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07090144 CITY OF CUPERTINO BUILL7NG DIVISION PERMIT � � TQR ZI\1RM4�TUN: su1LDIrjplEsMPERMIT NO. IRA VISTA RD ' A & H H EATING 07090144 OWNER'S NAME: PERMrr ISSUE DATE BOCCHIERI CARMELO J AND ADELE 1 770 CKEESTNUT ST 09/21/2007 SNE: SANITARY NO. CONTROL NO. (408) 279-0722 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description m ffirm that I am licensed under provisions of Chapter 9(commencing z t„ with Section 70(X))of Division 3 of the Business and Professions Code,and my license is FURNACE 1 A/C, 1 DUCT SYS, ELECT FOR HTR & A/C CL. in full force and eff t. . ��--7 ? License Cly^ v Lie.# lL GAS PSI F,❑ Dare Contractor ""—�_ — ARCHITECTS DECLA TION i a< I understand my plans shall be used as public records )yU U.y Licensed Professional y< OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the "00 following mason.(Section 7031.5,Business and Professions Code:Any city or county which requites a permit to construct,alter,improve,demolish,or repair any structure Z} prior to irs issuance,also requires the applicant for such permit to rile a signed statement x o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 sq.Ft.Floor Area Valuation aH$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $14000 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 Number Occupancy Type not more than five hundred dollars($500). 35702041q. ❑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 Contractor's License Law does not apply to an owner of q p 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes Li- cense Law docs 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 Conuactor's 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 ❑I have and will maintain a Certificate of Consent to self-insure for workees compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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 Workers Compensation Insurance carrier and Policy number are: Carrier. IXt/l+IA--� Policy No.:"A—'1 q IOZd CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section 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 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Codc,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY [~i(A 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.) Gw.Q Lender's Name z Lender's Address U 0 1 certify that I have read this application and state that the above information is U. r correct.I agree to comply with all city and county ordinances and state laws relating to OU building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (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. �. APPLICANT DDate ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: r-21 SOUR ""' - '`;'7_0 Re-roofs S' afore of Applicant/Con[rsctor Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant Store or handle hayardous 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 Will the applicant or future building occupant use equipment or devices which a roof is installed without first obtaining an inspection,I agree to remove which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes lzru— I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building does not current) . tenant,that it is my responsibility to notify the occupant of the rcquiremcnI611496 must be met prior to issuance of a Certificate of cupancy. Signature of Applicant Date 2l-,:t All roof coverings to be Class"B"or better Ow r or authorized agent Dam �. CITY OF CUPERTINO FURNA l""E /AC ,UPERTINO PERMIT APPLICATION FORM APN # 3 5�16 BuildingAddt-ess: 11D3-5-3oe4 V 15 I'►'l TiQ' Iz;� -� j Owner's Name.- Phone #: Contractor: License #: A,fH-H9e-,-&G°� �---- -SUS S-----SUSS -- -30 - Conm:ct: DAX Pl+C/ 5 Phone #3-5-"3-4.3 Applicant/Contractor: Building Permit Info: Bldg Job Description: F'vanttce- f 004. 1 (,cT Slsrenl, Residential: vier-794y- Port-_ 14fa Elst- 4 441 -Ccf%-ommnercial: Sq.Ft. Floor Brea: $/Sq.Ft.: Architect/Engineer: Valuation: — --SUSS--- ----SUSS-- / //G,:�o --SUS S------- - ipe of Construction: Occup ane Group: - Qty. it Applicably Fee ID _ — `ee Description Fee G,oup _ _ BENERGY _—_— _ En-�v —__ BUILIDNG _ L .BREMFURN Re.ocation of Furnace MECHANICAL --- - -� _R ACOVER _ _ A/t-_Unit_> 10,000 cfm MECHA^iICAL BREMAIRHAN _ A/(_' Units <= 10, 000 cfm MECHAN ICAI, BREMRECEP'I _Re_ptl, Switch & Outlets — ELECTRICAL -,SUSS—SUSS----- - BSEISMICRE Seismic Fee Res BUILIDNG _ EPERMrrFEE _ _ Ek c Permit Issuance ELECTRICAL, MPERMITFEE _ _ IVIG ch Permit Issuance MECHANICAL PPERIVIITFEE _—_ _Plt mbin�-, Permit Issue PLU.NIB ING - BPERMFEE - - --_Bldg Peraiit Fees BUILIDNG BPLANCHK PL n Check Fee BUILIDNG .--_TBUSLIC -SUSS-- - --Business License - - Community Development 10300 Torre Avenue Cupertino CA 95014 it Telephone(408) 777-3228 x Fax (408) 777-3333 ITY OF ' UPEf1TINU. Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Mete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 Rock Tile Owner/Contractor Signature Date 10/28/03 CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 35% 02041 .01 DATE ISSUED. . . . . . . : 09/21/2007 RECEIPT # . . . . . . . . . : BSC00002715 REFERENCE ID # . . . : 07C90144 SITE ADDRESS . . . . . : 10_53 MIRA VISTA RD Lam' SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BOC'CHIERI CARMELO J AND ADELE ADDRESS . . . . . . . . . . : 10-53 MIRA VISTA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2718 RECEIVED FROM . . . . : R PERLHEFTER CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079 COMPANY . . . . . . . . . . : A 6 H HEATING ADDRESS . . . . . . . . . . : 77C CHESTNUT ST CITY/STATE/ZIP . . . : SAY JOSE, CA 95110 TELEPHONE . . . . . . . . : (4C8)279-0722 FEE ID UNIT QUANTITY ZEOUNT 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 BSEISMICOM VALUATION 14, 000. 00 2 .94 0. 00 2 .94 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 185.94 0. 00 185.94 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 185 .94 MC --------------- TOTAL RECEIPT 185 .94 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue ZI ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ',UPEkTINO Building Department JOB ADDRESS: PERMIT # /0 �;) 3 -rte LA OWNER'S NAME: - CCS t end- PHONE # -07Z Z GENERAL CONTRACTOR — FAX # I am not using any subcontractors: ` 2 7�7 Signature Date Please check applicable subcontractors and co m ►lete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 Rock a Owner/Contractor Signature Date