07090211 CITE'OF CUPERTINO � NPOR
BUILDING DIVIS10N PE PERMIT NO.
BUiLDN�ADDRESS: RESII)ENTIAL HEATING AND A/C 07090211
BAYWOOD DR PERMIT ISSUE DATE
OWNER'S NAME: 65 CRISTICH LN 09/28/2007
PARADY SHARON E TRUSTEE SANITARY NO. CONTROL NO.
NE:
BUiLDiNG PERMIT INFO
gL_� ELECT PLUMB M
ECH
ARCHITECT/ENGINEER: FURNACE REPLACEMENT & A/C/
LICENSED CONTRACTOR'S DECLARATION
Job Description
U j: I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:Z w with Section 7000)of Division 3 of the Business and Professions Code.and my license is
I<a in full force and effect. Lle#
ZLicense Class-- -Contractor
tp
Date ARCHITECTS DECLARATION
j a< I understand my plans shall he used as public records
iyU
r o H Licensed Professional
OWNER-BUILDER DECLARATION
j<_a I hereby affirm that 1 am exempt from the Contractors License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city mr county Valuation
e which requires a permit to construct,alter,improve,demolish,or repair any structure _Ft.Floor Area
a"rn prior to its issuance.also requites the applicant for such permit to file a signed statement
?< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq
I- (commencing with Section 7000)of Division 3 of the Business and Profcssio o ardor a(or Occupancy Type
that he is exempt therefrom and the basis for the alleged exemption.Any penalty APN Number
section 7031.5 by any applicant for a permit subjects the applicant to a civil nail of
not more than five hundred dollars(5500).
0 1,as owner of the property.or my employees with"rages as Der sole compensation, Required Inspections
will do the work,and the structure is not intended or offend for sale(Sec.7044,Business
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:.).
❑I,as owner of the property,am exclusively contracting with licensed contractus to
construct the project(Sec.7044,Business and Prowho,Ons builds deor improves Uunrons>Nd
cense Law docs not apply to an owner of property
who contracts for such projects with a contract ( licensed pursuant to the Comracioes
License Law. ,B&P C for this mason
0 lam exempt under
Date
Owner
R ER'S COMPENSATION DEC TION
I hereby affirm under penalty of perjury one of following declarations:
1]i have and will maintain a Certificate of Consent to self-insure for Worker s 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 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 Worker's Compensation insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OFEX TIOnN INSURANCE ON FROM WORKERS'
COMPENS(Chis section need not be completed if the permit is for one hundred dollars($100)
or less.)
[certify that in the performworkfor
bje
for hct to iter ,t is issued.I shall not
orkers Compensation
employ any person i Y ance so as to
Laws of Califor i a
Applicanttion,P YOU should
NOTICE T P Ll A :If,after ma ng this Certificate of em
become subject to the Workers Compensation provisions of Labor Code,you must
,J`Z, forthwith comply with such provisions or this permit shall be deemed revoked. _
,Z CONSTRUCTION LENDING AGENCY agency tion lending for performance of
I hereby affirm that there is a construc
> the work for which this permit is issued(Sec.3097,Civ.Q
LL)Q Lendcrs Name
04 Lender's Address
U z 1 certify that i have read this application and state that the above information is
t-+ correct.1 agree to comply with all city and county ordinances and stale laws relating to
Ubuilding conswction•and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspccuon purposes.
J W (We)agree to save,indemnify and keep harmless the City of Cupertino against
tE"t liabilities,judgments,casts and expenses which may in any way accrue against said City Date s
U Z in consequence of the granting of this Per '
►� APPLICANT UNDERSTANDS AND L COM Y WITH ALL NON-POINT Issue y:
SOURCE REGU Ns. Q .v Re-roofs C —
Signature of Applicant/Contractor
Date Type of Roof
HAZARDOUS MATERIALS D CLOSURE
Will the applicant or future building occupan store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? A�1 roofs shall be inspected prior to any roofing material being installed.
C]Yes O(N° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which al l new materials for inspection.
emit hazardous air contaminants as defined by the Bay Arra Air Quality Management
District? No
Lffi -,c.h4n.,uns
Y
d the hazardous materials requirements under Chapter 6.95of the Califor-
ty Coale,Sections 25505,25533 and b34i 1 w ors!f m�UeratC Pant n Date
y have a tenon t it is respo Y $ gnature of Applicant
ich must be priorto' anteofa Cenificatc of OccupancyD All roof coverings to be Class"B"or better
Date
rized age t
CITY OF CUPERI'INO 0709 021 (
`U A C-
.
`E T
SUP �,NO PERMIT APPLICATION FORM
D
3'N# ate:
( o 12 � � � &? 97 - v
Building Addr ss: �i
Phone#:
Owner's Name:
Ph()r)e_
COAlfl" ctni: C
e —)Mz- Cupertino Business License #:
Contact: Phone. �-. t
,�9147/y I X08 i d `
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description: q �
u E
Residential Commercial r-1
For Residential Installations:
Attic ❑ 1' floor ® 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
;placement same weight E] Additional weight(structural calcs)❑
otructural Calculations required for new installation
New installation Planning Ap roval Required ❑ occupancy group:
Cost of PI
: 11 Type of Com coon: p y �
Sq.Ft. Floor Area:
Strapped On Platform ❑ Bonded
New Location Replacement N
Qty. if Fee Description Fee Group
A plicable Fee ID BUILDING
BENERGY E:lergy
BREMFURN F�zrnace MECHANICAL
A/C Unit> 10,000 cfin MECHANICAL
BREMACOVER MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 efm
R ec tl Switch & Outlets ELECTRICAL
BREMRECEPT p BUILDING
BSEISMICRE Seismic Fee Res
BSEISMICOM
Seismic Commercial BUILIDNG� EPERMITFEE F.lec Permit Issuance ELECTRICAL
MPERMITFEE l\Tech Permit Issuance MECHANICAL
� Plumbing Permit Issue PLUMBING
PPERMITFEE BUILDING
BPERMFEE Bldg Permit Fees
Flan Check Fee BUILDING
BPLANCHK PLUMBING
BPGAS (Jas Piping System Fee
BUILDING
BUSLIC Business License
CITY OF CUPERTINO
OPERATOR: patg
PERMIT
F,ECEIPT COPY # 1
$ ITEMS OF 8
Sec
Twp: Rng; Sub: $1631012 .00
APN
09/::8/2007
DATE ISSUED . . . . . . . : BSOi)0002821
RECEIPT #. • 070)0211
REFERENCE ID # • •
SITE ADDRESS • '
1958 BAYWOOD DR
SUBDIVISION CU]'ERTINO
CITY
IMPACT AREA pAgp,DY SHARON E TRUSTEE
OVMER " ' 95014-2316
ADDRESS • " • : CL PERTINO CA,
CITY/STATE/ZIP " • DY
SIIARON PARA LIC # 21161
RECEIVED FROM CATHY HAIRE HEATING AND A/C IN
CONTRACTOR RESIDENTIAL
COMPANY 65 CRISTICCAN95008
ADDRESS : CAMPBELL,
CITY/STATE/ZIP [ 083774073
TELEPHONE THIS REC NEW BAL
PD-TO-DT _ __----0.00
T ----
QUANTITY AMOUN---- ---------- -----34.86
UNIT __---- ----- 0.00 0.00
FEE ID ---- ---- 34 .86 0 .00 10 .26 0 .00
--- 1.00 10 .26 14.31
PERMIT FEE 1.0( 0. 00 0.00
BENERGY 14 .31 0 .00 1.20 0,00
BREMAIRHAN NO.UL`7ITS 1.00 20 00
1.20 0.00 1' 0 .
IT 1.0�) 40.79
BREMFURN NO OUTLETS 1.20 0 .00 0.00
BREMRECEPT NO. 11, 880 .OJ 40 .79 p.00 40 .79 0 .00
1.00 40 79 40 .79 _
BSEISMICRE VALUATION 1.00 0 ,00 -----
EPERMITFEE FLAT RATE 1.00 40 .79 -------- ---------- --- 0 .00
MPERMITFEE FLAT RATE TE _______-- 0 .00 184 .20
PPERMITFEE FLAT RA - 184 .20
PERMIT MIT REFERENCE-OBER__
AMOUNT
METHOD OF PAYMENT --------------- VISA
----------- 184 .20
CREDIT CARD --- 18z,•20 -
DESCRIPTION --_--
TOTAL RECEIPT VOICE ID ----------------------
DESCRIPTION ___ ----- ROUGH MECHANICAL
VOICE ID ------------------- 303
ROUGH PLUMBING 505 FINAL ELECTRICAL
301
ROUGH
ELECTRICAL 508 FINAL MECHANICAL
304
507 FINAL PLUMBING
Community Development
a 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
TPEkTINO
Building De artment
JOB ADDR S: PERMIT #
OWNER'S NAME: —Ski OW vop-69X), PHONE # fb4 - S
GENERAL CONTRACTOR: CA-r,#7 fl '� = JA FAX # -
I am not using any subcontractors: th,
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
IIectrical
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
_ Date
Owner/Contractor Si tore