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0702003110C :U� :z LL t<o -�v ;E u ia= �WV •O. �pC <m V ^v -Z� KFa L z. �t W' I Ut w 0 I �I U' CITE' OF CUPERTINO PERMIT INURlt4tTIEIN� . BUILDING DIVISION BUIL 1NGADDRESS: �32 ALDERBROOK LA AIR QUALITY HEATING & PERMIT NO. 07020031 OWNER'S NAME: PERMIT ISSUE DATE HILDEBRAND MARK W AND CAROL S 714 NORTHRUP ST )NE: SANITARY NO. CONTROL NO. (408)293 -7138 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is REPLACE FURNACE IN CLOSET AND ADD A/C in full force and f12eL License Lie. g Date Conmlor ARCHrTECPS DECLAMATION 1 understand my plans shall be used as public records Licensed Professional OWNER- BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to cnnswct, alter, improve, demolish, or repair any structure Sq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement Law 9 that he is licensed pursuant to the provisions of the Contractor's License (Chapter Business Professions Code) or $6900 (commencing with Section 7000) of Division 3 of the and that he is exempt therefrom and the basis for the alleged exemption. Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ( 36917026 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q p will do to 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 build or improve for purpose of sale.). ❑ 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 Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 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- tion, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's 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 Compensatio an Policy number j� Cartier / / �� ai C�- = -~�� CERTIFICATE OF EXEMPTION OM 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, 1 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 forthwith comply with such provisions or this permit shall be deemed revoked. ~ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) ~ Lender's Name Lender's Address 7 I certify that I 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. y (We) agree to save, indemnify and keep harmless the City of Cupertino against yi 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 Issued b) : Date SOU REGUL Re -roofs Type of Roof Sign of Appli tractor Da HA2ARDOUS MATERIALS 1SCLOSURE 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes° If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future bu ilding occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑ Ycs ° I have read the haza ous 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 to notify the upant of the Date rcyui cnts\which met prior to o aCertificate of l an Signature: of Applicant All roof coverings to be Class "B" or better Owner or authorized age t Date CITY OF CUPERTINO 10 FURN AC E/AC UPERTINO PERMIT APPLICATION FORM o-+ uacXD31 APN # rcc U BENERGY Date: Building Address: � r� Owner's Name: Furnace Phone #: _ Contractor: Phone: rs i `�3 ' d35 BREMACOVER License #: Contact: Phone: Cupertino Business License #: A/C Units <= 10, 000 cfm MECHANICAL Building Permit Info: F.ec tl, Switch & Outlets Bldg ❑ Elect P lumb ❑ Mech BSEISMICRE Seismic Fee Res Job Description: I a-,c . e. e— A/C, Residential Commercial ❑ Seismic Commercial For Residential Installations: K- 13 ❑ J 2nd floor Attic 1" floor Elec Permit Issuance Adhere to min set back requirement . or Commercial Installations: Additional weight (st:-uctural calcs) Mech Permit Issuance Replacement same weight ❑ Structural Calculations required for new installation Plumbing Permit Issue New installation Planning Approval Required Cot of Project: Type of Construction: Occupancy group: BUILDING Strapped I C1 On Platform Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement [9— __. Qty. if TT 1P.-,- Tlacrri »tinn Fee Group Applicable rcc U BENERGY " -- -- Etiergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIR14AN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT F.ec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG J EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE E;ld Permit Fees BUILDING BPLANCHK F Ian Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING _ BUSLIC Iusiness License BUILDING SO- CITY OF ':UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: MoA OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # , / 2 I am not using any subcontractors: l Signdture Date Please check avOicable subcontractors and complete the following information: G Owner / Contract Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing I 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 G Owner / Contract Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT Sec: Twp: Rng: Sub: Bl {: Lot: APN ......... 36)17026.00 DATE ISSUED.......: 02/07/2007 RECEIPT #.........: BS)00000409 REFERENCE ID # ...: 07)20031 SITE ADDRESS .....: 832 ALDERBROOK LA SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OPERATOR: kiersaw COPY # : 1 OWNER HI- =BRAND MARK W AND CAROL S ADDRESS .......... CITY /STATE /ZIP ...: CUPERTINO CA, 95014 -4614 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... R=IPT INTERFACE MAPTHEW FARBER LIC # 22791 AIR QUALITY HEATING & AIRCON 711 NORTHRUP ST SAV JOSE, CA 95128 (4)8)293 -7138 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 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 6,900.00 0.70 0.00 0.70 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 ---- - - - - -- 175.24 ---- - - - - -- 0.00 ---- - - - - -- 175.24 0.00 METHOD OF PAYMENT --------------- -- CHECK TOTAL RECEIPT : AMOUNT --------------- 175.24 --------------- 175.24 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 301 ROUGH PLUMBING REFERENCE NUMBER --------------- - - - -- 175.24 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL