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03090003 (2) LBU111,LDING ITY OF CUPERTINO BUILDING DIVISION PERMIT �N'PRACTOR'J PORM46N:: . ADDRESS: A PERFECT CLIMATE PERMIT"'03090003 R•S NAME: 10570 S DEANZA BLVD PERMITI55UBDATE NE: (408) 861-9545 SANITARY NO. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +Oo LICENSED CONTRACTOR'S DECLARATION C7 O O O 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description s� with SectionlMd fvon3of Ne Busineasand PmfemioneC de,andmylsonseis .oran immlfareeando e se Lee. / PLACE FURNACE—A/C - a Z Licenp_ -A s„❑ Dad Contractor e rJ` ARCHITECTS DECLARATION' C U i understand my plans shall he used as public records 6 soli Licensed Professional OWNER-BUILDER DECLARATION <q 1 hereby reaso affirm tart 1 em cBcmpl from the Gonias o :Any t Low for the my . O� followinguires a Permian ID3 s r Business and Professions Code:Any city fir county which requires n eennil re cores the epee.improve,tlpermith,or repair any statement 53e piton its censncc,also uant toithe provision Or Our such contrator's icense ae Lawdau¢mcm 2 < that hcerwitiwithStsficon7 the Division 3.1 tCo urines'and Plselsw(Chapdr9 Sq.Ft. Floor Area Valuation F G (eat he is xem with on ion nand the basis 3 the al eged exemption. pt on.An Vi Qylc)ser that he is exempt thcmfrom and Ne baso for Nc alleged exemption.Any violation of 32639045 . 00 Section 9031.5 by any applicant for a permit subjecu the applicant to a civil penally of ane APN Number Occupancy e - not marc Nan ova hundred dollars($5007. _...__..._ p y'IYp EJ 1,as owner.(the property,or my employoo with wages u their sole compensation, ,p7 i�i7rs�fL�-p 7sT(((�� will do the work,and lheaWctute is not intended or offered For sale(Sec.7044,Business 1 — ROUGH r[CgHRe ftctlons and Professions Code:The Conustown's License Law docs not apply to an owner of �".T Gl•. property who builds orimproves Nercon.and who does such work himselfor through his 303 - ROUGH M CHANT AL awn employees,provided that such improvements are not intended oroffered for sale.If. 3O4 — ROUGH ELECTRICAL however,the building or improvement is sold within one year of completion,the owner- builderwillhavetheburdenofprovingNalhedidnotWildorlmpmw for purpose of 505 - FINAL ELECTRICAL salt.). O 1,as owner of the property,am exclusively contracting with licensed contractors to 507 — FINAL PLUMBING _ construct the pmjeci(Sec.7044,Business and Professions Coil no Contrive orb Li. 508 F I NAL MECHANICAL cense Law docs not apply to an owner of property who builds or improves Bandon.and, who contracts for such projects with a compactor(s)licensed pursuant to the Contractor'a License Taw. ❑ l am uempt under Sec. ,B h P C for this mason Date WORKER'S COMPENSATION DECLARATION FINALEO 1 hereby affirm under penalty of Perjury one of the fallowing declarations: I ban and will maintain a Certificate of Consent to self insud for Workers Compon. c sation,as provided for by.Scetion 3700 of the labor Code.for the perfo....of the ..,.. ,�A N 2-Ur 2004 work for which this permit is issued. -- ❑1 have and will maintain Worker's Compensation Insurance,ex required by Section 3700 or the Labor Code,for the performance of the work for which this permit is issued. BUILDING My War c's Cnmpe setion Poi cy NOY num MIA)is11 1 Cart er. _ CER F C E PI'IONFRWORKERS' - COMPENOMPENS ION INSURANCE , (This section need nal bccompic¢d irrhe farad,is future hundred dollars($19)) lir loss.) 1 coni fy Nat in the performance of the work for which this Permit is issued,1 shall not employ any person in any manner so as in become subject o the Workers'Compensation Laws of California.Data Applicant - NOTICE TO APPLICANT:IL aper making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cnde,you dun Oforthwith comply with such provisions or this Permit shall be deemed revoked, N CONSTRUCTION LENDING AGENCY 1 hereby affirm that more is a construction lending agency for the performance of ]'> me walk for which this permit is issued(Sec.3097,Civ,C.) +1 Q Lender's Nam. z Lcoder's Address J Q I codify that 1 have read this application and sod that the above information is ;y correct.l agree to comply with all city and county ordinances and suis laws relating to U building convection,and hereby authorise representatives of this city to enter upon the 0.Wr "hove-mcnlioned property for insp.ction purposes. r (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgmcros,coca and expenses which may in any way accrue against said City J 7 in conscq..do.of the gmoling Of this permit. tom— APPLIC%r��1''UN STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCQJIEG ATI S. 071,)1 S. Gap, Re-roofs iB u o App r VComra HAZARDOUS MATERIALS DISCLOSURE Type of Roof dl the applicant or future building occupant sure ar handle haaamous madnal defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Yet;.sc❑ctien 25532o)1 All roofs shall be inspected prior to any roofing material being installed. }a" Wise the applicant or fa building occupant ore equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haxardouo air comamu u as defined by the Bay Area Air Quality Management all new materials for inspection. isnicl? ❑Yes 1 have mad the hamedrus materials requirements under Chapdr 6,95 of the Califor. ria Hcalin✓F Safety Codc,Settlors 25505,25533 and 25534.1 undmemnd Not if ire Wilding does no nrtenOrm u nam,Nel it is my rcsponsiM1ility m nnafy the ov:cupanl of Nc m THermisaamm .1'0Coufiea�yq.apa�e. Signature of Applicant Date owner aathori'retlagent '— fTf�l /�atDric All roof coverings to be Class "B"or better r CITY OF CUPERTINO 2 of 2 PERMIT RECEIPT OPERATOR: suem COPY # 1 Sec: Twp: Rug: Sub: Blk: Lot: APN . . . . . . . . : 32639045.00 DATE ISSUED. . . . . . . : 09/02/2003 RECEIPT #. . . . . . . . . : 22979 REFERENCE ID # . . . : 03090003 SITE ADDRESS 10321 PHAR LAP DR SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER FREERKS FREDERIK W AND LOUISE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1115 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) 861-9545 EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ ---------- ---------- BREMAIRHAN NO.UNITS 1.00 9.50 0.00 9.50 0.00 BREMFURN NO UNIT 1.00 13 .25 0.00 13.25 0.00 BENERGY PERMIT FEE 1.00 23 .10 0.00 23 .10 0.00 BREMRECEPT NO. OUTLETS 1.00 1.11 0.00 1.11 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0. 00 35.52 0. 00 BSEISMICRE VALUATION 6, 903.00 0.70 0.00 0.70 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0. 00 __________ __________ ---------- TOTAL PERMIT 154 .22 0. 00 154 .22 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ ___-_--______--___ CHECK 294.,99 018864 TOTAL RECEIPT 294.99 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL r • 11,- CITY OF CUPERTINO "J PERMIT APPLICATION FORM APN # Date: Building gess: r W(jk'r Owne ' e: Phone#: L Co acto : Lice se cS Contact: Cupertino Business i ense#: Al Building Permit Info: Bldg ❑ Elect Plumb ❑ Meeh Job Description: �-CA ResidentialCommercial F-1 For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor ❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Co of Project: Type of Construction: Occ ancy group: ffifA C,> Strap d On Platform Bonded Sq.Ft. Floor Jrea: New Location ❑ Replacement ❑ Qty, if App 'c`, e Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of 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 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