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07080001 -7-77777777-777-7777777 :z:.. CITY OF CUPERTINO BUILDING o-,-vlsloN PERMIT � ' `7ft� T '/�2I PERMIT NQ. :. BUILDfjffRFTENTW00D AV ABC COCLING & HEATING 07080001 j� PERMIT ISSUE DATE OWNER'S NAME: RAM CITINCHALI 31845 HAYMAN ST 08/01/2007 SANITARY NO. CONTROL NO. ,YE: (510) 471-8181 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION o Job Description U) I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z 8 with Section 7000)of Division 3 of Ute Business and Profess?n�_J,and my license is ADD A/C TD EXISTING SYSTEM y in fullforce and cffe - 3 z License C s Lie.# F p Datc Contractor f ARCHITECTS DECLARATION i a a I understand my plans shall be used as public records y U U.y Licensed Professional OWNER-BUILDER DECLARATION >• I hereby affirm 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,demolish,or repair any structure r^ prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. $4850 .Ent_ (commencing with Section 7000)of Division 3 of the Business and Professions Calc)err ?`3 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 A IDNumber Occupancy Type not more than five hundred dollars(5500). 3 5 9 3 10 L 2 � ❑1,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 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 build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contruting with licensed contracwrs 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 Contrsctofs 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: LJ I have and will maintain a Certificate of Consent to self-insure for Worker'sCompen- 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 Worker's Compensation Insurance,as required by Section 37 of the Labor Code,for the performance of the work for which this permit is issued My Worker's Compensation Insurance c rtter and Policy number are: /� e,_11j Carrier.�-=l 42 te �t�t s Policy No.•(:;rcj0b0 3Y.r1 RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ibis section need not be completed if the permit is for one hundred dollars($10(y) 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 F-,Cn 1 hereby affirm that there is a construction lending agency for the performance of 0y > the work for which this permit is issued(See.3097,Civ.C.) QLender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is LL " correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. ✓' G>~ (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City ff U Z in consequence of the granting of this permit. Date t" APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b3: SCQR4&REGULATIONS. ,t.l' _� -" � Re-roofs Signature of Applicant/Contractor " Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp 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 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 r iaterials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- 0 nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the adding ?d-,Lco does not ntly have a tenant,that it is my responsibility to notify the occupant of the . requi whA�muet prior t issuance of a Certificate of Occupa� Signature:of Applicant Date All roof coverings to be Class"B"or better Owner or authoDate" Community Development 10300 Torre Avenue ax Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 f-UPEkTINO Building Department JOB ADDRESS: Ke 4 iAj 00&1 PERMIT # OWNER'S NAME: c4 PHONE # 1410Y--3�6-2 7y GENERAL CONTRACTOR: C 1 a FAX # I am not using any subcontractor • 0 7 Sign Date Please check applicable subcontractors and corn-Aete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing VHeating L �,A C? i�•. 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 OF CUPERTINO FURNACE/AC CUPE�TiNO PERMIT APPLICATION FORM APN# Date: Building Address: s' X. lse,4 wood Ave Owner's Name- Phone#: 9 A? (27-�N6 l/ 4 Yob' .366 - Z 7V/ Contractor: Phone: License#: ��e�� did'/ Contact: ! G r2� r j% f �, Phone)_�a, �Y Y, Z/ Cupert14Business ,p 4 2 License#: Building Permit Info: Bldg ❑ Elect PlumbMech Job Description,:q Residential)�,- Commercial ❑ For Residential Inllations: Attic ❑ 1"floor A 2nd floor❑ Adhere to min setback re uiremerAU-� For Commercial Installations: Replacement same weight ❑ Additional weight (struElctural calcs) Structural Calculations required for new installatio:i New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: �/ ASO G4;1- 3 Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL tl BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING 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 BUSLIC Business License BUILDING CITY OF CUPERTINO 7 ITEMS OF 7 PERMI`[' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl'-,: Lot: APN 35')31022 .00 DATE ISSUED. . . . . . . : 08 /01/2007 RECEIPT #. . . . . . . . . : BS)00002213 REFERENCE ID # . . . : 07 )80001 SITE ADDRESS . . . . . : 1155 KENTWOOD AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER RAMI CITINCHALI ADDRESS . . . . . . . . . . : 1135 KENTWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5838 RECEIVED FROM . . . . : EDaARD GREGORY CONTRACTOR . . . . . . . : GERALD UNRUH LIC # 24643 COMPANY . . . . . . . . . . : AB-- COOLING & HEATING ADDRESS 31845 HAYMAN ST CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510)471-8181 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 BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1 .20 0. 00 BSEISMICRE VALUATION 4, 850. 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 161 .93 0. 00 161 .93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 161. 93 MC --------------- TOTAL RECEIPT 161.93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL