05100129 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT x CONTRAC"�UR INRMATUN e
BUILDING ADDRESS: SCHAUMANN AIR CONDITIONIN 'PERMIT No.05100129
OWNER'S NAME: PERMIT ISSUE DATE
NITT DANIEL
.NE: SANITARY NO. CONTROL NO.
800) 986-0133
ARCHIIEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
C=
LOo
LICENSED CONTRACTOB'SDECLARATION lob Description
i 1 hereby affil m that 1 am licensed under provisions of Chapter 9(commencing
a< wim Senior 7000)of Division Sof Bra Buaineu and Professions Code,and my Becascu
Lk'anfarnandcrce REMOVE & REPLACE FURNACE
g ' f11f ins it IT 63 ue.g 970e3S�
yya...... Dam CantrumrS UMsrA/N, C- •0
? ARC e a moo
DECLARATION
F. I understand nJ my plansshallall be be used public ch
U ON
4 ad Uccau d professional \�
OWNER-BUILDER DECLARATION
�S I hereby affirm that I am exempt from does Conranofs License Law far the , x1005
O O following moan.(ScOon 7031.5,Business and Professions Calc:Any city or county ` t
$K which requires a Permit in cmWmst.alcor.Improve,demallah.o raped,any wucturc 11111111% 98362
ZL^ prior or is issuance.also requires the applicant for such Permit o file a signed statement
gg that he is licensed pursuant o the provision of also Comrumr's License Law(Chapter 9 Sq.Ft,Floor Area 1 I�at0 1
remain ncing with Section 7000)of Division 3 ofine Bommumand Professions Cade)or j •ty tfly�
that k u exempt Ihaefrom and IM hub fm the alleged exmtptta.Any violation ofUIL s
Section 7031.5 by any applicant(Us Permit subjects the applicant to a civil penalty of Occu"pahcy Type
not mote than five hundred dollars(5500).
�1,u owner of tis,Pmpmy,o my wplaycn wim wages u the'v sole compensation,
will do Newark and late structure is not mounded wafered forsale(St.,7W.Business Required Ins ecdons
and Profeuuns Cade:The Committees Limine Law don nal apply to an Owner or q p
pmpmywho builds or improv thereon.and whodoessuchwork hinnselfor Waugh his
own employes,provided that such improvements are not intended moRered fouls.If, v
however,the building or improvement is sold within one you of completian,the owner.
builder will have the human of proving inn ha did not build or Improve for purpose of
ate.).
❑h as owner of the property,am eaeluavely contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conrncmh LL
rams Law dao not apply to an oamr of property who builds at improws Neaten,and,
who contracts for such patinas with a con"clar(q licensed pursuant to me Contrsemr's
License Law.
❑I am exempt undo Sec. .B&P C for mu mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aMan under penally of perjury ane of dm following declaration:
❑Ihawaudwlllmalnana CeNftuteaf Cansenlmvelf-insumfo WmYeh Compen.
cation, provWhi Tar Ss issued.3700 of the labor Code.(o the peRonnence of Ne
work forr which this Permit Is issued.
❑1 have and will maintain WwkeYs Compensation insurance,as required by Section
3700 of the lame,Cade,for the part...of the wart for which mis permit is Issued
My Workefs Compensation Insurance carder and Policy number are: /
ciaer•AtIW—.Rf PolicyNa.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Otis scc0on mss not be completed time Izmir Is foron,hundred dollara($100)
m tax)
1 certify that in the perfmmance of the work for which this permit is issued,I shall not
employ any person in any manrs,rso as to become subject to the Workers'Compensin a t
Laws of Califamia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Coolness,of Esomption,you should
became subject to the Worker's Compensation provisions of ma Labor Code,you in=
.,O raMwith comply with such provisions or this permit hill be deemed revoked.
z� CONSTRUCTION LENDING AGENCY
[r I hammy aOirmmu mem iso construction lendingagency forme perfomtams of
ai> the work fur which this permit 1,issued(Seg.3097,ON.C.)
aQ Lender's Name
= z Lendmes Address
C)Q 1 certify that 1 have mad this application and sum that the above information is
fY correct.I agree to comply with all city aha county oNinances and sae laws relating to
Q building construction.and hereby aumorise mpmxnumes of this city to enter upon the
IZl arum-mentioned pnopeny far Inspection purposes
(We)agree m eve,indemnify and keep harmless the City of Cupertino against
y liabilities.judgmenu.can and expenses which may in any way menta against Wit City ,
U in comequnme of the granting of this Permit.
APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ra Date
S ,x-wREGULATI 7
n,.� , i - 2>wi l oaS-as Re-roofs
Signammof ApplinnUContnctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building occupant nom"handle haardous material
as de0md by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 33532(a)7 /
Oyu All roofs shall be inspected prior to any roofing material being installed.
�'f1u
Wilt the applicant or comm building occupant use equipment of devices which If a roof is installedwithoutfirst obtaining an inspection,I agree to remove
Cook bavardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have real the hauNws materials rcquimments underChi 6.95 or W Glifar.
at.Health&SafetyCod,gentians 25515,25533 said 25334.1 undmtwd thin if the building
docs no ntly haw a memo,mal It Is my responsibility m redly W occupant of the
an which must he mel,fPpyrt a�aa�ceaIacertificate oroccupancy. Signature of Applicant Date
�r�.�� /5P'LcLrf vote✓ /oY 9� All roof coverings to be Class„Bra or better
Owner of authorized agent Dam
CITY OF CUPERTINO
1� 1 of 1 PERMIT RECEIPT OPERATOR: kieraaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35707021.00
DATE ISSUED. . . . . . . : 10/19/2005
RECEIPT #. . . . . . . . . : 31656
REFERENCE ID # . . . : 05100129
SITE ADDRESS . . . . . : 10412 SCENIC CL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NITTA DANIEL H AND KAREN S TRU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014
RECEIVED FROM . . . . : SCHUMANN AIR CONDIT.
CONTRACTOR . . . . . . . : SCHAUMANN, EDWARD LIC # 20738
COMPANY . . . . . . . . . . : SCHAUMANN AIR CONDITIONING,
ADDRESS . . . . . . . . . . : HEATING & PLUMBING INC
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (800) 986-0133
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMFURN NO UNIT 1.00 14.31 0.00 14 .31 0.00
BSEISMICRE VALUATION 9, 000.00 0.90 0.00 0.90 0.00
BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00
BUSLIC FLAT RATE 1.00 102.00 0.00 102.00 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 267.18 0.00 267.18 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 267.18 38954
TOTAL RECEIPT 267.18 -
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 -ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
o - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�JPERTINO
Building Department
JOB ADDRESS: PERMIT #
j044/ 2 Scc:.-M/c GR
OWNER'S NAME: /V/7TA lkf+REN * PAN PHONE # zy s-- ZoW
GENERAL CONTRACTOR Scl44UM4Ne1c-H}%-PLBG ) wMk* 4,,?o - 7/oy
-- ANc�
I am not using any subcontractors:
Signature Date
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 mA-ju C•AT&- tJc 770034 fYcx.oc34
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
:::#Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
"c.,
Owner/Contractor Sijnature Date
CITY OF CUPERTINO
�rv'
FURNACE/AC
WUP'E" TIN0 PERMIT APPLICATION FORM
APN # 2 S�y '�a , Date: 0 —18 - OS
Building Address: '
Owner's Name: / p Phone #:
Contractor: License#:
S�.GLavn-�a,7e-, `77oo3 00
Contact: cCuperting BusinessOLicense#:
e 4- r C- 1 I o 71- :o(f
Building Permit Info:
Bldg ❑ Elect P Plumb C9' Mech
Job Description:
urnac�
Residential Commercial ❑
For Residential I t lations:
Attic ❑ 1"floor 4 2nd floor❑
AN Adhere to min set back requirement[]
IN For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: �f j� a 36 2 , Type of Construction: Occupancy group:
Strapped On Platform ❑ ] Bonded LJSq.Ft. Floor Area:
New Location ElRe Replacement-v/
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 c$n 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