06080241 (2) CITY OF CUPERTINO -
BSILDInG DIVISION PERMIT CONTRACTOR INFORMATION
TM :.i. ` ::>. - e'er:- .aex.ax•� .<,.
BUILDING ADDRESS: ST ORD PLUMBING HEATING &E$hlRO 06080241
10151 PRADO VISTA DR
OWNER'S NAME: PERMIT LSSUEDATE
Alk JOEL SEIDMAN 1965 KYLE PARK COURT 08/29/2006
WINE: - SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT ,PLUMB MECH
0
i0C LICENSED CONTRACTOR'S DECLARATION Job Description
n1 Mreby affirm Nat 1 am licensed under provisions of Chapter Y(commencing
� with SectionT Oi ' o of dm Busincvmd Rofesswon bo.and myliccnmu
N fafirm
t REMOVE AND REPLACE FURNACE AND ADD A/C
i License CI Lie,g
R ITECI-S DELLA A 1
w< 1. rsunJ m plan:stun W uud u poetic.cordss
IED
G Licensed Pmfcssil
ona
OWNER-BUILDER DECLARATION
iI hereby aRnn Nat I am exempt from One Contractors Liens Law for the
cO following mason.(Suction 71171.3,Business and Profcssiom Code:Any city or county
w� which rtyuim_s a permit m enn.uct,alter.improve.demolish,or repair any someone $6700
i?—a prior N yui
its issuance.also rems the applicant for such permit to rile a signed statement
: < Nat W ulicmaaed pursuant to the provisions of the Commmor's Licence law Chapter 9 Sq.Ft.Floor Area Valuation
91-0
(commencing with Section and of Division3 ofthecged Business;apt Professions Code)or
s $ Nat he uexempt1.5 btherefrom and the baso for the alleged exemption.Any violation of
A.%methan by any applicant for a permit subjttu the applicant a civil Penalty of r Occupancy Type
not mom Nan five hundred do1Wa 15500}
01.uowneror Meg prey.armymploymswithwartsuduosolecompensation,
will do One work,and On structure is tet intended or offered finitude(Sec.TON,Busincu
and Professions Code:The Connxcter's License Law docs tet apply N an owner of Required Inspectio
propenywho buildsarimproves thereon.and whodoessuchwark himvJfor through his
awn cmployces,provided Nat such improvements Area an,immmded..Ifianed fmaale If.
however,the building or improvement is mid within one year of eompletion,the owner.
builder will have the burden of proving Nat he did not build or improve for purpose of
sale I.
de
0 1,as owner of the progeny,am exclusively contracting with licensed emanations in
comtmct the pmjca(Sec.70th,Business and Profusions Code:)The Contractors Li-
ceme law docs not apply us an owner of property who Wilds or improves Merton,and
who cimin cs for such projects with a smurnemr(s)licensed purri in Na Canuacemrs 1
License la
0 w.
I am exempt under Sec .B h P C for this rtamn
Owner Data
WORKER'S COMPENSATION DECLARATION
4ilad wmby arm under penalty of perjury one of the following declarations:
As ill Rmaid
uina Cer iflate.rcrosem In self-insumfnrwarkcrSCrimper.
provided for by Section 3700 of the Labm Code.for the pesformance of the
work or which this permit is issued.
I ave and will maintain WMIar's Compensation Imuran..u required by Section
37 f the Labor Code,far Ne performance of Ne work for which Nis permit u issued,
We,Carrier.kers m tion u. Po'cy No ny .V�f
CERTIFICATE OF EXEMPTION FROM/WORKERS' L/Ven
COMPENSATION INSURANCE _
(Thissection need iter W completed if the permit Is forme hundred dollars(SI00)
or less.)
I certify Nat in the performance of the work for which this permit is issued.I shall not
emptor any perms in any manner.As to become,subject in the Workers'Compenution
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenibcam of Exemption,you should
become subject in On Wodo's Compensation provisions of the Labor Coda you most
Z faMwith comply with such provisions or this perm ishall W deemed revoked.
OCONSTRUCTION LENDING AGENCY
[-a IWreby affirm Nat Nem is a construction lending agency for the performanu of
athe work for which this permit is issued(Sec.3(197,Civ.C.)
uj A Lenin's Name `
=Z Lender's Address
U C) I certify Nat 1 love rod this application and sure Nu Nc move information is
ly P canon.1 agree to comply with all city and county ordinances and sum laws misting to
0U building construction,and hemby authorive representatives of Nis city to enter upon the
er,
above
ies 19cd progeny for inapcNon purposes.
H 6, (W c m indemnify and loop harmless the City of Cupertino against
liabilities udg .cos mdcapc which may in my way accmc against mid Ciry
U aZ in conte tic On Lingo s it
^
LI U ST S W COMPLY WIT - NON-PO Issued by: Dale
SOVR AEG T G!
G Re-roofs
Signature of Applicm AZA DO D -
HALoffor= MATERIALS trameo RE Type Of Roof
WIII On a C.pmr or fmure Wilding',Chapter
m handle Heath Ad material
u defined By 0m Cupenina Muni i(ifCodc,CTapmr 9.12.and Ne HcsIN anJ Safety
Code,Section 35332(,1)? . No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Wil Ne applicant or uwm Building occupant um equipment or devices which g P g '
emit hazardous air conumina u u dcfncd by On Bay Amo Air Quality Management all new materials for inspection.
Disnict7 P
0y. N
ave maJ eWram Ze
am IsmyuimmensunderCWpmr6.95ofthc Califon
ria N Safety ode, 23 .25537 and 25534.1 understand Wrifthc Wilding
d t cu by ho ant t u my rcspmuffiduy N notify ds occupant
re a per ssan nracenr¢a _ a G SignatureofApplicant Date
Owner or autharrzed egerd ate - All roof coverings to be Class"B"or better
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34214108 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35821
REFERENCE ID # . . . : 06080241
SITE ADDRESS . . . . . : 10151 PRADO VISTA DR
SUBDIVISION
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOEL SEIDMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ATLAS-STANFORD PLUMB
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : STANFORD PLUMBING HEATING &AIR
ADDRESS . . . . . . . . . . : 1965 KYLE PARK COURT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 286-8931
•
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
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 7, 000 . 00 0 . 70 0 . 00 0 . 70 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 . 44 0 . 00 176 . 44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---- - --- - - - - ----- ------------ - - --------------- -
CHECK 176 . 44 8059
TOTAL RECEIPT 176 . 44
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
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: i G,rl 1 PERMIT #
OWNER'SNAME: e ' PHONE # 3`(-65
GENERAL CONTRACTOR l C FAX #
I am not using any subcontractors: P� G
t Date
Please check applicable subcontractors and complete the following info n.
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
'Ga FURNACE /AC
• CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
g
Building Address: lO '� l�/
r��� n VISI-C), Dr
J
Owner's Name: Phone#:
/'Contractor: ^ } License#:ro �S � 2")
Contact: �n ac I Phone#:�a Jai 3
Applicant/Contractor: 0 �0
Building Permit Info:
Bldg E ec P m c
Job Description: 11 II
Residential: A- C! Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: OO
• Type of Construction: Occupancy Grou
Qty. if
A licable Fee ID Fee Descri tion Fee Group
BENERGY Energy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
1 BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILIDNG
EPERMITFEE Flee Permit Issuance ELECTRICAL
i MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee EBUILIDNG
• BUSLIC Business License BUILIDNG