06090092 (2) CITY OF CUPERTINO + € ^ `
BUILDING DIVISION PERMIT �-CONTRACTQR,INFORMATION k
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BUILDING ADDRESS: HUSSEY BROS INC PERMITNO.06090092
10531 RAMPART AV
OWNER'S NAME: PERMIT ISSUE DATE
WILSON JOHN 640 TAYLOR AVE
NE:
SANITARY NO. CONTROL NO.
(408) 733-6360
ARCHITECDENGD EER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hcmby affirm Nal 1 am licensed under provisions of Chapter 9(commencing P
�i with Sccdon]Ord)ofOlvision 3 Of de Business Professions,Code.and my license is
.�i klltoClass T='LO Lk.11 1r(r� INSTALL AIR CONDITIONING
'ro Dam - onuazmr N
ARCHITECTCSw DECLARA ION I understand my plans shall W used as public mcurds
U
0 H Licensed Professional
S OWNER-BUILDER DECLARATION
<f I hereby affirm that 1 am exempt fmm the Coneracmrs License Law for the
inc rollowimg muan.(Section 7001.5.Business and Professions Calc:Any city or county
S2E which mquires a pemth m c^^uruct.alms improve.dmmiah,or repah any Bwaum $5143
Prior m is,issuance,akau rcqu;ru IW applicam for such Permil to file a 1 ignce suNmens
�i door he is licensed purmanl to the previsions of the Comncturs Lice.Law(Chapter 9 Sq.Ft. Floor Area (/ Valuation
I�m (commencing with Section 7000)of Division 3 of NC Business and Profusions Cods)or
that he Is ucrript therefrom and the basis for the allegnd exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil Penalty of XPRiO pane Type
not mom than five hundred dollars(SSW). J
I,as owner of the property,or my employs with wages as their sok cempenandan, /
will do the wart,and we mossom is not Intended or offend forsala(Sac.70,14.Basin, /
Required Inspections
and Proressiau core:The convaatora License Law dos,not apply to m owner of
prepeny who Wilds w improv theman,and wW doessuehwarkhimsrdforduough his
awn emplayo,provided Nat such improwmenks are not intended ora@red for oak If,
however,the Wilding or improvement is sold within one year of completion.the owner-
builder will Wve thc WNen of proving that be did mat build er Improve for purpose of
sale.h.
❑1,as owner of the Property,am cindusiwly connecting with licensed mnbacton to
convect the project(Sec.706,1.Business and Professions Code)The Contractors U.
cense Raw do not apply to in owner of proPeny who Wilds or improve thertan,and.
who contracts for such prejeeu with a conaaclor(s)licensed pursuant m the Contractor's
License law.
❑lamuemptundr Sec .BBPClorthisheason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemhy affirm under p,, ty of perjury one of the following dedaratiotu:
1 have and will maintain a Ccrdfowe o
tf Cmnem to sclr-insure forwe ftes Compcn-
sasion.as pmvidcd for by Section 37W or the labor Cale.for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as mquised by Section
37W of the Labor Cod,for the Performance of the work for which this permit is Issued.
My Workers Cam(�nwdan Ines, unix and Policy number one:
Co.,,: 1,227 EYLL PoI;,No.:AoTI14'14�
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aced.mend ret W canpletod if ee permit u(arose Wndred doll.(sl W)
or Iess.) .
1 enmity dost in Ne perkemunw of the work for which this amoii is issued,I shall not
employ any person in any manner so u to become subject,.the WorkersCanferes dim,
Laws of California Dam
Applicant
NOTICE To APPLICANT:if,after making this Cer iOcam of Exemption,you should
become subject to the Woheh Compensation previsions of the Labor Code,you must
.J O forthwith comply with such provisions or this permit shall W deemed revoked.
?N CONSTRUCTION LENDING AGENCY
[—� I Mouthy affirm Nal then iaa cdnaudnn lendingaged.,Tar the Performance of
C' the work fur which this Permit is issued(Sec.3W7,Civ.C.)
G Q Lenaer's Name
=z Lenders ss
Addre
V 0 1 ennify that I have mad this application and more,that Ne aWve infamadon I,
f" correct.I agree to comply with all city and county ordinances and alone laws relating to
V building construction,and hereby authorian representatives of this city to curer ulnen the
above-mcnuonW property for inspection purl,uses
HW (We)agree to save,indemnity and keep harmless Ne City of Cupcninu against
"n carnation
gmcnu.coss end upensu which may in any way awmcapinstsaid Ciry
U Z inconsequence a( Snmin6 of this
permit �J
APPLICANT U ST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU
Signature of ApplicrosUConRDOU Dam Re-roofs
xAZARpous Ma Ars LmomDISCLOSURE Type of Roof
vera the applicant no revere Wal Co e.Chapter
tion or din ea,manmaz,,im
ho
u defined m the Cupertino Municipal Code.Chapkr 9.13,and the Health and Safety
Code.Odan zss3z(an All roofs shall be inspected prior to any roofing material being installed.
41 Tu
Will thea recent or man Wnain azo,rat am e w If a roof is installed without firs[obtainingan inspection,I agree to remove
PP 8 p q prem m dvin which
emit hawmnus air canuminanu as dOncd by the Bay Arca Air Quality Management all new materials for inspection.
D WI<17
❑YCs
Ihavehoulth hvardousmaterialsrequimmenu under LTapmr6.95 olds Califon
mall Safety Sccdon T5505.35577,nd 25334.1 undnwa Nat iftW builJing
Jo sat currently h a m nL WI it u my respouihilitY to nadfy We acevpant nr Ue
mwiremenn wni niarmissaanwaracemfiwmpr capm '.�� Signature of Applicant Date
Owner use aumorizce agcm D„e 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
•CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
os� i V--. 6GQbd z
OWNER'S NAME: ` Sow PHONE # Yoe '7-) -L3Go
GENERAL CONTRACTOR: u ss a mS FAX # 6 F 7J1G_�S1L 9
I am not using any subcontractors: l /3',96
Signa Date
Please check applicable subcontractors and complete e 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
-l3-aL
Owner/Contractor Sign e Date
CITY OF CUPERTINO
•em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36926044 . 00
DATE ISSUED. . . . . . . : 09/13/2006
RECEIPT # . . . . . . . . . : 36027
REFERENCE ID # . . . : 06090092
SITE ADDRESS . . . . . : 10531 RAMPART AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WILSON JOHN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : HUSSEY BROS
CONTRACTOR . . . . . . . : HUSSEY, STEVE LIC # 20758
COMPANY . . . . . . . . . . : HUSSEY BROS INC
ADDRESS . . . . . . . . . . : 640 TAYLOR AVE
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94085
TELEPHONE . . . . . . . . : (408) 733-6360
18FEE 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 5 , 143 . 00 0 . 60 0 . 00 0 . 60 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 162 . 03 0 . 00 162 . 03 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- - -------------- ------------ ------------------
CHECK 162 . 03 26665
TOTAL RECEIPT 162 . 03
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
0
CITY OF CUPERTINO WMUq L
FURNACE/AC
•CUPEI,TIN0 PERMIT APPLICATION FORM
APN # Date:
Building Address:
kaw, a,rf Avc .
Owner's Name: Pone#:
P
Contrtor: Phone: -733_G3�v License#:
nk/SICLI Bros. YO
Contact: IPhone: Cupertino Business License#:
VevC 4issc
Building Permit Info:
Bldg ❑ Elect E�' Plumb '®-- Mech
Job Description:
Residential Commercial ❑
For Residential I s llations:
Attic ❑ 1" floor2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural cales) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: y Type of Construction: Occupancy group:
Strapped ❑ On Platform Ise.� Bonded= Sq.Ft. Floor Area:
New Location 0�— Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm 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 Elee Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
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