04050057 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT yCOXTR -'TDR A X '
BUILDING ADDRESS: _ A PERFECT CLIMATE PERMIT NO04050057
7954 SUNDERLAND DR
OWNER'S NAME: FERMITLSSUHDATE
WENDELL KERR
ONE: SANITARY NO. CONTROL N0.
(408) 861-9545
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB
MKH
O
y o ij LICENSED CONTRACTOR'S DECLARATION Job Description
1 Mrcby affir t m ' pmu sed under visioof Chapter 9(commencing Job
SK.2 iNSmuon7000)o i f Elmi....nd1musot a.an ljc¢paefr / /
mmBmrca, _/7 1 XV R CE FURNACE & ADD A/C
ZN License lass onN
n F p Dam Cantruter
A GHITECT$0 R TION y
u��i�" tans used a lie teeth[
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OS OWNER-BUIL�CLARATION ns
ae) I hereby maso .(firm on 11. exempt Item Ne Conimat Co eLicense Aa Law for the �� C
O O folwhich
mason.permit
t 7fD 1.4 Business and Pro.dam m Code:Any any nsummo County
,
$ which its iirua a Permit m 1tmthconstruct,tlter,tmprow,demrmil t or mash any tmenturo
Prior m its issuance,pursuant also mqo ffic the applicant forsuchMe Con pemnr'to Ne salgal stammem
that heencing witSectiontothc orprevisions sion(theeBminex,m License Law(Chapter Sq.Ft. Floor Area Valuation
y $ (cat he
exempt Section 70)(1)of basis n3 oltheBed exemption.
Any
vi Cndcj or
Nat M1e Is exempt therefrom and dte stela for Ute alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Al7P(i1MerOO Occupancy Type
not mom than rive hundred dollars(5500).
❑I.as owner ofthe property,or my employees with wages as their sole compensation,
and Pr the work end Ne swcmm Is oat intended ofa w de Tonle(Sec, owner
v
and Professions Calc:The m Means License Taw dela tort apply lf an owner or Required Inspections
property who build[or improves thereon,and who dun etch work himselfedthrough M[
own employees,Me Wilding
pr wchimprowmentearcnet intended or leflod finsaleMe .owner..
border Ne building ar improvementissoldwdiinaneynr of completion,Nesseof
builder will haw the Warden of proving Nu he did not build or improv for puryoa of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.Nuel.Business and Profnsmas Code)The Conoactar's Li.
come law docs not apply to an owner of property who builds or Improv thereon,and
who contracts for such pmjmm with a convacmr(s)licensed pursuant o the Contractor's
License Law.
❑I am exempt under Sao ,B d P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarallons:
1 have and will maintain a Certificate of Consent in self-iamrc far Worker's Catalan.
tation.as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Campensation Lmursnce,as required by Section
3700 of the labor Code,for Mas performance of the work for which this permit is issued.
My Worker's�C/a/mPensation sumo nrriu and Policy nu ra�
Carrier.
CERTIFICATE OF EX ON FROM WORKERS'
COMPENS NINSURANCE
(Thu section need not be completed lithe Permit Is fnronehundred dollars($101)
or leas.)
1 mrdfy that In the performance of the work for which this permit it issued,l shell not
employ any person in any mannerm as to become subject to the Worked Compensadon
Lam of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workers Compensation previsions of the labor Code,you must
,Z forthwith comply adult men provision or this Permit shall be deemed mused.
„z„O CONSTRUCTION LENDING AGENCY
I hereby affifm that dmrt is a comwNnn lending agency for Me Performance of
Qf ,7 the work for which this permit is Issued(Sec.3037,Civ,C.)
0 Lender's Name
D Z LeaM,e.AMMmd
V Q 1 certify that I have rood this application and state that Ne above information is
{L correct,1 agree to comply with all city and county ordinances and state Iaws relating ta
OO building construction,and herebyauthoria mprcscamunm of this city to enter upon the
W .have-mentioned propcny for impaction purposes.
(We)agree to avc,indemnify and keep harmless the City of Cupertino against \ O
fv liabilities.judgmeab,casts and expenses which may In my my amente against Said City \\
U 7 in consequence of the granting of his permit.
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature o(APPlicarsclor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or fretum building accupem stere or handle hmordous materiel
m defined by the Cupertino Monte de;Chapter 9.13,and the Health and Safety
oJ0. 0 en15532(.)? All roofs shall be inspected prior to an roofing material being Installed.
p reg ❑Na P P Y g g
Will the applicant or future building ca pent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haamous air contaminants as died n -by the Bay Arca Air Quality Management all new materials for inspection.
District? -
❑res
I have mad the N.M..materials requirements ,Chapter 6.95 of Ne Califor.
-is Health dr Safety Cade,Sectio.25505,35533 and 34. adersmndthmirdbabolding
does t cumcruy w a Nat it ism ibi' m notify the occu ant of N
re n wh' st metpdon uancc f colficamofOcupan . 3EU, fAppllCant Date
woof or an agent — Da All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228 Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:C PERMIT #
JU v 1deQJ� �f�Lo)C_ `v�L I lj� CD s c) 0 1
OWNER'S NAME: k?,je'-�' PHONE c, 5 -
GENERAL CONTRACTOR: C- # C7
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following info tion:
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
I. Tfle
Owner/Contractor Signature Date
-fffi CITY OF CUPERTINO _ 7
CITY OF
�CUPERTINO PERMIT APPLICATION FORM
APN # �Q�j9 Date:
51 lob
Building Address:
_-Rsy r
Owner's Name: Phone#:
S
Co tractor: Phone: License #:
Co ct: 0 n , Phone: N 13U I OLS' tlS— Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Job Description: ()o,� fiXVlLi-CRGvxaA 61,QJ fY(C,
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
Adhere to min set back requirement❑
For Commercial.Installations:
Replacers}ent"same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations re ired for new installation ❑
N installation Planning A roval Re wired ❑
C st of PProjel Z -,q Type Wntion: Occupancy up
f IV
Strapp form ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty 'f
A i ble Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 elm 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 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