04120010 (2) CITY OF CUPERTINO l �'nFzdq
BUILDING DIVISION PERMIT CU ,TRACTUR=TN' 'C1MAD(°yLV —• - -
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BUILDING ADDRESS: A PERFECT CLIMATE PERMITN004120010
10261 PHAR LAP DR
OW NEWS NAME: PERMIT ISSUE DATE
PHYLLIS REINHARDT 1 570 S DE
ONE: - SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
>3oij LICENSED CONTRACTORS DECLARATION -
cab xflim Nn 1 em licensed un r provhiom of Chmpter 9(commcnefny Job Description -
velaSwti )of Division 3 ortc and Pm10%`mCod`,end my license is
mum ertµt REPLACE FURNACE
Gm�3 Lken Clus
Cu
ARCHnEGTS Q RTION
- I understand my plans mall W hard as public records
. G Licensed Pmfessinnai �\
p OWNER-BUILDER DECLARATION
3 E I hereby am.that 1 am exempt from the Conbamafs License Law for the -�� ``•> .! ' -
i 0 o following mamn.(Swoon 7031.5.Busineu and Pmfessiun Code:Any city or county
u�$ which requires•permit m cormmct alter.Impows.demolish,m npatr any nnterom !\ _ 7n._
Fly prior m I%issuance,she requima the applicant for such Permit m file a signed statement / " r
< NalalsliccnwdpunuantteNepmvisi^nnft Con mwe Lknnseiaw(Chapm9 Sq.Ft. Floor Area / - Y✓ Valuanon
�$ (commencing with Senlm7000)of Division 3`flhe Burnham and Professions Codc)er �f /� // 1 rt ct ^ -•
�.. tat he h exempt rh-mfrom and the bash fm to alleged exemption.Any violation of \\\ /I •1
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of g 0 -''"' %'d '1`,!//r,�Oceupancy Type
not mom Ws five huMnd dollar(SSW),
0 h as owner of the pmpeny,m my employees wit wages as their rete compensation, V
will de the wok and testrunvm h net intended.,offered per ask(Sec.70th,Reelected Required Inspections y
and Proread`m Code:The Committees License Law does not apply.m an owner of q p - ,
propeny who builds or improves Heron,end who dmf such work himself or through his
ownemployees.provided that such Improvements arm not Intended moBerrd for aceto.If,
however.the building or improvement is mid within can Sear ofcmnpleom,the owner, -
Isdider will have the burden of proving that he did net Wild or improve for purpose,of.
rale,),
❑1,or owner of the property,am exclusively contracting with licensed mnummr in
connnset the project(Sec.70m,Busineu and Perfinei^m Code:)The Conuacmh I.A. ... ,. . .
came Lew dose not apply m an owner of progeny whe bWlds or improve themm,and
who contracts for uch projects with scontrac er(s)licensed purswnl to the Committees
Line.Law,
I am muopl under Sec. ,B&P C for this rcamn
nor Data
WORKER'S COMPENSATION DECLARATION
1 hereby affum under penalty of perjury ore of the following deWaradon:
I ham and will maintain aCertificate of Cement to self-nmm for Wmker.Compen-
Men,as provided for by Section 37W of Lite labor Code,fm out porfomanm of to
wank for issued.which this pnll is issued.
0 1 have and will maintain Workwl Compensation Insurance,M required by Section
3700 of to labor Code,for the performance of to week for which this permit is Wmd
*�y Wp rkets Cnmpenution Insenntt artier an�d Po'lJieyI number tee:
a�ffr. gl tnC,r t PmBy p@A P'1 n I I om a-
�� CERTIFICATE OF E)(EMPTION"+ROROM WORKERS'
COMPENSATION INSURANCE
mismcdm recd not bccompleud if the parent,is foromhundmd dollars($1 00)
or Ines.)
1 moify Nat in d c perfomance of the work for which this Permit is Issued.I WW1 net
employ any person In my manMrm as N become subject to dC Wedoers'Compensation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If,viler making this Certificate of Exemption.you should
become subject in the Worker's Compensation provisions of the laMr Code,you must
OZ foMwith amply with such provision or this permit Mail he demand revoked
r CONSTRUCTION LENDING AGENCY
[-�4 I hemhy oRin^Uut Nero h a construction hadinpgency for the perimeter.or
y'r7 tite work for which this permit h issued(See 3097,Civ.C.)
W Q Lenders Name
]z Lender.Add.,
U0 I ceNfy tat i hate hum!this application and mm that Ne,show information is
W F correct.1 agree in comply with all city and county ordinances and ate laws mhtieg m
OU building construction,and hereby statement reprommutives of this city to enter upon to
W above-mentioned Property for inspection Purposes.
py (We)agree to save,indemnify and keep harrier the City of Cupertino against _
rA Ilabiliticajudgmenu.emu sndexpenes which may in my way seems againeseld City /3
U Z In consequence of the granting of this permit /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
rN,�d.w
EO TI2-I Re-roofs Appl uComrcmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
the applicant m futon building occupant nom or centile havallow maurisl
y the Cupertino Moipal Code,Chapter 9.12,and the Health and Safety
n 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
tc applicant or furan building aceupant use eyulpmenl or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
.w air cmumman a as defined by the Bay Area Air Quality Management all new materials for inspection.
I —
❑Ycs ,✓�'R�
I have med the luxardnusmatedah requirements under Clumu r6.95 of gar Califon
his Health&Safety Code.SeNm125505.25533 and 25534.1 understood Latif Ne,building
door not commitL Nu it h my responsibility an notify Ne,oaupant of Ne,
requirement m met prior to issuance or a Certificate orOcmpancy. _ Signature Of Applicant Date
C ��i a� All roof coverings to be Class"B" or better
,ouil er to authorised agent Dau
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY F Fax(408)777-3333
UPEkTINO
Building Deartjment
JO O ADDRESS: �\ C.VP, . PE II;C7
OWNER'S NAME: o: P�,vjkj'- 'IPHONE #LAoK — 5
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
Signa Dl afe i
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
J
J
Owner/Contractor Signature Date
CITY OF CUPERTINO
FLJP-NACE/AC Cl?COF
UPERTINO PERMIT APPLICATION FORM I G
APN # ,/ 1 Date:
Building Address:
k
wne 's Name• Phon(�e#: _ 02ontractor: p Phone: t jo I -Q Lice�eoelll I s � J
2 h1�Q_ 'I
Contact. Phone: Cupertino Business License #:
020 6er C�mv-ZA-k
08 �I- qS�S
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description:
40(;-60. y,o._eA 6
Residential Commercial ❑
For Residential In 1 ations:
Attic ❑ 151 floor 22nd 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 ❑
Cost of Project: S z w Type of Construction: Occupancy group:
ou"-C -�- r e SF
Strapped On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location El Replacement Re lacement �`�
Qty. if
Appri5able Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMA]RHAN A/C Units <= 10, 000 cfin MECHANICAL
J BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
J MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check FeeBUILDING
BUSLIC Business License BUILDING
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