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08110060 CITY OF CUPERTINO ��,g� )�•v ��]aT!!«gge..�:w �ev4 .a�*s+n� �+�]�gp 4p��Ig��`'{ �' *' �� ` BUILDING,DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10544 ORANGE TREE LN CRITCHFIELD _CQNSTEUC11DN___ 08110060 OWNER'S NAME: PEN TISSUE DATE NE: A CONTROL N0. - (408) 371-3777 ARCHI'IECTIENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH Q o p LICENSED CONTRACTOR'S DECLARATION U 1 hueby affirm that 1 am Bxrted under provisions of Chapter 9 hammerer ng Job Description Intl ]0(kB of ido.3ofdre Buuncem and Profrsdoo Code.and mylkenxu ntlI=ndcfr �� REPLC EXSTNG HVAC . yr.�Z I�ccmc Clas Lk.N =p Date fl I 1 GnD I £7W7W ARCHRhe nee DELLA rmob W U hON 1 understand my plans shall h need a public umrN g C Lfcenad Prop sembled 3 OWNER-BUILDER DECLARATION 1 homey ann.Net I am mempt from Ile Comracloe,Lknm law for the 0 o following reason.(section]0113,Business;and Pm(essiom Cade:Any city mou century %fLi which mgrruo a permit w eermrtcs alcor,improve.dcmol W,or mpalr any suuc um -iy pmsenju iduance.alsomquimstheapplicanl forsuchpermjWrlm..r,mO.utement ESC matte uliavcdpmenanttudemM isiomofNcCon=wr'sLicc=Uw(Chapur9 Sq.Ft. Floor Area Valuation :1- (cmvma endng wide Section 7000)°Division Jofine Budvsaand Profession Cou)m 5000 y 5 3 mhe u eampt thend.and the basis for me alleged eampdat Any violation of Seeman 7031.5 by joy applicant But a permit subjects me applicant to a civil putalty of APN Number Occupancy Type rot moa man ftw hundred dollar ISM 31634016 . 00 (]1.as awns of de Ptt,PutY,a mY wPloyco with wgn u mens mk eanpertadan, wmdOmework.wdmcswetma4notinundcdorofrcmdfarsak(sec.7ae.Bn mus ns Required Inspections and Ptofadons Code The Convacmh Liars,Law does not apply m an owner Of q P property who builds or improves thereon,and who docs such work huvel(Or through his own employees,provided that such improwmenss am notint:nded monered(orale.If. howem.me building"improvement is sold within One)ear o(completion,the Owner- builder will have the bummer of proving that he did not build or Improve for purpose of ale.). ❑1.a avoer of me property,am excludwly contracting with BcvuW conuanOrs to commas the project(Sec.70/4.Business and Professions Code:)The Conuacmr's V• cove law don not apply was owner of property who builds or impre.mcman.and, who contracts for such projecs,widea eenuacmRs)licensed pursuant to tnd Contractor's License law. [I1 an uempt under sec .B A P C for this reason Owner Date WORKERS COMPENSATION DECLARATION I hereby of iren under penalty of perjury,One of the following declarations: haw and will maintain a CertiEoe of Content be self4mue,for WOrkeh Compcn- on,as proviMd for by section 3700 Of the Tabor Code•for me pofoanance of the work for which this permit is limed. kI haw and will maintain Wmkef.Compemalon I..u required by Section ]00 of me labor Code.for me Performance or the work for which this permit u Issued. My Worker's Compensait,n I °roe<a ' end Policy nau,m�b,me:/5 Grtiv — flO 2 olio/No.:"i U I l/ CERTIFICATEOFEXEM ONFROMWORKERS' COMPENSATION INSURANCE (This section need not be Completed if tle permit is fort,ro hundred dollars(SIM) or less) I terrify dent in the Performance of me work for which this permit Is issued,l shall not employ any peran in any manor an as to become subj"t to the Workcn'COmpcnsadan Laws Of California.Dam ' Applicant NOTICE TO APPLICANT:If,after making this Certificate Of Exemption.you should become mbject to the Workcra Comxmdon provisions or me Labor Code,you most .J O forthwith comply wit such provisions or this permit shall be doomed revoked. 'z CONSTRUCn0N LENDING AGENCY [...�.r Ibereby affirm mat more is a construction lending agency for the performma of (Yirte•, the work for which this permit a barred(Sec.3097.Civ.C.) fz1 Q Lendehm Nae le le z Unice,Address rJ 1 co tify that 1 haw sad this application and sum man the.bow information be concoct.1 aj.be comply with.11 City and county ONlnatas and slam Iowa Rhting no -0U building construction.and hereby aumnrim repmtenudwa of mu city m enter upon the U aMw-reentioad property for inspection purposes gy (We)agree to arc.indemnify and keep barmlrst the City Of Coherent,!nmol CV) Imbil41EG" mena.eosta andexpensu which roar'in any way mrnm agaiotseid City („),Z in.. Of the granting of this Permit. n -� ti LICUNDE ST ND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t--v Q� Re-roofs PP t HAZARDOUS MATERIALS DISCLOSURE I Type of Roof Will de applicable,future building occo,amstoe,or handle haallov material as deEoed by the Cupertino Municipal Code.Chapter 9.11.and the Hnith and Safety Code.Sretiun 25572(!)7 ' All roofs shall be inspected prior to any roofing material being installed. ❑Yn K. Will the applicant or future building occupant use equipment m dew aa which If a roof is installed without first obtaining an inspection,I agree to remove hmsrom.air c cum,1 an as defined by the Bay A.Air Quality Management all new materials for inspection. c0 ❑Yn No Califor- (have the hasaNausmacriaumquhcmenu unrkrCNPmr G95Ofthe bitHOmthh CaM,Se au 25505.25577 aW25514.1urtivswE muifdm huiWing diemrot y rep, nUpet bt u my tespovihiliry m ratify Ile axupant of Ne \ v w wM end Ham ss mar,Certirmamora pm Signature of Applicant Dale Owner Or mthor gent Dam All roof coverings to be Class'W'or better CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: pdtg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31634016 . 00 DATE ISSUED. . . . . . . : 11/18/2008 RECEIPT # . . . . . . . . . : BS000006635 REFERENCE ,ID # . . . : 08110060 SITE ADDRESS . . . . . : 10544 ORANGE TREE LN" SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . ... . OWNER . . . . . . . . . . . . : FUJIKAWA RICHARD S AND ATSUKO ADDRESS . . . . . . . . . . : 10544 ORANGE TREE LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2015 RECEIVED FROM . . . . : RONALD E GALVIN CONTRACTOR . . . . . . . : RICKY CRITCHFIELD LIC # 29200 COMPANY . . . . . . . . . . : CRITCHFIELD CONSTRUCTION ADDRESS . . . . . . . . . . : 845 S MCGLINCY LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 371-3777 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ------ ---------- --- 1BSEISMICR VALUATION 5, 000 . 00 0. 50 0 . 00 0 . 50 0 . 00 lEPERMITFE 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 . 04 0 . 00 286 . 04 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- - ----------------- CREDIT CARD 286 . 04 MC --------------- TOTAL RECEIPT 286 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO 'I a `' FURNACE/AC :CUPEkTINO PERMIT APPLICATION FORM APN# I _ O I ' ^ ' O O Date: O Building Address: V� r � Owner's Name: ' Phone #: Contractor: 1 Phone#: t�pta_ qct, riT I (�i- �;0r� Fax #: 405 3-fk - 59rj `U Contractor License#: Cupertino Business License#: Contact: n Phone #: yb9->_ q 9-7_3 60 C OtJ ��hl J� Fax #: LJ U - -SqS Building Permit Info: Elect [ Plumb Mech Residential Commercial Ask Job Description: For Itesidential Installations: Attic ls` floor ❑ 2nd 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 Constructs n (Usage Class): �� Strapped On Platform Bonded LJ New Location ❑ Replacement Pro'ect.Size: Ex ress [Standard ❑ Large ❑ Major❑ 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. Revised 6/16/08 CITY OF CUPERTINO FURNACE/AC ana- CUPEkTINO FEE SCHEDULE Quantity . Fee ID Fee Description Fee Permit Type Group FURNACE I 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. 1MCREPALT 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. 1MCSUSHTR 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 113PGAS 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 1MRRAA Residential 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. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. IMRAPPVNT Residential for the install/relocate/or M • replacement of ea appliance vent install &not incl in an appl permit. Quantity Fee ID Fee Description Fee Permit Type