07080123 t'rliO IUYI '��01�
C U��RTIo � PERMIT NO.
CITY (;F PERMIT
BUILDING DIVISION 07080123
D ss: SATURN AIR PERMIT ISSUE DATE
6UlLDI1 P�2 BYRNE CT ----
CONTROL NO,
OWNER'S NAME:
5 2 51 LAF-CHW SANITARY NO.
VINCENT JOHN V AND LINDA M
(4 O$) 806-5087 BUILDING PERMIT INFO
E: BLDGELECTPLU�MJB ML_EC�N
ARCHITECT/ENGINEER: 701)Description
LICENSED CONTRACTORS DECLARATION CHANGE OUT
z lice under provisions of Chapter 9(coin ccnscis ACE C
I hereby affirm that i am
with Section 70(10)of Division 3 of the Business and Prot�i°°S;°d`�d my F11
ti in full force and cffecV•` Lic.#
Z License las C Contractor
p Datc ARCHITECT$DECLARATION
a '
understand my plans shall he used as public records
U
U
Licensed Professional OWNER-BUILDER DECLARATION
for the
1 hereby affirm that I am exemPt Crum the Contractors Licenschty La�r county Valuation
air an structure $1800
demolish,or rep y Sq.Ft.Floor Area
o following reason.(remit w 7031.5,Bus"
altcr5imprnveand Ccssie�itons Ctodfile a signed statement
which reyuires ce p applicant for such p to 9 e
N prior to its issuance,also req°ices the app Occupancy Typ
ursuant to the provisions of the Contractor's License Law(Chap
that he is licensed p of Division 3 of the Businessmptiand on A y pi an o� �Number
e (commencing with Section 7000) licant to a civil penalty of C,716081 .P'
00 that he is exempt therefrom and the bPersmit subjects the applicant
~ Section 7031 S by any applicant for a pe J
not more than five hundred dollars(3500)• nation, Required InspectIons
I,as owner of the property.or my employees with wages as their sole compensation,
w does not apply to an owner of
will do the work.and the p rttaure is not intended or offered for sale(Sec.7044,Business ughb s
roves thereon,and who does such work himself or twsa
and Professions Code:The Contractors License
Property who builds or imp ear of completion,the owner-
own employers,provided that such improvements are not intended or offered Cor sale 1,
rovement is sold within one y for purpose oC
however,the building or imp roving that he did not build or improve
builder the
have the burden of p
sale.). in with licensed contractors to
am exclusively contracting Contraetoes U,
C3 1.as owner of the property, oves thereon,and,
constroct the project(Sec.7044,Business and Professions
builds or tmpr
1 to a[owner
�a conproperty
a tc or(s)licensed pursuant to Utc Contractors
cense Law docs not apply.
who contracts for such profess B&P C for this reason
license Law. t under Sec.
�I am exempt Date�--
Owner WORKER'S COMPENSATION DECLARATION
J hereby affirm under penalty of perjury one of the following declarations:
Certificate of Consent rfarmance o!the
0 1 have and v demaintain a s for by Section 3700 of the Laboom
r Code.for the rpe offs e'If tit
cation,asp trait is issued. Section
work for which this Pe aired by
I have and will maintain Workers Compensation Insurance,as reqfired
is issued.
3700 of the Labor Code.for the performance of thew for which this Pe
nsaton insurance carrier and Policy m r are'
My Workeer,snCompe 0
Policy No.:
Carrier. `v PC WORKERS'
CERTIFICCOMPENSATION
o PENSAT OPN IOt S>JRRJ'NCE
(This section need not be completed it the permit is for one hundred dollars($100)
or less.) Ibbs Permit is issued,1 shalt not
the work for
1 certify that in the perto so as to become subject
ect to the Workers Compensation
employ any person in any Manner
Laws of California.Date tion.you should
Applicant If,after making this Certificate of Excmp nu must
NOTICE TO APPLIC Wo cls Compensation provisions of the Labor Code,y
become subject to the. emit shall be deemed revoked.
Z forthwith comply with such provisions or this pe
0 CONSTRUCTION LENDING AGENCY Performance
of
I hereby affirm
i Cit
that dhere is a construction lending agency for the pe
emit is issued(Sec.3097,Civ.CJ
.-+ the work for which this Pe
] Lender's Namc
Q Lenders Address
3 Z l certify that I have read this application and state that the above information
is
0 10
I with all city and county ordinances and state Taws relating the
correct.I building construction"gree and hereby authorise representatives of this city t°coot upon
purposes. vino against
U above-mentioned property for inspection pure harmless the City of Cups Date VV
(�
(We)agree to save,indemnh(y and keep
R' ( judgments costs and expenses which may in any way accrue against said City
liabilities,j g ng of this permit.
in conseyu
Z NDE NDS AND WILL COMPLY WITH ALL NON-POINT ISS le y'
PLI
APURRe-roofs
SOUR L'''TT S _H-0)_
r
Date Type of Roof
Signature PP UCon H OUSMATERIA[-S DISCLOSURE y roof
material being installed.
licant or future building occupantstorc or handle hazardous material inspected
Wilitheapp A.1 roofs shall be insp prior to an an g s ection,I agree to remove
as defined by the Cupertino Municipal Codc.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? 0 If a roof is installed without first obtaining P
0Yes "" which ection.
Will the applicant or future building occupant use cyuiPmcnt or devices
emit hazardous air contaminants as defined by the Bay Area Air Q°slay Management
a 1 new materials for Insp
District?
0 yes h[or-
uirements under Chapter 6.95 of the Cal Date
I have the hazardous materials requirements ant it the _
afct Code,Scc' 25505,25533and25534IunderstandthatiCthcbuildtng pplicant ' orbetter
niaHcalth at it i my responsibility to notify the oaup
docs not c n ave a ten nt, trance of y Ccruficatc of O�cupagcY• , E ignature of s to be Class"B
requiremc
most x t .p All roof covering
Date
�,h orized agent
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY Of
"'UPEI�TINO artment
Buildi.n De
PERMIT #
JOB ADDRESS:
So
PHONE #
OWNER'S \J +� C FAX #
GENERAL CONTRACTOR: S(; vv
I am not using any subcontractors: Date
� ature
Please check a licable subcontractors and cor. lete the followm infNESS LICENSE #
SUBCONTRACTOR BUSINESS NAME
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
e
Date
er/C ac lgnature
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
6 ITEMS OF 6 COPY # 1
Sec: Twp: Rng: Sub: B]k: Lot:
APN 3c-,716081 .00
DATE ISSUED. . . . . . . : 06/14/2007
RECEIPT #. . . . . . . . . BS000002369
REFERENCE ID # 0'7080123
SITE ADDRESS 21930 BYRNE CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER VINCENT JOHN V AND LINDA M
ADDRESS . 95014-1156
CITY/STATE/ZIP CUPERTINO CA,
RECEIVED FROM CHRIS JOCHHEIM
CONTRACTOR CHRIS JOCHHEIM LIC # 29234
COMPANY :ATURN AIR
ADDRESS E,251 LARCHWOOD DR
CITY/STATE/ZIP SAN JOSE, CA 95118
TELEPHONE 408) 806-5087
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL-
-----
- ------------- 0 .----------00 34 .86 0 . 00
BENERGY PERMIT FEE 1. 00 34 .86 1. 00 14 .31 0 .00 14 .31 0 .00
BREMFURN NO UNIT 0 . 00 0 .50 0 .00
BSEISMICRE VALUATION 1, 800 . 00 0 .50 0 .00 38 .37 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 ----_-----
---------- ---------
TOTAL PERMIT
164 .78 0 .00 164 .78 0 .00
METHOD OF PAYMENT
AMOUNT --REFERENCE_NUMBER
________
-----------------
CHECK 164 . 8 #508
-------------- -
TOTAL RECEIPT 164 .78
VOICE ID DESCRIPTION
- VOICE ID DESCRIPTION
------------------------- •-
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF C UPERTINO 0 0 �Z
CUPEkTINO PERMTT APPLICATION FORM
_PN # _ Date.
.�.� 7/ �o vS 1 FS-1 k-1- 07
Build in Address. _
I ' L- ` % r
Owner' Name• Phone #:
`ir�. V-
Con
S O
ce
Cont Phone: Cupertino Business License #:
rr j e- fly YL;4-7
Building Permit Info:
Bldg ❑ Elect P lumb Mech
FZK
Job Description:
Residential 1 Commercial ❑
For Residential Installations:
Attic ❑ 1" floo2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
,placement same weight ❑ Additional weight (structural calcs) ❑
otructural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project: —00, Type of Construction: Occupancy group:
Strapped ElOn Platform ElBonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
gREMFURN Furnace MECHANICAL
BREMACOVER A'C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A'C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT R-,cptl, Switch & Outlets ELECTRICAL
BSEISMICRE SI;ismic Fee Res BUILDING
BSEISMICOM S,;ismic Commercial BUILIDNG
EPERMITFEE E.ec Permit Issuance ELECTRICAL
MPERMITFEE N ech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Van Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING