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07060163 77-77777777777777-77777777 CITY-01'. CUPERTINO STTZR'v� iTI4N: BUILDIG DIVISION PERMI1 _ PERMIT NO. _ F BUIL I REss: A PERFECT.' CLIMATE 07060163 � �� MONTEREY CT PERMrr L95UE DATE OWNER'S NAME: 10570 S ]�EANZA BLVD 06/19/2007 MOSS, ELLEN SANITARY NO. CONTROL NO. NE: (408) 861 L9545 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job DeSCilptlon W r 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 REPLACE FURNACE E AND AIR CONDITIONER >>H in full force and effect. 33 c�OJ v�z License Class Lic.M q Contractor f Date ARCHITECTS DECLARATION j a< I understand my plans shall be used as public records )yU LL y Licensed Professional •o a OWNER-BUILDER DECLARATION >. I hereby affirm that 1 am exempt from the Contractor's License Law for the cp O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m 9 which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation u—y prior u)its issuance,also requires the applicant for such permit to file a signed statement 'qFt.Floor Area $10 9 7 8 Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 � t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that rte is exempt therefrom and the basis for the alleged exemption.Any violation of Q �Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3562101 STV not more than five hundred dollars(5500). ❑1,as owner of the property.or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. B&P C for this reason ❑i am exempt under Sec. Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I]I hsve and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the tabor Code.for the performance of the work for which this permit is issued. ❑1 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 Com -on Insurance carrier and Policy number Carrier. W q% Policy No.. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) i certify that in the performance of the work for which this permit is issued.1 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z 0 CONSTRUCTION LENDING AGENCY (� rr I hereby affirm that there is a construction lending agency for the performance of a, > the work for which this permit is issued(Sec.3097,Civ.C.) (fa Q Lender's Name Gr Lender's Address U 0 1 certify that 1 have read this application and state that the above information is [L " correct.I agree to comply with all city and county ordinances and state laws relating to Q Vbuilding construction,and hereby authorise representatives of this city to enter upon the above-mentionedproperty for inspection Purposes. W (We)agree to save,indemnify and keep harmless the City o[Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City / ( �f U Z in consequence of the granting of this permit. Date 6 ( "7 APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT Issued b y: SOURCE REGULATIONS. (o \ -4, Re-roof: Signature of Applicant/Contractor Dare 'j of Roof HAZARDOUS MATERIALS DISCLOSURE y� Will the applicant or future building occupant store or handle harardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety All roof s shall be inspected prior to any roofing material being installed. Calc•Section 25532(x)? C]Yes PC No If a room is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which all new materials for inspection. croft hazardous air contaminants as defined by the Bay Area Air Quality Management District? E3 Yes 19 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 the building does not currently have a tenant that it is my responsibility to notify the occupant of the Date requirements which mu l be met p' issuance of a Certificate of Occupancy. .S lgnatll-e of Applicant �•1`l—0� All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 31 PERMIT RECEIPT OPERATOR: bethe COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35621017 . 00 DATE ISSUED. . . . . . . : 06/19/2007 RECEIPT #. . . . . . • • • : BS000001699 REFERENCE ID # . . . : 07060163 SITE ADDRESS . . . . . : .11221 MONTEREY CT SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MOc�S, ELLEN ADDRESS : 11221 MONTEREY CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4739 RECEIVED FROM . . . . : A PERFECT CLIMATE CONTRACTOR . . . . . . . : SM=:TH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A ]PERFECT CLIMATE ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD CITY/STATE/ZIP . . . : CU'?ERTINO, CA 95014 TELEPHONE . . . . . . . . : (41)8) 86119545 FEE ID UNIT QUANTITY .%MOUNT 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 10, 978 .00 1 . 10 0 . 00 1 . 10 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 1 . 00 38 . 37 0 . 00 38 . 37 ------0 00 PPERMITFEE FLAT RATE ---------- ---------- ---------- TOTAL PERMIT : 176 . 84 0 . 00 176 . 84 0 .00 VOICE ID DESCRIPTION VOICE ID --------DESCRIPTION ----- -- ----------------- -------- ----------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNA.CE/AC CUPEkTINO PERMIT APPLICATION FORM n 7 p(vo/(o3 APN# Date: 35b r 21017 �� °�' °? Building Address: � Phone* Owner's Name: rs _ ------ _ Phone: License Ali Contractor. � 3 iS$ �f Phone: Cupertino Business License#: Contact: -� y 0Y Building Permit Info: Bldg ❑ Elect Plumb 61- Mech Job Description: C.o�.� 'Dme- (,� u j�Y.AuL �, r -�; Residential Commercial ❑ For Residential Installations: Attic ❑ 1" floor*1 2nd floor❑ Adhere to min set back requirementVI For Commercial Installations: _eplacement same weight ❑ Additional weight (structural calcs} ❑ Structural Calculations required for new installation New installation Planning App, royal Required ❑ Occupancy u Cost of Pr( Type of Construction: p y � p' GVP �2—� � Sq.Ft. Floor Area: Strapped El On Platform � Bonded New Location ❑ Replacement Qty. if Fee Description Fee Group Applicable Fee ID BUILDING BENERGY Energy � BREMFURN Furnace MECHANICAL EX Unit> 10,000 cfin MECHANICAL BREMACOVER MECHANICAL BREMAIRHAN f�/C Units <= 10, 000 cfin BREMRECEPT lZecp tl' Switch& Outlets ELECTRICAL BSEISMICRE 'Seismic Fee Res BUILDING 'Seismic Commercial BUILIDNG BSEISMICOM ELECTRICAL EPERMITFEE ?lec Permit Issuance MPERMITFEE Mech Permit Issuance MECHANICAL Plumbing Permit Issue PLUMBING PPERIvIITFEE BPERMFEE :31dg Permit Fees BUILDING BPLANCHK ,:Ilan 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 Fax(408)777-3333 CITY OF "WEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # 112- NN- o-) 06 0 C 6 OWNER'S NAME: PHONE # y Q4- (.k - y.r GENERAL CONTRACTOR: Q r�' C ; ..,, FAX# o a - 1.1 - I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the follow' information: 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