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07090121 CITY OF CUPERTINO BUILDING DIVISION PERMITIOMA�I(JN* PERMIT NO. BUILD1l,Ntrl dDpgESS�INDA VISTA DR CONDITIONED AIR 07090121 l fJ PERMIT ISSUE DATE OWNER'S NAME: AOKI 1701 LITTLE ORCHARD ST 09/19/2007 SANITARY NO. CONTROL NO. 'NE: (408) 291.-2220 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH w z LICENSED CONTRACTOR'S DECLARATION Job Description U, l hereby affirm that I am licensed under provisions of Chapter 9(commencing y with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE REPLACE FURNACE & DUCT WORK. h y in full force and effect h z License ic.# F p Date Tl 1 '7 CSR Contractor `tY' a ARCHITECrS DECLARATI N i C a 1 understand my plans shall be used as public records ryU u.y Licensed Professional e OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the la o following reason.(Section 7031.5,Business and Professions Cale:Any city or county <m which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement t' ,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $10493 e tZ (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 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 616 01�1?(��Number not more than five hundred dollars($500). 0 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 Conuactoes 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.). 0 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 contractor(s)licensed pursuant to the Contractors License Law. 0 I am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 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. 0 I 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 Worker's Compensation Insurance carrier and Policy number arc: Carrier: b?-,L i Policy No.. IDD 1 ) l CER77FIE O EMPTION FROM RKERS' 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.1 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 C,O) I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(See.3097.Civ.C.) w A Lender's Name z Lender's Address I certify that I 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 U building construction,and hereby authorise representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURC EGULATIONS. /� r l G•O q Re-roofs Sign tApp,licant/Con r Dae T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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. 0 Yes Pk Will a roof is installed without first obtaining an inspection, agree to remove ill the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr.aterials for inspection. District? 0 Yes -No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc,Sections 25505.25533 and 25534.[understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant or the requi�horjic7zd t be t prior to issu of a Certificate of Occupancy. Signature of Applicant Date O All roof coverings to be Class"B"or better Own nt D21C CITY OF C UPERTINO FURNAC a,,, CUPCITY OF EkTINO PERMIT APPLICATION FORM ?N# Date: 5 G 16 - 011. , vv q Building Address: 6 l��n� V'�� br, Cn- 5 01 Lq Owner's Name: Phone #: Z53 ^ 662-`? `olltractor: Phone: Lire nse : Contact: Phone: Cupertino Business License#: ,1nurkeSQA rn 3� Building Permit Info: Bldg ❑ Elect Plumb ( � Mech Job Description: y Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor� Adhere to min set back requirement` For Commercial Installations: eplacement same weight ❑ Additional weight(stnictural calcs) ❑ ,tructural Calculations required for new installation C� New installation Planning Approval Required ❑ Cost of Project: Type of Construct on: � Occupancy group: C, v � - 3 Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement CR- Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En;rgy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rerptl, Switch & Outlets ELECTRICAL BSEISMICRE Se.smic Fee Res BUILDING BSEISMICOM Se.smic Commercial BUILIDNG EPERMITFEE Eloc Permit Issuance ELECTRICAL MPERMITFEE Moch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK PIEn Check Fee BUILDING BPGAS GE.s Piping System Fee PLUMBING BUSLIC Bi:.siness License BUILDING CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 35616014 . 00 DATE ISSUED. . . . . . . : 09,19/2007 RECEIPT #. . . . . . . . . : BS000002684 REFERENCE ID # . . . : 07090121 SITE ADDRESS . . . . . : 11:.66 LINDA VISTA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER AOM ADDRESS . . . . . . . . . . : 11:-66 LINDA VISTA DR CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAIT JOSE, CA 95125 TELEPHONE . . . . . . . . : (408)291-2220 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 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14.31 0. 00 BSEISMICRE VALUATION 10, 493 . 00 1 .10 0. 00 1 .10 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 .64 0. 00 172 .64 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 172 . 64 VISA --------------- TOTAL RECEIPT 172 . 64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL