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07120112CITY, OF CUPERTINO BUILDING DIVISION PERMIT��' ...... B A D PERMIT NO. UILDI � %T bERBR00K LN I AAA FLRNACE & AIR 1 07120112 T01a17QG— OWNER'S NAME: PERMIT ISSUE DATE WATSON LOUIS L AND BETTE M TR 1712 STONE AVE 12/14/2007 r'-nONE: i SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: u p C LICENSED CONTRACTOR'S DECLARATION V 5 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z m ction 70(0) of Division 3 of the Business and Professions Code, and my license is =y with Se in full force and eff v� Z License CI tic, Lle• M 'n F Date Contractor A C CPS DECLAR ee Jt I understand my plans shall be used as public records ;yU us u in Licensed Professional n y OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the p o following mason. (Section 703 1.5, Business and Professions Code: Any city or county K $ which requires a permit to construct, alter, improve, demolish, or repair any structure prior to is issuance. also requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 ytz- $ (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 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 Cale: The Contractors 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors 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 Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION O0 z� a Q �z U wP 0 W "rA Uz I hereby affirm under penalty of perjury One of the following declarations: have and will maintain a Certificate of Consent to self - insure for Worker s Compen- n, as provided for by Section 3700 of the Labor Code, for the performer= of the work for which this permit is issued. �I have and will maintain Workers Compensation Insurance, as required by Section 3�jOp of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carter and Policy number arc: ` j Cartier - r L I J Policy No.:. W I � r� Y �� CERTIFICATE OF EX PTION FROM WORKERS' 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 Workers 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 constructinn lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address I certify that I have read this application and state that the above information is corccL 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- mentiorued 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 UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. C` Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 0 Yes Will the applicant or �tu. bu ilding occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Management rict? OYes re lu I have ad the hvardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility o notify the occupant Of the maul Oments which must be met prior to issuance of a Certificate of Occupancy. , or REFLC FURNC 60,000 BTU & AD Issued by Re -roofs Floor Area Job Description Required Inspections BUILDING PERMIT INFO ELECT PLUMB Valuation Type Type of F.00f All roofs shall be inspected prior to any roofing material being installed. If a roof : s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date CITY OF CUPEI�TINO CITY OF CUPERTINO FUIV ACE/AC PERMIT APPLICATION FORM APN # / C) � Date: Building Address: Owner's Name: Phone #: Contractor: Phone #: kiloe - p2 f'3 - y 21 �J C Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: VV ?l -,? /,t;l3 - y ;71,7 Fax #: Building Permit Info: Elect 19 Plumb ❑ Mech Job Description: Residential Commercial For Residential Installations: St 2 °d floor Attic 1 floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): �/ V-P V Strapped On Platform Bonded New Location Replacement Valuation: IGreen Building: Must attach Green Building Check list to this application Stu CITY OF CUPEI,TINO FURNACE: Qty. if A-- 1; -.'klo 'VAO Tn CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE TRPP T)PCrrintinn Fee Grout) Permit Tvpe MCRAA Furnace M FURN /AC MCREPALT Commercial Mech Repair /alt/add M MCSUSHTR Commercial Suspend Wall /floor Heater M PGASCOM New Gas Piping System 1 -4 Outlets Commercial P BSEISMICO Seismic Commercial B / MRR.AA Residential Mech Repair /alt/add M MRSUSHTR Residential Susp °,nd Wall/floor Heater M BSEISMICRE Seismic Residential B MFLRFURN Install /relocate Floor Furnace M MECPLNCK Mechanical Plan Check M MFR = <100 Furnace Syst <100k BTU M MFRN >100 Furnace Syst > 100k BTU M MRAIRHAN Comm/Res < 10,)k BTU M EPERMITFEE Electric Permit Fee E / MPERMITFEE Mechanical Permit Fee M BREMRECEPT Electric Receptazles E PGASRES New Gas Piping System 1 -4 Outlets Residential P BPGAS Gas Piping System 5+ Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business Licens B CITY OF CUPEkTINO AIR CONDITIONER: Qty. if A-1;,. M- RAA TI-1 CITY OF CUPERTINO FUIVIACE /AC FEE SCHEDULE FPP 1)Pecrintion Fee Groun Permit Tvve BCAIRHAN Commercial A/C Units <= lOk CFM B FURN /AC MCRAA Commercial N_ech Repair /alt/add M SEISMICOM Seismic Commercial B BREMAIRHAN Residential A/,' units <= IOk CFM B MRRAA Residential Mcch Repair /alt/add M BSEISMICRE Seismic Residential B EPERMITFEE Electric Permi: E MPERMITFEE Mechanical PE rmit M PPERMITFEE Plumbing Permit P BREMRECEPT Electric Recertacles E PGASCOM New Gas Piping System Commercial 1 -4 Outlets P PGASRES New Gas Piping System Residential 1 -4 Outlets P BPGAS Gas Piping System 5+ Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business License B 5 ITEMS OF 11 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 3E917022.00 DATE ISSUED.......: 12/14/2007 RECEIPT #.......... BE000003496 REFERENCE ID # ...: 0-/120112 SITE ADDRESS .....: 8E4 ALDERBROOK LN SUBDIVISION ....... CITY CL PERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: WI.TSON LOUIS L AND BETTE M TRU ADDRESS ..........: 8`_4 ALDERBROOK LN CITY /STATE /ZIP ...: CL'PERTINO CA, 95014 -4614 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... JIM RANDO RANDO, JIM LIC # 8050 AZA FURNACE & AIR CONDITIONING 112 STONE AVE SIN JOSE, CA 95125 (408)293-4717 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW - - - - -- ---- - BAL - - - -- ---- - - - - -- ------- 1EPERMITFE FLAT - - - - -- ---- - RATE - - - -- 1.00 ---- - - - - -- ---- 40.79 - - - - -- 0.00 ---- 40.79 0.00 1MPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1MRRAA UNITS 2.00 122.38 0.00 122.38 0.00 1PPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 - - - - -- ---- - 0.00 - - - -- TOTAL PERMIT ---- - - - - -- 285.54 ---- - - - - -- 0.00 ---- 285.54 0.00 VOICE ID DESCRIPTION VOICE - ID - -- ---------------------- DESCRIPTION - - - - -- -- - - - - -- ----------------------- 113 SLAB - - - - -- -- - - 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax(408)777 -3333 Building Department JOB ADDRESS: ks y 4 L /) Z�X 13 n -ov X Z -A PERMIT # q-7 (-�-- OWNER'S NAME: 13 & 7- r e:- PHONE # p GENERAL CONTRACTOR: i ? FAX # i I am not using any subcontractors: vJ- x�/ -, Signature Date P1PaCP rhPrk annlir nh1P s,ihcontractors and complete the followine information: Owner/ Contractor Signature Date 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