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07090034SOC ;mP :UL :Z =V IF'u i- �a- �aF -0F .O� �pC ==t 2Ei 0 7— U U w H U CITY OF CUPERTINO PERMIT fi�Tk? I�E?RI4T�f�l�* ; BUILDING DIVISION PERMIT NO. BUILD N ADDRESS: 8921 LOREE AVE ALLIED LIRE SERVICE INC 07090034 PERMIT ISSUE DATE OWNER'S NAME: NIJMEH & ROSE BUTROS 661 SINCLAIR FRONTAGE RD 09/10/2007 SANUARY NO. CONTROL NO. NE: (408)934z- . 8844 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 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 nests and Professions Code. and my 1' erase is GV REPLACE EXISTING WALL HEATER. in full force a jfpgL G Zd 4 , License as Lam• S Date / Contractor ARCHITECTS DECLARATION 1 understand my plans shall he used as public records i Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i following reason. (Section 7031.5, Business and Professions Code: Any city or county which requites a permit to construct alter. improve. demolish, or repair any structure prior to is issuance, also requires the applicant for such permit to file a signed statement 9 >q Ft. Floor Area Valuation t that he is licensed pursuant to am provisions of the Contractor's License Law (Chapter $1500 (commencing with Section 7000) of Division 3 of the 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 N Number Occupancy Type not more than five hundred dollars (S5M 375 13 ) ❑ I, 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 Canuactoes 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 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 Contractors 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: L] 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. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My)hlorkees�x tion Insurancecarrier and Policy number arc: Carrie �- 'I 34,4 Jct Policy No.:�Y3JQ,20C0 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY -�- 1 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 0 1 certify that I have read this application and start that the above information is ►-� correct. I 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 ahove-mentioned property for inspection purposes. W W (We) agree to save, indemnify and keep harmless the City of Cupertino against CA liabilities• judgments, costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit Date l✓ "� :-� APPLICA UNDERSTAN WILL C MPLY WITH AL NON -POINT Issued by: SOU R O 9 Re -roofs Signa&k of Applicant/Contractor Dare v Type of F.00f� 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 Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes ❑ No a roof �s installed without first obtaining an inspection, I agree to remove ll the applicant or future building occupant use equipment or devices which Will 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 y responsibility to notify the occupant of the M men whit mustt mpeppriortujisuancc faCcrtificatrof_Qccypancy. Signature of Applicant Date "B" O ncr or authorized agent Date All roof coverings to be Class or better 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 375 13 001 DATE ISSUED.......: 09/10/2007 RECEIPT #.........: BS000002586 REFERENCE ID # ...: 07090034 SITE ADDRESS .....: 18921 LOREE AVE SUBDIVISION ...... CITY CUFERTINO IMPACT AREA ...... OWNER NIJMEH & ROSE BUTROS ADDRESS 18921 LOREE AVE. CITY/STATE/ZIP ...: CUFERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ALLIED AIRE SVC INC CONTRACTOR STEINER, ARNOLD R LIC # 19207 COMPANY ALLIED AIRE SERVICE INC ADDRESS 661 SINCLAIR FRONTAGE RD CITY/STATE/ZIP ...: MILPITAS, CA 95035 TELEPHONE (4C8)934-8844 FEE ID UNIT QUANTITY FMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- BENERGY ------------- PERMIT FEE ---------- 1.00 ---------- 34.86 ---------- 0.00 34.86 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 ---------- 0.00 ---------- TOTAL PERMIT ---------- 279.04 ---------- 0.00 279.04 0.00 METHOD OF PAYMENT AMOUNT ----------------- --------------- CHECK 279.04 --------------- TOTAL RECEIPT 279.04 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL REFERENCE NUMBER -------------------- #19282 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY oF` CJPEkTINO CITY OF C UPERTINO URACEAC PERMIT APPLICATION FORM PN # Date: Building Address: BREMFURN Owner's Name: Phone #: P� i Q1_ ox�tracfol : , `�e Ucerlsc i1 . Contact: Phone: Cupertino Business License #: Building Permit Info: MECHANICAL Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: BSEISMICRE Residential ❑ Commercial ❑ BUILDING For Residential Installations: ❑ floor El2nd floor ❑ Seismic Commercial 1St Attic EPERMITFEE Adhere to min set back requirement ❑ ELECTRICAL For Commercial Installations: — Additional weight (strzctural calcs) ❑ M(.ch Permit Issuance eplacement same weight ❑ C) J PPERMITFEE BPERMFEE ,tructural Calculations required for new installation PLUMBING BUILDING New installation Planning Approval Required ❑ Pl,n Check Fee Cost of Project: Type of Construction: Occupancy group: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ L Bi:.siness License Qty. if i-.r_W-m I W FPP Descrintion Fee Group L-�Y�ticaulc �� 1L BENERGY - 1 En:,rgy BUILDING BREMFURN Fu-nace MECHANICAL BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/,'- Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Se',smic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Eloc Permit Issuance ELECTRICAL MPERMITFEE M(.ch Permit Issuance MECHANICAL J PPERMITFEE BPERMFEE Pli rnbing Permit Issue Bldg Permit Fees PLUMBING BUILDING BPLANCHK Pl,n Check Fee BUILDING BPGAS GE_s Piping System Fee PLUMBING BUSLIC L Bi:.siness License BUILDING 1 - CITY OF CUPEkTINO CITY OF (,IJPERTINO WATER NEATER PERMIT APPLICATION FORM 070q 003y 1\L+VY LVVGLL1Vu +��1-'�^--��----- Qty. if T TT% Fiaa Tlacr-Tintinn Fee Groun BPWHEATER Vater Heater / Vent Date: Building Address: Flumbing Permit Issuance PLUMBING BENERGY Finery BUILDING Owper's Name: ell Business License Phone #: _ry Contras ar. , Photic: D icense #: C tact: Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect 'lumb F2r- Mech - Job D/iptio Residen ial Z�aL Cdffimercial ❑ Cost of Project: /.Sao Strapped ❑ On Platform ❑ Bonded C1 1\L+VY LVVGLL1Vu +��1-'�^--��----- Qty. if T TT% Fiaa Tlacr-Tintinn Fee Groun BPWHEATER Vater Heater / Vent BUILDING PPERMITFEE Flumbing Permit Issuance PLUMBING BENERGY Finery BUILDING BUSLIC Business License BUILDING CITY Of .,UPEkTINO Building De JOB ADDRESS: / l 8--�F2, / , Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 partment PERMIT# 0'7 Cbr'av�JL OWNER'S NAME: PHONE # 3 GENERAL CONTRACTOR: ,moi FAX # I am not using any subcontractors: Date Signature Please check applicable subcontractors SUBCONTRACTOR anu cU11i '1=« u.. ��u� •- -�- ----- BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation ELandscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering LEJPlumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date