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07080185 CITY OF CUPERTINO BUILDING DIVISION PERMITI� T GT'� IQRMT��NR PERMIT NO. BUILDjNQ�I� Es BROOKWELL DR A PERFECT CLIMATE 07080185 l U PERMIT ISSUE DATE OWNER'S NAME: ROWE DOUGLAS G 8375 BRENTWOOD BLVD STE B 08/20/2007 _ SANITARY NO. CONTROL NO. VE: (408) 861 9545 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH Z 0p LICENSED CONTRACTOR'S DECLARATION Job Description o vP I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing z with Section 7otw)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE & AIR CONDITIONING. y in full force and cflee S ? License Class Lic.# p Date Contractor 1 F ARCHITECT'S DECLARATION i a< I understand my plans shall be used as public records tall F' Licensed Licensed Professional 1 H OWNER-BUILDER DECLARATION > 1 hereby affirm that I am exempt from the Contractor's License Law for the .no following reason.(Section 7031.5.Business and Professions Code:Any city or county :19 which requires a permit to construct,alter,improve,demolish,or repair any structure t" priorto its issuance,also requires the applicant for such permit to file a signed statement Valuation Z,. p S Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 9• $1016 5 F (commencing with Section 7000)of Division 3 of the Business and Professinns Cade)or 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). 36921017 . ❑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 oroffered 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.). O 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors U. cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations J 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. have and will maintain Worker's Compensation Insurance,as required by section 700 of the Labor Code,for the performance of the work for which this permit is issued. My Work5;''sCo1m pensation Insurance carrier and Policy number are: Carrier:CYLV 6)4XZ1q,4,WVt("Policy No:Waa(��?�J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I cenify 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 Fra I hereby affirm that there is a construction lending agency for the performance of (Yr> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name Lender's Address U I certify that 1 have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to rJ- U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Mto liabilities,judgments,costs and expenses which may in any way accrue against said City ^ U Z in consequence of the granting of this permit. Date QI c APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'r: SO REGULA NS. Re-roofs Signature of Applieant/Contractor Datc e� HAZARDOUS MA ALS DISCLOSURE Type of'Zoof 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 roof:.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 uturc building occupant use equipment or devices which _mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new I naterials for inspection. District? ❑Yes o 1 have read the hazy ws 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 cu have a tenant,that it is my responsibility to notify the occupant of the requireme ch must be me prior",i ee of certificate of Occupancy. Signatur�of Applicant Date 'Date V All roof coverings to be Class"B" or better Owncr or authorirc agcn Date CITY OF CUPERTINO 8 ITEMS OF 28 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36921017. 00 DATE ISSUED. . . . . . . : 08/20/2007 RECEIPT #. . . . . . • • • : BS000002431 REFERENCE ID # . . . : 07080185 SITE ADDRESS . . . . . : 10803 BROOKWELL DR SUBDIVISION . . . . . . . CITY CUPEFTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROWE DOUGLAS G ADDRESS . . . . . . . . . . : 10803 BROOKWELL DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4608 RECEIVED FROM . . . . : EDWARD GREGORY CONTRACTOR SMITE, BYRON E LIC # 21144 COMPANY A PEF.FECT CLIMATE ADDRESS . . . . . . . . . . : 8375 BRENTWOOD BLVD STE B CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513 TELEPHONE . . . . . . . . : (408) 861 9545 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 BREMRECEPT NO. OUTLETS 1 .00 1.20 0 .00 1.20 0 .00 BSEISMICRE VALUATION 10, 165.00 1.10 0 .00 1.10 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 176 .84 0 .00 176 . 84 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL n CITY OF CUPERTINO FUKvACE/AC CUPE OF PERMIT APPLICATION FORM APN# Date: s Z .3&q / 0/ Building Address: /© �O 3 k 4/�'LL �r Owner's Name: Phone#: 17— V6 ZZ Contra tor: �/ ok� / PYO 9�y S Lice 3 1,S Contact: r Ph�IL�� / Cupertino Business License#: C G (� 5 h 7 Building Permit Info: Bldg ❑ Elect Plumb Mech Job Descri tion: /L C Residential ly Commercial ❑ For Re.idential Installations: Attic. 1"floor �r-2❑d floor❑ Adhere to min set back re uirement For Commercial Installations: Replacement same weight ❑ Additional weighs (structuralEl talcs) Structural Calculations required for new installatio n New installation Planning Approval Required ❑ Cost of Project: Type of C�oonns ction: Occup c roup: Strapped On Platform Bonded Sq.Ft. Floor Area: EAV"New Location Re lacemenX 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 BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMTTFEE 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