07090065 CITY OF CUPERTINO
BUILDING DIVISION PERMIT +EaRMt�TIQ�t,`
BUILDING ADDRESS: PERMIT NO.
10032 SCENIC 'RIAZ A
OWNER'S NAME: CONDITIONING
7N V CONTROL NO.
R1DTT
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i p LICENSED CONTRACTOR'S DECLARATION Job Description
P: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7000)of Division 3 of the Business and Professions Code,and my license is
y in full force and of C LC-7 REPLACE FURNACE 72000 BTU.
3? Liccnsc Class Lic.d
tp Datc Contractor
.'.i AR ITECTS DEC RTI
cQ
1 understand my plans shall be used as public records
U
F_ Licensed Professional
a OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's Liccnsc Law for the
j o following reason.(Section 7031.5,Business and Professions Calc:Any city or county
which requires a permit to construct.alter,improve,demolish,or repair any structure
yy prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
G that he is licensed pursuant to tI(c provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area
- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 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 APN Number Occupancy Type
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation, 35709047 . 00
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.).
[11.as owner of the property,am exclusively contracting with licensed contractors to
Conswct 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 Contractor's
License Law.
C3I 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 Worker's Compen-
.ation,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 Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wor�*ERTI
Compesation rtsurancc carrier and Policy number arc:
Polity No.:
CAT OF EXEMPTION FROM 0 KERS'
COMPENSATION INSURANCE
(This sectior need not be completed if the permit is for one hundred dollars(S 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 r
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
t O forthwith comply with such provisions or this permit shall be deemed revoked.
i
CONSTRUCTION LENDING AGENCY
m I 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.)
I A Lender's Name
Z Lcndees Address
0 I certifythat 1 have read this application and state that the above information is
►-' correct.I agree to comply with all city and county ordinances and state laws relating to
jV building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,toss 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 COMPLY WITH ALL NON-POINT Issued by:
SO CE REGULA S.
—Z)') Re-roofs
ignaturc o Ap itant/Con or I Date Type Of R Jof
HAZAR US 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:;hall be inspected prior to any roofing material being installed.
❑yes No
uwre building occupant use equipment or devices which
If a roof i;;installed without first obtaining an inspection,I agree to remove
Will the applicant or
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
JistricO
❑Yes No
I have read the hazaIsmamrials 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,that it is my responsibility to notify the occupant of the
rcqu• rents which must be met prior to issuance of a Certificate of Occupancy. Signature O f Applicant Date
A
All roof coverings to be Class"B"or better
Owner or authorized gent tc -'
CITY OF CUPERTINO
6 ITEMS OF 6 PERMI`I RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 35109047 . 00
DATE ISSUED. . . . . . . : 09/11/2007
RECEIPT #. . . . . . . . . : BSC00002616
REFERENCE ID # . . . : 07C90065
SITE ADDRESS . . . . . : 10C32 SCENIC BLVD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOITBY GLEN D AND ALISON J TRU
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2725
RECEIVED FROM . . . . : JIN RANDO
CONTRACTOR . . . . . . . : RAPDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAJ. FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE (4(,8)293-4717
FEE ID UNIT QUANTITY 1,MOUNT 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, 943 . 00 0.50 0. 00 0.50 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 172 . 04 0. 00 172 . 04 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 172 . 04 VISA
---------------
TOTAL RECEIPT 172 . 04
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 CUPERTINO
FURNA
CUPEkTINO PERMIT APPLICAI°ION FORM
Date:
Building Address:
SC
Owner's Name:Phone #:
CDe'
Contact: Phone: Cupertino Business License #:
oell �"vZe � o
Building Permit Info:
Bldg ❑ Elect - Plumb C Mech
Job Description:
d —
Residenfi-A ez
Commercial ❑
For Residential Installations:
Attic ❑ 1St floor IR' 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
(eplacement same weight ❑ Additional weight (strzctural calcs) ❑
otructural Calculations required for new installation El
New installation Planning Ap royal Required ❑
Cost of Project: Type of Construction: Occupancy group:
—�?
Strapped On Platform ❑ Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BUILDING
BENERGY En orgy
u:nace MECHANICAL
BREMFURN F
BREMACOVER A/1�Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/,�Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
% BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elt;c Permit Issuance ELECTRICAL
MPERMITFEE Moch Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Pl,n Check Fee BUILDING
BPGAS Gzs Piping System Fee PLUMBING
BUSLIC Bi.siness License BUILDING