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07060057 CITY OF CUPERTINO BUILDING DIV(•SION PERMITPERMIT NO, Cl ']1C) � �QN* Bu1LTdl' 'VhILLER AVE #Z. AIR QUALITY HEATING & AIR 07060057 OWNER'S NAME: PERMIT ISSUE DATE FUGMAN, COERY 714 NORTHRUP ST 06/08/2007 .ONE: (408) 293-7138 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l O p LICENSED CONTRACTOR'S DECLARATION U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Professim ode,and my license is REPLACE FURNACE AND ADD AC !-C y in full force and ecL r,2? License Cl s ' / 0 Lic.ff ;Fu Date Contractor RCHrIECT'S DELLA TION era U I understand my plans shall be used as public records a U.y Licensed Professional t y OWNER-BUILDER DECLARATION jag I hereby affirm that 1 am exempt from the Contractors License Law for the in O following reason.(Section 7031.5,Business and Professions Cale:Any city or county m EZ4 which requires a permit to construct.alter,improve,demolish,or repair any structure Z In prior to its issuance,also requires the applicant for such permit to file a signed statement =G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor AreaValuation iH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6400 6400 ,,W'.$ 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(5500). 3691403 J . ❑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 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 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 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. vc and will maintain Worker's Compensation Insurance,as required by Section oC the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance tamer and P91icy number arc: carrier.TrVl L�145 A IJ� 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 cenifv 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 Cenificatc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you mus O forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY z I hereby affirm that there is a consauction lending agency for the performance of LYi the work for which this permit is issued(Sec.3097,Civ.C.) �W Q Lendcr's Name z Lender's Address U Q I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. f` (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City V Z inconsequence of the granting ofIpermit. � ^ t"t APPLICANT M PLICANT UNDERSTANDSSAND WILL COMPLY WITH ALL O -Po NT Issued by: Date V-4'-•vy---/7 U S. gnaturc of Applib4Contractor N Dam Re-roofs HAZARDOUS MATERIALS SCLOSURE Type of Roof 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)? C3 Yes All roofs sl­all be inspected prior to any roofing material being installed. Will the applicantr future building occupant use equipment or devices which If a roof is i nstalled without first obtaining an inspection,I agree to remove MR hazardous air contaminants as defined by the Bay Area Air Quality Management all new mat-rials for inspection. District? ❑Yes I have read the hazarl rws materials mquirernrms under Chapter 6.95 of the Califor- nia Health&Salcty Code, alifor-niaHealth&SafctyCode,Sections 25505,25533 and 25534.1 undcrstand that if the building t / �� - A 7 docs not currently have a tenant,that it is my responsibility m notify the occupant of the l J rcyui cots;h;ch rqF mel prior issman«ofa Cen;ftcam of Occupancy gnature of Applicant ��� Date (�gY) Ownir or au honxcd ag m Dam All roof coverings to be Class"B"or better CITY OF CUPERTINO 8 ITEMS OF 16 PERMI`C RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bll:: Lot: APN 36: 14035. 01 DATE ISSUED. . . . . . . : 06,'08/2007 RECEIPT #. . . . . . . . . : BS000001584 REFERENCE ID # . . . : 07060057 SITE ADDRESS . . . . . : 10;,53 MILLER AVE #I. SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FUGMAN, COERY ADDRESS 10: 53 MILLER AVE #1 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : AIF. QUALITY & HEAT CONTRACTOR . . . . . . . : MA'T'THEW FARBER LIC # 22791 COMPANY AIF QUALITY HEATING & AIR ADDRESS 714 NORTHRUP ST CITY/STATE/ZIP . . . : SAIS JOSE, CA 95128 TELEPHONE (4C8) 293-7138 FEE ID UNIT QUANTITY PMOUNT 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 BSEISMICRE VALUATION 6, 400 . 00 0 . 70 0. 00 0.70 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 176 .44 0 .00 176 .44 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF C UPERTINO FURN/SCE/AC 'UPEkTINO PERMIT APPLICATION FORM © 1%0 o-5 7 APN# Slog - 14- 035 Date: v 7 Building Address:, /� 3 s-3 rrm Me/- li-J-e- Owner's Name: Phone #: El og - Sc' - 3ro� Contractor Phone: License-2136 76 #: Contact: Phone: Cupertino Business License#: Lf o9ci - -71 Building Permit Info: Bldg Elect P lumb ❑ Mech Job Description: Residential Commercial ❑ For Residential In tallations: Attic ❑ 1" floor � 2`1d floor❑ i'/ Adhere to min set back requirement n Jor 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 Coonnstrction: Occupancy_gr9 Strapped C3 On Platform LJ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if A licable Fee ID Fee Description Fee Group BENERGY Er ergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL BREMRECEPT RE;c tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE M.-ch Permit Issuance MECHANICAL PPERMITFEE Pl-umbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Kin Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING w` r Community Development . 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # a e-,,- -e- 2, 070&0057 OWNER'S NAME: Co r w PHONE # 4-0 --,5`0 (o ,3`v g GENERAL CONTRACTOR ,- << AX # I am not using any subcontractors: � G ignature Date Please check applicable subcontractors and com Mete the following information: ha 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 er/Contracto ignature bate