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07060160 -7777777-77--! 777777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT � IIt1V ;TI4�N' PERMIT NO. BUIPERFECT��FkENDLE ST A PERFECT CLIMATE 07060160 G G PERMIT ISSUE DATE OWNER'S NAME: SARGENT BRAD L 10570 S ::)EANZA BLVD 06/19/2007 SANITARY NO. CONTROL NO. NE: (408) 86119545 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p Zo LICENSED CONTRACTOR'S DECLARATION Job Description Wt hereby affirm that I am licensed under provisions of Chapter 9(commencing REPLACE URNACE AND HEAT PUMP :Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is y in full force and effect. t v�Z License Clads Lic.M F Date Er� Contractor ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records >aU U.F' Licensed Professional OWNER-BUILDER DECLARATION > 1 hcrehy affirm that 1 am exempt from the Contractor's License Law for the *00 following reason.(Section 7031.5,Business and Professions Calc:Any city or county e which requires a permit to construct,alter,improve,demolish,or repair any structure rn prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.I'lOOr Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 st 1 $15161 I= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 32613111 Number Occupancy Type not more than five hundred dollars(5500). ❑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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does 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 contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- 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 Contractor's License Law. ❑I am exempt under See. 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 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. ❑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 CCoom`pe�r uon�Insurance carrier and Policy number are: r t�e� Cartier. Vr� Policy No.:O��N gJ-k--9 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars($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 Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Y > the work for which this permit is issued(See.3097.Civ.C.) Gr)A Lender's Name Lender's Address (�0 1 certify that I have read this application and state that the above information is w— correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned properly for inspection purposes. GL (We)agree to save,indemnify and keep harmless the City of Cupertino against C/1 liabilities,judgmcros,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date `f ►" APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Dare T of Rc of 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 s gall be inspected prior to any roofing material being installed. fi ❑Yes *KNo 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 .:mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if dtc building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whit use met p�pr to issuance ora certir tc oroccopancy. Signature OfApplicant Date �_ 'C-�S_ n All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF C'.UPERTINO 6 ITEMS OF 31 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk Lot : APN 326:_3111 . 00 DATE ISSUED. . . . . . . : 06/:_9/2007 RECEIPT #. . . . . . . . . BS000001699 REFERENCE ID # . . . : 07060160 SITE ADDRESS 22270 KENDLE ST SUBDIVISION . . . . . . CITY CUP:ERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SARGENT BRAD L ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CURERTINO CA, 95014-1025 RECEIVED FROM . . . . : A PERFECT CLIMATE CONTRACTOR . . . . . . . : SMI'PH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (403) 86119545 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 15, 161 . 00 1. 60 0 . 00 1 . 60 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 .37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 165 . 88 0 . 00 165 . 88 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO URNA.CE/AC CUPEkTINO PERMIT APPLICATION FORM 07060/40 APN# Date: 3.4 Building Address: t� � Owner's Name: WPhone#: —- Contractor— --- -- Phonei License r : QL-AoTt=C61 - -1 -�L3 Contact: ` n Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect dta P'[umb Mech 19 Job Description: C1 Residential Commercial ❑ For Residential Installations: Attic ❑ 1"floor K. 2nd floor❑ Adhere to min set back requirement( For Commercial Installations: _eplacement same weight r-1Additionweight(structural calcs) Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Pect: Type of Construction: Occupancy gr rojoy}�: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement`p Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A'C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A'C Units<= 10, 000 cfin MECHANICAL BREMRECEPT R,-cptl, Switch& Outlets ELECTRICAL BSEISMICRE Soismic Fee Res BUILDING BSEISMICOM Soismic Commercial BUILIDNG EPERMITFEE E.ec Permit Issuance ELECTRICAL MPERMITFEE M ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE B.dg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 C-UPEkTINO Buildin De 7artment JOB ADDRESS: P # S"�rat 6,)o6o�6d OWNER'S NAME: $ PHONE # GENERAL CONTRACTOR: 1P P, ,- FAX # N v to I am not using any subcontractors: <�- �, 6 - " 3-) Signature Date Please check applicable subcontractors and co m >lete the following ' 0 tion: 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