06060060 (2) 7BUILDING
F CUPERTINO .Q ,. -.��ix a -
DING DIVISION PERMIT .C®NTRACTnRINFORMATI�N
R
DDRESS: , A PERFECT CLIMATE PERMIT Nil.06060060
6 N PORTAL VAME: PERMIT ISSUE DATE
REUER ROLF 10570 S DEANZA BLVD 2006
E:
SANITARY NO, CONTROL NO.
(408) . 861-9545
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
TIN
yyt..___,, fw
GKIA Q O
iuFj LICENSED CONTRACIOR'S DECLARATION IObDs >j I(OIn
1 hereby affirm Ihet 1 am licensed under provisions of Chapter 9(commencing r7 pP
; LCU
Zw with Section 7()M)of Division 3 of the Business and Professions Code,and my becvcu
r<n infull force and cfrmREPLACE FURNACE 40 YEAR ADD A/
;'q4 Lkasc Class Llc.x • r.oOr.
b
t;:, Dale Contractor L
:EW ARCHITECTS DECLARATION
1 C a I understand my plans shall he used as public mearda
C H Licensed Plnfessia..I
3
OWNER-B UILDERDECLARATION
I hereby.(Seco on 11. exempt s a IW Conmctars License Law for the
i_O o fallowing mason.(Section 7U31.5.Boniness and PmlcNuas Calc:My oily ar aunty
m which mind.a permit re co4 all
nvrucey,improve,demir an
demolish,Or repay wum $1000
prior miu issuance.also requires the applicant for such strait o filo asigncJ mtemmuom
• < thatheislicensedpurmmttothepmvisioonoftheContmcur'sliccnsclawfast 9 Sq.FC Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Busincested Professions Codc)or
that he is exempt therefrom end the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant fa a permit subjects the applicant to a dvil penalty of er Occupancy Type
not more Nan five hundred dollars(SR)0).
❑I.as Owner of the Property,ar my employees,with wages as their sok compensation,
will do the work.and ft structwe is not intended Or offered for sale(Sec.7064,Business
and Profesdav Cade:The Ctiouscmrs Liatue law does not apply to m awnm of Required Inspections
property who builds nrimprow thereon,and who doessuch work himalfor through his
Own employ nes,provided that such impriumm un,O e notintended aroffersd for sale.If,
however.the Wilding or improvement is mid within ane year of completion,the manes.
builder will have the harden of proving Nat he did not Wild or improve for purpose of
sale
❑1.as owner of the Property,as exclusively concocting with Bttnsed conuamms in
construct Ne project(Sec.7060.Business and Potassium;Code:)The Contractors U.
cense Law does not apply to an owner of preperry who Wilds or improves theman.and.
who contracts for such projects with a cantractoKs)licensed pursuant m the Contractees
License law.
❑1 am exempt under Sec ,B A,P C for this reason
Owner Dau
W ORKER'S COMPENSATION DECI.ARATTON
P1 thereby affirm under penalty of perjury one of the following declamation:
T ham and will maintain a Caulicau of Consent in aelf-insure for Workers Compcm
satian,as provided far by Section 37M of the labor Code.far the part...of tie
web for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as testified!by Section
37W of Jm tabor Code,for Ne performance ofthe work for which this permit is issued. '
My Worker' ompensati n Insurance artim and Puliry nu
Curler. 1` cv.c � Polley NO.: vs 7/ OJ]3v �SflO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This..firm coed not W completed if the permit Is fauns hundred dollars(SIM)
or leu)
1 certify that in the Performance Of the work for which this permit is issued,I shall not
employ any poison in any manner m as to bttome subject in the WankfaV Compensation
Laws of Califomix.Dau
Applkeot.
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject m the Worker's Compensation provisions of the labor Code,you meet
OPfoMwith comply with such Provuians w Nu permit Nall W demand revalued.
) CONSTRUCTION LENDING AGENCY
y
5 IWr by which rte Nat Vert is.constriction Mt7,ding agency for Ne Performance of
CL Ne work for which this permit Is issued(Sec.309],Civ.C.)
G0 Lenders Name
5 z Leaders Address
U C) 1 certify W t I have read this applicvism tab auu that the above infotmakun is
I, f"' correct.1 agree to comply with all city and county ordinances and sum laws mlating to
0 building construction.and hereby amhorim repmacatatives of this city to enter upna the
above-mcnuaewd SmC.U.crty forionpccuon propos.
(~ gL (We)agree to savor,indemnify and keep harmless the City of Cupertino against _
inconsiximdgmcnu,caring ofshisamit. may in any vnYatttuc against sad City
U inonrraequcnceafthe DERS`ringofthNDWit. d�^7ae
^ APPLI NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR
sgn rt (Or-q/ Re-roofs
ppll HAZARDOUS MATERUALS DISCLOSURE Dam Type of Roof
Will the applicant or future building accupantawc m handle hmmdous material
as defined by Ne Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
code,Scctien 23s32(a)?
❑Yea �Na All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicum or future Wilding Occupant taw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
limit lut.raous air conumimnu.dcOxd by ted Bay Arta Air Quality Managcmc. all new materials for inspection.
District?
❑Yu CzNu
I have mal the loran does materials mtinimmenu under Chapter 695 of the Dahlias.
me does lth&SafctyCade,Sccsm,deama it is m 73andnsibah15534.1 tto nouund occu,n Wilding
dna m I have a unma,Jw it is my ruponsihililY b notify,the attupant of tie
myuireme hmu melprioruissu — )R — —
faCemOcateata Y' Signature of Applicant Date
� � All roof coverings to be Class "B"or better
owns or au zed agent Dam-
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31629007 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # . . . . . . . . . 34744
REFERENCE ID # . . . : 06060060
SITE ADDRESS . . . . . : 10356 N PORTAL AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BREUER ROLF
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ROLF BREUER
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 10 . 26 0 . 00 10 . 26 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 1, 000 . 00 0 . 50 0 . 00 0 . 50 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 176 . 24 0 . 00 176 . 24 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 176 . 24 VISA
TOTAL RECEIPT 176 . 24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
am Telephone(408)777-3228
CITY Of Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
JOB. A) . Pow+,Q v ,,50 Goo 6o
OWNER'S NAME: CF It/E7u E0('—' PHONE # C(c&- GdP 017?
GENERAL CONTRACTOR: 1, FAX #
I am not using any subcontractors: - d - 0b,
Signature Date
Please check applicable subcontractors and complete the following information:
66 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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
aox
FURNACE/AC
*UPEkTiNO PERMIT APPLICATION FORM
APN # ✓ n om Date:
Building Address: �� 356 6Um.flt �or�a2 f�Vpi �t.t�
Owner's Name: (20�F $i2EV E2 Phone#: (o dp,/2 0/- Z
Contractor: License#: 7 Z31 S?
Contact: A ./ /' Cupertino Business License #:
r�'rl CS'owz.A-Qe�
Building Permit Info:
Bldg IS Elect ❑ Plumb ❑ Mech ❑
Job Description: IZOP&OP, 40ge,),f F � — ki A/C
Residential Commercial ❑
For Residential Ins llations:
Attic ❑ 1" floor 2nd floor ❑
Adhere to min set back requirement 09
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: X0. 000 'r Type of Const tion: Occupancy roup:
-
Strapped W On Platform ,M Bonded Sq.Ft. Floor Area:
New Location 0 Replacement
Qty. if G76S'c40
Applicable. Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
/ BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000cfm 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
Wr BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING