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07020045FY OF CUPERIII AUILDING'DIVISION BUILDING ADDRESS: 10120 PASADENA AV PERMIT OWNER'S NAME: PAPP MICHAEL AND DOROTHY C /IQEDT T ARCHITECr/ENGiNEER: p Zo LICENSED CONTRACTOR'S DECLARATION vF I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z ni with Section 7000) of Division 3 of the Business and Professions Code, and my license is r <y in full force and effe License Clea s, 0 Lic. S o Date L4 CHn EL-rS DECLARM IO j aL4 < I understand my plans shall be used as public records )aU u.in Licensed Professional y OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the n Oa following reason. (Section 7031.5• Business and Professions Cade: Any city or county < m { which requires a permit to construct, alter, improve, demolish, or repair any structure a— w prior to its issuance, also requires the applicant for such permit to file a signed statement - ^ a that heis licensed pursuant to the provisions of the Contractor's Liccnse Law (Chapter 9 is (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or i that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500)_ 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 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 (wild or improve for purpose of sale.). 0 I, 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 Contractor's License Law. 0 1 am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION A B S HEATING & AIR COND 334 S HAI (408)233-7178 PERMIT NO. 07020045 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REPLACE -FURNACE AND DUCTING 1 hereby affirm under penalty of perjury one of the following declarations: -1 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. -1 I have and will maintain Worker's Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. Ny Worker's C`om�pensation urancee carrier and Policy number are: artier. —)t�� 1[� PolicyNo.:12M L W O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (bis section need not be completed if the permit is for one hundred dollars ($100) or Icss.) 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 w the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a conswction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNIARSTANgS AND WILL COMPLY WITH ALL NON -POINT SOUR Signature o Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? �,✓ 0 Yes qh`c' Will the applicant or future building occupant use equipment or devices whist emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmen District? ❑ Ycs I have read the hazardous materials requirements under Chapter 6.95 of the Califor nia Health & Safety, , Sections 25505, 25533 and 25534. I understand that if the buildin; does not 5117 l ve a tenant,4h�at is my responsibility to notify the occupant of th ren„i encs h must brrtt9lxriw issttartryzbj a Certificate of Oct'. I_ Sq. Ft. Floor Area 35717027. Number Issued E Re -roof Type of Roof Valuation $6500 uccupancy Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roo" is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signatu -e of Applicant Date All roof coverings to be Class "B" or better 4 CITY OF r:UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: �'� C a E: PERMIT # o c) '� OWNER'S NAME: G�Alo PHONE # _ GENERAL CONTRACTOR: FAX # / am not using any subcontractors: �&&o S ignature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 21 SUBCONTRACTOR BUSI]vESS 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 7 ITEMS OF 7 PERM -:T RECEIPT Sec: Twp: Rng: Sub: B --.k: Lot: APN ......... 31717027.00 DATE ISSUED........ 02/08/2007 RECEIPT #.......... BS000000421 REFERENCE ID # ...: 07020045 SITE ADDRESS .....: 10120 PASADENA AV SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: amyw COPY # : 1 OWNER ............: PAPP MICHAEL AND DOROTHY C TRU ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5919 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: ROBERT HALL LIC # 22481 COMPANY ..........: A B S HEATING & AIR COND ADDRESS ........... 3.4 SHAMROCK DR CITY/STATE/ZIP ...: C114PBELL, CA 95008 TELEPHONE ........: (4:08)238-7178 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 6,500.00 0.70 0.00 0.70 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMFEE SQUARE FEET 1,800.00 144.00 0.00 144.00 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 ---------- 308.98 ---------- 0.00 ---------- 308.98 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 308.98 --------------- 308.98 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL REFERENCE NUMBER -------------------- 10836 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL a1F CUPEfZTINO CITY OF CUPERTINO . FURNACEAC PERMIT APPLICATION FORM ATN # 3.61-17--* a2 Date: 2 8 0 Building Address: BREMFURN furnace MECHANICAL Owne 's Name: 14,45ha ( ��' � ' Phone #: - -3 E o rat or: Phone: License #: Contact: Phone: Cupertino Bi4siness License #: BREMRECEPT Rec tl, Switch & Outlets Building Permit Info: BSEISMICRE Bldg ❑ Elect Plumb Mech Job Description: /�� - !� cC Gl'LCG /✓l Residenti Co tial ❑ EPERMITFEE For Residential Installations: ❑ ❑ ❑ 1'A-nJE'r -Roo r ELECTRICAL 2nd floor Attic 1" floor Mech Permit Issuance Adhere to min set back requirement ❑ PPERMITFEE For Commercial Installations: _eplacement same weight ❑ Additional weight (structural talcs) ❑ PLUMBING Structural Calculations required for new installation ❑ 13ldg Permit Fees New installation Planning Approval Required ❑ BPLANCHK Cost of Project: Type of Construction Occupancy group: AZ 1 Strapped ®i On Platform ❑ Bonded D- Sq.Ft. Floor Area: New Location ❑ Replacement Er- 46W worwaugoo t I Qty. if VvA m Fee Descrintion Fee Group A jl11VRVlV + BENERGY - Energy BUILDING BREMFURN furnace MECHANICAL BREMACOVER Y�/C Unit > 10,000 cf n MECHANICAL BREMAIRHAN f�/C Units <= 10, 000 cf n MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE 171lec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE 13ldg Permit Fees BUILDING BPLANCHK flan Check Fee BUILDING BPGAS Jas Piping System Fee PLUMBING BUSLIC Business License BUILDING