License #:
Contact: l l (y\p 91 Phone: `[ 5 / Cupertino Business License#:
asa
Building Permit Permit Inf : CJ
Bldg Elect Plumb ❑ Mech
Job D seription:
Residential Commercial ❑
For Residential I allations:
Attic ❑ Is` floor 1 floor❑
Adhere to min set ack re uiremen
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 Occu ancy�o
- c/O
Strapped ❑ On Platform Bonded Sq. 'Ft. Floor Area:
�j
New Location Replacement ❑
Qty. if
Applicable 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
Auk 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