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CITY OF CUPERTINO
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BUILDING DIVISION PERMITC�NTRACTQ
HIIi�[k'QRMATIO, -51
V'aas$'.ieko e
BUILDING ADDRESS:
PERMIT N0.
10397 VISTA KNOLL BLVD
A PERFECT CLIMATE
08100031 ,
OWNER'S NAME:
PERMIT SUE DATE
MCLAUGHLIN DENNIS R
8375 BRENTWOOD BLVD STE B
10/06/2008
NE:
SANITARY NO. CONTROL NO.
•
(408)861 9545
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
I hereby affirm that 1 sm licensed under Provinces of Chapter (Commencing
with Section 7(Xs)) of Division 3 of the Business and Professions Code, and my license is
REPLC FURNACE, 100K BTU& ADD A/C TO SYS 4 TON 13
in full face and Urec{. 3 �Sd
Lk.ee Gla» C u1.+
SEER
Date /n. DonlraMr
ARCHrrECrS DECI-026O"'2,,
1 understand my plans shall he need as public records
Licensed Romoommal
OWNER -BUILDER DECLARATION
I hcmby alarm Nal 1 am eamnpt from the Conu actors Limon law for ft
following mann. (Section 7011.5, Business and Pmfessions Code: Any city or county
_
which requires a permit to construct, alter, impmw, ticmulish, or.pair my structure
prior to its issuance. also requires the applicant (or such permit to file a signed statement
M is licensed a the of the Connector. Llccue Law (Chapter 9
Sq. Ft. Floor Area
Valuation
than pursuant pmrismes
(commencing with Section 7000) of Division 3 of the Business ted Profeuiou Code) or
$13853
that he is exempt them= soulthe basis for the alleged exemption, My violation of
Number
Occupancy Type
p y yp
Section 7031.5 by my applicant for a Permit subjects the applicant in a civil penalty of
net more Nan five hundred online, ($500}
32613036,
1, u owner of the property, m my wPloyoa with wages u tk'vmk campewtien,
Required Inspections
and d0vewant andth forsa Buri«.•
a.do not apply a an awn.
TheCoreismts License,law
and Pmfandou Coda The Cmuxmrt I.i apply in am
wW mh is
iminmeuch mon,andwbo deosuch workbimulredthrough bee
mumenywlebuilds i
Ow Wiprovitlrd than suchimpmvem.uartnot eurbndmOBemd for Sala If.
aver. a Wild of mprove
builds ,Ne Wildingorden
ofpm.tumidwithinore fn,theOwner-
will base the burden of proving out he did rot buiM or improve for purpose or
,
sak.),r
eek.}
❑ 1, as owner of the propeny, w excluuiwly convecting with licensed cantracwn in
construct Ne project (Sec. 7044. Business and Protections Code:) The Comraemrs Li.
ecus law dans not apply to an owner of property who builds or impmws Merton. and,
who contracts for such projects with a contractor(s) Reused personal in the Contractors
L.iamm law.
❑ I am exempt under See .B h PC for this msw0
Owner Dau
WORKERS COMPENSATION DECLARATION
1 hereby aQus, order Peadty of perjmy one of the following tleclaruiau:
haw and will mainuin a Certificate of Covent to aelf-inure for Workers Compost.
- -
sarion, an provided for by Secdon 3700 of the labor Code, for the Performance of the
soak for which this permit is issued
l .
I Ip Nva end will maintain Workers Com
nwort�hich
3M Nc labor Code. for to perfamaoap othe thus .I, is issued.
My Warter/t Co%)cassation mole. or and Policy nymber art:
G:Jvrh)2
Grrier. G.r.o+I'r.u✓_ 4 PolicyoN Gs06-Oi
CERTIFICATE F ECEMPION FROM WORKERS'
COMPENSATION INSURANCE
,
(nds sane m need not he canplced Bt a penitis to enc hundred clothes ($100)
or leu)
1 Lenifv that in the performance of the work fa which this permft is Wood. l shall not
mnid.,myperm. in any manner. as b become subject to to Warleces'Compemom e
Laws of rxlifomis. Dam
Applicant
NOTICE TO APPLICANT. If. a0cr making this Cenifiae of Exemption, you should
become subjem to the Workers Compewtim provisions of the labor Code, you mut
forthwith comply with such provisions or this Werm(tball M decmnd invoked.
.
CONSTRUCTION LENDING AGENCY
1 hereby affirm out there us construction lending agency for the put..
the work for which this permit is Wood (Sec. 3097, Civ. C.)
Lenders Name
Undoes Addrea
1 I certify that 1 have mad this applicant. and some than the above ofomudun is
comes I age to comply with all city and county ordinances and suss laws mixing in
Wilding conduction, and hereby authorize representatives of this city to toter upon ltu
l above-mentioned pmMrty for inspection purpaus.
(We) agree to save, indemnify, and keep hdmleu the City of Cuporme against
i liabilities, Judgmcnu,casuanal esp.w which may lotry way amus Matins, said City
in consrquenca of Nc granting of this prsmit,
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 0sj -
S01 REGO" ONS('�_
Re -roofs
�ixr6w `irYl,Cy,trl!! /o-G.O r
signstum of Appli AZRDOn�—US ATERIAIS DISCLOSURE Daee
Type Of Roof
Will the applicant m future building occupant suue orhmAe h mordou manerial
as &0.d by the Cupertino Municipal Code. Chapter 9.13, and the Hedit and Safety
Code, secY.onzss3z(a)7 'C'"'
❑Y.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
�+
WiII 0e, applicant or future Wilding rxcvpant tic equipment m dcrims which
.t bmilt u air commit.fined by the Bay Area Air Quality Management
all new materials for inspection.
suit,
0Yes No
lb. mad the harardousma¢rials requirtm.ta underCTupterfi.95 olthe Cdifw-
nisHealth&SdmyCnd-Sc6orn25.505.25533and25534.1uMssund thnifthe building
docaltnq cumendy have a men. out It 4 my responsibility a notify tie mYPml Of the
i ntawbienm le priraie,nanmnhccNOe.eprOcmpdmy.
Signature of Applicant Date
All roof coverings to be Class': qar or better
Owner
or iufficriond&eDna
6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32613036.00
DATE ISSUED.......: 10/06/2008
RECEIPT #.........: BS000006285
REFERENCE ID # ...: 08100031
SITE ADDRESS .....: 10397 VISTA KNOLL BLVD
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER .............. MCLAUGHLIN DENNIS R
ADDRESS ..........: 10397 VISTA KNOLL BLVD
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1035
RECEIVED FROM ....: EDWARD A GREGORY
CONTRACTOR .......: SMITH, BYRON E LIC # 21144
COMPANY ..........: A PERFECT CLIMATE
ADDRESS ..........: 8375 BRENTWOOD BLVD STE B
CITY/STATE/ZIP ...: BRENTWOOD, CA 94513
TELEPHONE ........: (408)861 9545
0 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR
VALUATION
13,853.00
1.40
0.00
1.40
0.00
1EPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1MPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1MRRAA
UNITS
2.00
122.38
0.00
122.38
0.00
1PPERMITFE
FLAT RATE.
1.00
40.79
0.00
40.79
0.00
1TRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
-----
286.94
0.00
------------
286.94
----
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
286.94
---------------
286.94
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
0
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ------- --------------------
507 FINAL PLUMBING
CITY OF
*UPEkTINO
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
14 v 97 i54s h-. all &llj
PERMIT #
Od!:YOOo
OWNER'S NAN4E:'3)ek+H,'s A4C /„t
PHONE #
GENERAL CONTRACTOR: eei CC-,_k,FAX
#
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information
Date
"-ter x 4
Owner/ Contrac or i a e
✓ 22-W f
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
jG
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
"-ter x 4
Owner/ Contrac or i a e
✓ 22-W f
Date
SEA
CITY OF
OCU PEkTINO
L'.
CLQ /bOD> 3'/
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN # 2e2 (0 / J O
Date:
Building Address:
�r7 ����1✓�lvd
%D3 1/ ��s�9
Owner's Name:
Phone #:
'Deoa;s
Contractor:
`?e,,,re- c�T l� (° �N� 2 ��
Phone #: Y.9 e6l F-5--5/J—
.S 5/S—
..
Fax #: y0e 86l
Contractor License #:
Cupertino Business License #:
7 Z 3
17//y,/
Contact:
Phone #:
Fax #:
Building Permit Info:'
Elect 9 Plumb ❑ Mech
Residential Commercial ❑
Job Description: /ze Ple�e d�ns�L /,/20 K (j7U
Add A c �, �,�5-/ek el
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
3 �0
Strapped On Platform Bonded New Location Replacement
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
ISM -
CITY OF
CUPEkTINO
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Permit Type
Group
FURNACE
FURN/AC
1MCRAA
Commercial-Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT
Commercial for the repair of alt/add to
M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1 MCSUSHTR
Commercial Install/Relocate ea
M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM
Commerical for ea gas piping System
P
1-4 outlets
1 BPGAS
For each gas piping system of 5 or
P
more per outlet.
1MCAPPVNT
Commercial for the install/relocate/ or
M'
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO
Commercial Seismic
B
1 MRRAA
Residential Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
I
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR
Residential Install/Relocate ea
M
suspended heater,recessed.wall htr, or
floor mounted unit heater.
1MRAPPVNT
Residential for the install/relocate/ or
M
replacement of ea appliance vent
install & not incl in an appl permit.
0
•
•