06090018 (2) CITY OF CUPERTINO
BUILDING LQVISION PERMIT r 'NTRAGTQR T1�F0RMA.TI0N ';
BUILDINGADDRESS: CONDITIONED AIR PERMITN0.06090018
7764 SOUIREHILL CT
OWNER'S NAME: PERMIT MUE DATE
KOLAND GOAY 1701 LITTLE ORCHARD ST 09/OS/2006
NE:
SANITARY NO. CONTROL NO.
(408)291-2220
ARCHI'IEC IFNGINEER: BUILDING PERMIT INFO
BLDGEIPCr PLUMB MECH
I� L t�
mmOp LICENSED CONTRACTOR'S DECLARATION
of 1 thereby affirm Nat 1 am licensed under provisions of Cbapmr 9(commencing Job Description
:iW withSc<uon 7l1IN1)of Oivision3ofthc Business and Profcssium Coda.and myliccna is
<om in fallfmcemal.ffcl. REPLACE FURNACE ADD A/C
m Z License Class� m
Lk.
F p Dam �� GOanar ^
ARCHITECTS DECLARATION 7 f
i s< I undersand as,plans shall he used az public cards 1
iyO 4.0.0�^ Licensed Pmfcssional 2
M31
OWNER-BUILDER DECLARATION
M0'i
31 I hereby
roil mot I am exempt from me Connectors Licm.law for tiro
.pe O following mann.(Section 7031.5,Business and Prfessiam Cole:My city or county
m which me,fres a permit to cotstrcL alter.impmm,demaimb,or repair my swctum 4050
oar to its issuance.alsu acquires;the applicant for such permit to file asignnl summer
< mat he is licensed pursuant to the provision of me CmuracOra Beene Law(CTupmr9 Sq.Ft.Floor Area Valuation
1FG (commencing with Section 7")of Division 3 afore Businessand Pmficohns Code)or
u $ that Its,is exempt mertflom and IK basis far the Mulled deetapuav My violation a(
Section 7031.5 by any applicant far a permit subjects the applicant m a civil penalty of r Occupancy Type
not more man firs hundred dollars(5500).
❑I,ssownerofinepmpmy,Ormyemployeeswimwagesastebrlecompenssdon,
will da the work.and the m etre u nor Wooded m,mile ted fmaule(Sec.7064,Besides;
and Prlessiam Cada:The ComuacOra License Law does Out apply to an Owner of Required Inspections
property who builds Or improves thereon,and whodoessuch.,it himselforthmugh his
Own employees,provided met such improvements art notinendad oroReted for tile.If.
however.me Wilding or improvement is sold within ane year of completion.the owner-
builder will have the Wrdcn of proving that W did not Wild or improve for purpose of
sale.).
1.as owner of the property,am exelmively contracting wit licensed contractors of
construct the project(Sec.7044.Business and Professions Cade:)The Contractors Li.
come law does not apply in an owner of property,who Wilds or improves Lemon,and
who contracts Ler such pmjeem with a conu mors)Iiceread prsuant in the Contractors
License law.
❑ I am aempwnan See ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affil under penalty o(pe0ury nen of the fallowing declarations
1 hum and will maintain a Cerufiam of Co..in elf-inwR far Worker's Compen-
sation.sm provided fou by Section 3700 of the Labor code.far me paaformane of the
wart for which this permit is wood.
❑1 have and will maintain Workers Corpensstion Insurance,m renamed by Section
3700 of the Labor Code.far dm pedormance of me work for which this Permit is issued.
My Workers Compensation Ire..artier and Policy number art:
Cartier. W'ti k? '-aao.rit PolicyNo.: a I CC006d/S'6'SI
CERfIF ft'-ATEXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
mums senium need not W completed if the permit is faronc hundred dollars(SIM)
or Icss.)
1 andv that in me performance of the work for which this Permit is issued.I shall root
employ any person in any mannerso as to became subject in the Workni Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ceruficam of Eamption.you should
become subject 0 me Workces Compensation provision of tc Labor Code,you mut
.JO forthwith comply with such provisions or thiserm
pit shml W damned revoked.
P: "! CONSTRUCTION LENDING AGENCY
[-a� 1 kmbyafiim that mere is a consuucunn lending agency for the pedornmmc of
a
the work far which this permit u issued(Sec.3197,Civ.C.)
!L7 Lenders Name
D' lenders AM.
a Z
U Q 1 artily that I have read this applicmion and all that de;boa informma is
LL. F corrin I agme 0 comply with all city and county ordinanem and sum laws relating m
building construction,and hereby amharim represcnutives ofthis city to enter upon the
U
ra move mentioned pmpcny for dexpeNon purposes.
(We)agree to seam,indemnify and keep harmless me City of Cupcnino against
U Z incoflabilmmeme ce Of the cost andOfpusImbot. they in any way accrue against mid City
V z A APPLICANT
of mM UNDERSTANDS
of this g WILL
Date
^ APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by:
SOU REGUI.ATf0N5.
f�����/•`E`er O
6 Re-roofs
�AZARDOUS MATERIALS DISCLOSURE / D 0 Type of Roof
Will dm appliant or future Wilding accupant SOta or handle haurdaus material
as defined by 0th Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
Code,Section 35532(x)?41 0 All roofs shall be inspected prior to any roofing material being installed.
Ya /��.I•so
Will the applicant or future Wilding aaopant me equipmm�l or devices which If a roof is installed without first obtaining an inspection,I agree to remove
crit Inwmmus air contaminants at defined by the Bay Ama Air Quality Management all new materials for inspection.
Diibicl?
❑Ya _amu
1 have rad the harardats mamritilmquimmcnts under Chamm 6.95 Ofde Califon
nu Halm&Safety Cada,Sessions 2550125533 and 25534.Immakrvand mmifde Wilding
does Out currently has a abroad,Wt it or my responsibility of badly me de,,sml of due
ntswhichm bcme,prior to issuance afaceniriamofOccupancy. Signature of Applicant Date
LCP,ft, milmrifed.'enr Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
!m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . 1 - : 36223026 . 00
DATE ISSUED. . . . . . . : 09/05/2006
RECEIPT # . . . . . . . . . 35899
REFERENCE ID # . . . : 06090018
SITE ADDRESS . . . . . : 7764 SQUIREHILL CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KOLAND GOAY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CONDITIONED AIR
CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334
COMPANY . . . . . . . . . . : CONDITIONED AIR
ADDRESS 1701 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 291-2220
•
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 4 , 050 . 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
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
t Cupertino CA 95014
.1 1400 Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPER,TINO
Building Department
JOB ADDRESS: PERMIT #'
060 fool d'
OWNER'S NAME: . Cz PHONE # Li 46 • f r,6
GENERAL CONTRACTOR: FAX Cf I gy
I am not using any subcontractors: rf /s I c>6
Signature Date
Please check applicable subcontrac d com Tete the 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 Me
Painting/ Wallpaper
Paving
Plastering
Plumb' g
R?Ag
tic Tank
Sheet Metal
Sheet Rock
Tile
•
916106
er/Contract ignature Date
;
CITY OF CUPERTINO (Q cob
®ro FURNACE/AC
UPERTINO PERMIT APPLICATION FORM
i
APN# Date:
19 • oS • p6
Building Address:
A Lfc� t t. CP G S ., ► 4
Owner's Name: Phone #:
ko\-&ra \\ . C-10aL'---, 446 1666
Contractor: Phone: License
Contact: Phone: Cupertin"Business License#:
Ctrs t(3 �oFlm j!
Building Permit Info: j
Bldg ❑ EleAPR Plumb ❑ Mec
Job Description:
Residential_ Commercial ❑
For Residential Installations:
Attic ❑ 1' floor ❑ 2nd floor❑
dhere to min set back re uiremen�
or Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑ i
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occuparildlygroup:
Strapped n Platform Bonded Sq.Ft. F iArea:
New Location R ]acement 0
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 1 0,000cfm j MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
ti BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
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
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING
I