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06060003 CITY )F CUPERTINO � 13UlL)ING DIVISION PERMIT BUILDING ADDRESS: CONDITIONED AIR PERMIT No.O 6 0 6 0 0 03 22946 LONG DOWN RD PERMTr ISSUE DATE OWNER'S NAME. PERRY CHARLOTTE J 1701 LITTLE ORCHARD ST 06Z01/2006 SANITARY NO. CONTROL NO. NE: (408) 291-2220 ARCHITECT/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description v I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 o(tnc Business and Professions Code,and my license is REPLACE FURNACE AND ADD A/C ! y in full force and cff�ect !r aC f 6i p� v�z License Class ('_ _Lic.8 t w Date IfiSt CQContractor ,Ir I t�rOrl 1 ARCHrmc:73 DECLARATION i a< 1 understand my plans shall be used as public records >aU oin Licensed Professional u OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $6500 = Pi which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior m its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area imin (commencing with Section 7000)of Division 3 of titc Business and Professions Code)or 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 3VAIMer U. Occupancy Type not more than five hundred dollars(5500). ❑f,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 Conuactoes License Law docs 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 Mild or improve for purpose of sale.). ❑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 Contractor's License Law. ❑1 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: �]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section r, f 3700 of the Labor Cade,for the performance of the work for which this permit is issued. '> My Workers Compensation insurance carrier and Policy number arc: Cartier. 1J��rMa1 rritio �:f�olky No.:A AM i R 6 CERTIFI TE O EXE Pl-ION 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY [�t,. I hereby affirm Out there is a construction lending agency for the performance of p� t7 the work for which this permit is issued(Sec.3097,Civ.C.) Wn.Q Lender's Name a z Lenders Address V 0 I certify that I have read this application and state that the above information is Lt+ correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 0.C/1 liabilities,judgments,costs and expenses which may in any way accrue against said City (�Z in consequence of the granting of this permit Date } �� ►'" APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NON-POINT Issued by: SOU GULATIONS. 61t /4 Re-roofs SigtutuR of pplicant/Contracthr Dam Type Of Roof u 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 Cote,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ( !o Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �No 1 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,drat it is my raspofibility to notify Ute occupant of the require ich must be met prior to iss certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner r a nzed agent Date CITY OF CUPERTINO :m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34240025 . 00 DATE ISSUED. . . . . . . : 06/01/2006 RECEIPT # . . . . . . . . . : 34639 REFERENCE ID # . . . : 06060003 SITE ADDRESS . . . . . : 22946 LONG DOWN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PERRY CHARLOTTE J ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 7, 000 . 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 176 .44 0 . 00 176 . 44 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 338 . 37 VISA TOTAL RECEIPT 338 . 37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIT1(OF Fax(408)777-3333 ^UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # { GENERAL CONTRACTOR: ccv\ FAX I am not using any subcontractors: r . G 1— � Signature Date - Please check applicable subcontractors and complete the following information: 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 Met Painting/ Wallpaper/ Paving Plastering Plumbing; Roofing` Septic Tank Sheet Metal ;Sheet Rock Tile er/Contractor Signa e Date CITY OF CUPERTINO � FURNACE/AC -UPEkTINO PERMIT APPLICATION FORM APN# -3 L1 0 CDPDate:P S G C G i C C' Building Address: Phone#: Owner's Name: Cr t P22 Or CA Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bld ❑ Elect Plumb---ET Mech C� Job Description: Residential Commercial ❑ For Residential Installations: Attic 131' floor ❑ 2nd floor❑ Adhere to min set back requirement®k- For GFor Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs)F-1Structural Calculations required for new installation New installation Planning Approval Re juired ❑ Occupancy Cost of Project: S©� Type of Construction: �group: Strapped ❑ On Platform ❑ Bonded Er Sq.Ft. Floor Area: New Location 0❑ Replacement Qty. if Fee Group Fee Description P A licable Fee ID BENERGY Ener BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Ree tl, Switch &Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG C 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING