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05110092 (2) CITY OF CUPERTINO ` a+ '+� "'" BUILDING DIVISION PERMIT '--CLINTRAQTT ,R INFORMATION:- • BUILDING ADDRESS: A PERFECT CLIMATE PERMIT No.05110092 1348 S STELLING RD OWNER'S NAME: - PERMIT ISSUE DATE JANICE DAVIS 10570 S DEANZA BLVD 11 /17 /200S NE: SANITARY NO. CONTROL NO. (408) . 861-9545 ARCHITECT7BNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +Op LICENSED CONTRACTOR'S DECLARATION Job Description EZ C 1 Mrtby affirm Nat 1 am licensed under previsimu of Chapter 9(commencing <tl with Section 7000)of Divivan 3 ofdw Business and Professions Cade,and my license,is in full fmro ane ha ( REPLACE FURNACE & ADD A/C DIgmLlcmve Claz ... a. tg, Dam Coneacmr - - t'h ARCHITECTS D RATION 1 urldersunJ my plans shut M used az public records ��Ds /3 Pf �© y a.U \\`s`gl}f1✓////Gr/—alr\L11116r111� L G in Licensed Pmfcasional 3 OWNER-BUILDER DECLARATION v�.a f 1 hemby affirm Not I am exempt from Ne Con"Cim's Let..Law for the HC following mason.(Section 7031.5,Business and Professions Cods:Any city or county 5_2 which requires a permit m cmrdmM alus,improve,dnmolixh,or repair any Worn u e NOV— so n � $6964 _Z< pdormiuissuame.alwmquimatieapplicanlforsuchpermitm Bic a signed atsmmcm v Iles he islicenmJ purwanl to Nc pmvwom of Me Conuactari Lienor law(Chapmr9 Sq.nI1Ft.Floor Area Valuation ERC (commencingwiLhScation70W)ofDivision3ofthe Businusand Professions Codc)or �r•)ts^I .. Nat he ti exempt Nertfrom and de basis for de alleged exemption.Any violation of ri' Section 70315 by any applicant for a pemdt subjects de applicant or a civil pcvlty of e, - ` f,V VOccupancy Type not more Nan firs hundred dollars(5500). ❑I.ssownm of the Mopmy,mmy rmploym with wagesssNe'v sole cmnpensstion; will do Nesioma and Ne he Cortuno's Lica doraw don, t an cro rrof Required Inspections arM PnY WW ns code:The Canuacmts nd.1ho law dots cot apply lf an Owmr is 9 P pmpusywho build,mimprai Merton,andsobadoesouchwork himselfm Nmugh his awe,em.M,Wipinga, Nalsuchimprovementsart rot ear,Of dmnRratll for sale B. Wilder.Ne building sur mar of pmene u sold within arc Weld o(romp,ve ns.far the owmr- buil4r will how the buNro of proving that he did ros Wild m imprms(a Purpose of sale.). ❑1.as owner of the Property am exclusively contacting with licensed ronamms m wnswct the project(Sec.7044.Business and Professions Cade:)The Conuacsoes U. term Law does not apply or an owner of property-'ho builds or improm4 Merton.and. who contracts(branch projects.41h.contactor(,)licenud pursuant in the Conoactoes Lkense Law. ❑Iamexemplunder See .B&Pcf.athismuan Owner Data Am WORKER'S COMPENSATION DECLARATION 1 hem" a1Rrm under penalty of perjury nm of the following declarations: 'I ham and will maintain a Certificate of Covera to I(Ass m(arwor e s Compen- sation,as presided for by Section 37013.17 the Lothar Code.for the performeec of the work tsr which this permit is issued. Vl have arta will mumaln Wortrls Compensation Insurance,an required by Secdo. 00 of dm Lohor Code.for the perfurmana of Ne work for which this permit is issued. My Workc�fAs�Campena toas insurance arriv and paliq numbs tie: ✓ Carter. YI i Polity No.: �V — CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This xnlan mend rot M completed if Ne Permit Is foram hundred dollar(SIM) Or less.) , I certify Not in the porlormanco of Me work Iso which this permit is issoed,I shut not employ,nY Pcomm in any On ors azmb cwbjcnw Ne Ware ri Compensation Laws of Caliu.Da NOTICE TOA # PPLICANT.If.after making this Ccniricam of EicmMion.you should became subject to the Warknfa Compensation provisions of the labor Cade you mint .J z forthwith comply with such pmvisiov or Nu Permit shut be domed revoked. z CONSTRUCnON LENDING AGENCY (•+ Ithereby affirm that dere is a covuacuon lending agency for the perfesmance of fY > Ne work fur which this permit is issued(Sec.3097.Civ.C.) f17� A Lende's Name Z) z 1<ndefs Address U C) I emtify Nat 1 have read Nis application and sum that the atom information is IT. P coned 1 gree w comply with til city and county ortimncss and stale laws mladng to CU building construction,and hemby authodm representatives of this city to enerupon de alcove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City at Cupenum against fn tiabilitiv,judgrimms,evts and expenses which may In anyway mount againslsud City of tho ramm,of this permit. U z APPL CANTcUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4"C&rv�r Date SOURCE REGULAfTIONS. Re-roofs HAZARDOUS SignatureofAppliaOne HAZARDOUSMATERcA13 DISCLOSURE Type of Roof Willshesuppliantor(courtbuilding eccttpantnmcmand to hamdounmaterial as ask. Sections ec by tie 32(a)Cogitation Mumcipai Code.Cbaper 9.11,and the HeuN and Suety we,p°"15531(')" All roofs shall be inspected prior to any roofing material being installed. Yu If a roof is installed without first obtaining an inspection,I agree to remove Will Ne applicant or future building occupant ase equipment or devices which P+ mit haxardnv air contsminants az vfined by the Bay Amo Air Quality Management Disuict7 all new materials for inspection. ❑Yv a 1 have mad On hvarNlvmamdab rtquimmen i under Clrpmr6.95 ofde Calirm- asHealth&Suely Code.Setmv15505,15533 and 25534.1 umlerand Nnif Nc building does not turmoil have tenant.that it' ymspo� ilitym notify de oecupent of the no, comma sort nm be metpda oars¢sur mntifiaearaapumy. Signature of Applicant Date owmr ar,amat.<d agent cam All roof coverings to be Class"S"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 SCITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # 3�� s�� i VU OWNER' NAME: PHONE # 2- 46 - q( Q GENERAL CONTRACTOR: FAX # Al--95-41-6 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followmi 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 Owner/Contractor Signature Date CITY OF CUPERTINO CITY or PERMIT APPLICATION FORM CUPEkTINO JFAPN # 3 6 C ! c.r--o C� Building Address: C8 Mailing Address (if different from building address): Ly Owner's Name: C� d Phone #: ks -y#6 -`/#/o Contra or: License #: -293 Sk Contact: Phone:$(QI-4S Cupertino Business License#: Fax: $ — Building Permit Info: kv%-�� C- Bldg ❑ Elect 6Y l l l Plumb Cff Mech ILS Job Description, Residential ir Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: a ��I �� Occupancy Group: -3 e f Constru tion: Please check this box if the project is a second-story addition: ❑ ct Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILERS Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING EEFBCONSTAXR ONSTAXBQ Con. Tax for BQ Zone BUILDING ONSTAXH Hotel and Motel BUILDING Constax —Resi/Mobile BUILDINGELEC1000 Elec 600V <= IOOOA ELECTRICAL ELEC1001 Flee 600V > 1000A ELECTRICAL BELEC200 Flee Svcs 600V <= 200A ELECTRICAL BENERGYEnerg BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILLDING l of3 � � 7 CITY OF CUPERTINO CUP TY-OF VO PERMIT APPLICATION FORM QuantityAik Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDINTG BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERM4E Ins ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Cbeck Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMB11VG BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBU1 G BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING AIL BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUA'IBING BPIVHEATER Water Heater/Vent PLUIVLBIIS'G BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL / BREMARULkNT A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMg'URN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT. Heater Installation MECHANICAL BREMZINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMZPOWER Power DeAce/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap liance ELECTRICAL 2of3 1 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEP\TINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL 13SCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEA11PPER1\1 Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERAHTFEE Elec Permit Issuance ELECTRICAL MPER.MFEE Mechanicals . foot MECHANICAL MPERMITFEE A4ecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address ChangeBUILDING 3of3