07020092 CITY CUPERTINO
BUILDINGOF DIVISION PERMIT � t�GQR
' PERMIT NO.
BUILDING ADDRESS:
965 NOVEMBER DR A PERFE-"T CLIMATE 07020092
PERMIT ISSUE DATE
OWNER'S NAME:
JAMES HARRAH 10570 S DEANZA BLVD 02/1 /2007
SANITARY NO. CONTROL NO.
SNE:
(408) 86119545
BUILDING PERMIT INFO
ARCHITEC(ENGINEER: BLLD_G, EO PLUMB ME�CH
i ed ZO LICENSED CONTRACTOR'S DECLARATION Job Description
w F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and professions Code,and my license is
REPLACE FURNACE
y in full force and eff
r vn Z License pus ?0 Lie—
Contractor
Date 2= FARC ITECTS DECLARA ION
i C< I understand my plans shall be used as public records
)aU
U.H Licensed Professional
• a
OWNER-BUILDER DECLARATION
I hereby alYrm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
$ which requires a permit to construct,alter,improve,demob h,or repair any structure
u' prior to its issuance,also requires the applicant for such permit to file a signed statement q,Ft.Floor Area Valuation
-?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S $3431
e.F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A��l Number
not more than five hundred dollars($500). 3 6 2 13 0 4 5 . V V
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
0 I am exempt under Sea B&P C for this reason
Owner Date —
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
J I have and will maintain a Certificate of Consent to self-insure for Workers Comthe
sation,as provided for by Section 3700 of the Labor Code,for the performance o[f he
t
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Polity n rube
CartierAal a l�S i7A'7L l l4 Polity Na.:�r
OFSREMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z► CONSTRUCTION LENDING AGENCY
E r rte. 1 hereby affirm that there is a construction lending agency for the performance of
pC> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Z Lender's Address
U 0 I certify that I have read this application and state that the above information is /I
[T. correct.I agree to comply with all city and county ordinances and state laws relating to
F {/./�/A+•
U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,Fr to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. D
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE R CATIONS. (,
.,�1 v2—117 Re-roof:;
Signature of Applican ntractor Dai Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roots shall be inspected prior to any roofing material being installed.
0Yes Ne If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants u d ned by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date
requircmcn ch must be met norto issu of rtificate of Occupancy. Signatu-e of Applicant
All roof coverings to be Class"B"or better
Owncr or authorized a9fit Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
rUPEkTINO
Building Department
JOB ADDRESS:CA M t(N E�6� �R— P 0 _ZERMIT # V
_"l �j, W 92 fM
OWNER'S NAME: jjbWwS,b ftlpft4 PHONE # 2r_ i
GENERAL CONTRACTOR: C l j M 2, 1 FAX #
I am not using any subcontractors: i a
Sture Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI?4ESS 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 OI' CUPERTINO
6 ITEMS OF 6 PERM=:T RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: B--.k: Lot:
APN . . . . . . . . . 3E0213045. 00
DATE ISSUED. . . . . . . : 02/16/2007
RECEIPT #. . . . . . . . . . BS000000481
REFERENCE ID # . . . : 07020092
SITE ADDRESS . . . . . : 965 NOVEMBER DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . JINES HARRAH
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4120
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY . . . . . . . . . . : A PERFECT CLIMATE
ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (4:08) 86119545
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BENERGY PERMIT FEE 1. 00 34 . 86 0. 00 34 . 86 0. 00
BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00
BSEISMICRE VALUATION 3, 431. 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
PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 164 .78 0. 00 164 .78 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 164 .78 6806
---------------
TOTAL RECEIPT 164..78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF C
UPERTINO � ' j' ';
FUR
NICE/AC
f PERMIT APPLICATION FORM 501
CUPEIZTINO
APN # Date: G-_� � - O
Building Address: ke y— 0�U� WL, `�(�,,
Phone#: d.
OwneCA
r's Name: O
Fhone. — "LicenseContractor: Phone: ness License#:
Contact: r
PrM
Building Permit Info: �,/
Bldg ❑ Elect CtY
Plumb [� Mech
wpoo
Job Description: � L r ''� r ��-- �n.,—
Residential Commercial ❑
For Residential Installations: ❑
Attic 1:1 1St floor � 2 floor
Adhere to min set back requirement❑
For Commercial Installations:
Additional
_eplacement same weight [:] tional weight(st[ictural calcs)❑
Structural Calculations required for new installation
New in
Planning Approval Required ❑ Occupancy group: R�
Type of Construction:
Cost of Project: 3`�.�1`
'T Bonded ❑ - Sq.Ft. Floor Area:
Strapped n Platform ❑
New Location
❑ Re lacement x
Qty. if Fee Description Fee Group
Applicable Fee ID BUILDING
BENERGY FurEnergy MECHANICAL
/C Unit> 10,000 cfm
BREMFURN A/C
MECHANICAL
BREMACOVER ASC UMECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm ELECTRICAL
BREMRECEPT R ec tl, Switch& Outlets BUILDING
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial ELECTRICAL
EPERMITFEE Faec Permit Issuance MECHANICAL
MP FEE Mech Permit Issuance PLUMBING
PPERMITFEE F lambing Permit Issue BUILDING
BPERMFEE F�ldg Permit Fees BUILDING
BP HK flan Check Fee em Fee pLUMBING
BPGAS Jas Pi ing SystBUILDING
BUSLIC 13usiness License