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07060058CITY OF CUPERTINO BUILDING DIVISION PERMIT�1R THSKY SQ OWNER'S NAME: BENJAMIN, ROY & SIMONA 199 t00 iVV :Z uaa iNE: ARCHITECTIENGINEER: AIR QUA:�ITY HEATING & AIR 714 NORTHRUP ST (408)293-7138 PERMIT NO. 07060058 PERMIT ISSUE DATE 06/08/2007 SANITARY NO. CONTROL NO. LICENSED CONTRACTOR'S DECLARATION Job D05CTlptlOn I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7(XX)) of Division 3 of tate Business and Professions Code, and my license is REPLACE FURNANC E AND ADD A / C in full force and est, License las L1c. Date Contractor ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 arty applicant for a permit subjects the applicant to a civil penalty of not more than rive 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 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.). ❑ 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- ccnse 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. ❑ lam exem pt under Sec. B At P C for this reason Owner _ Date WORKER'S COMPENSATION DECLARATION 1 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. j ave 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 Worrkkeess Compensation I�nsuurra�nycee carrier ail Poli number arc: Cartier. 1 [_ u{/ k- lf�. r PoTrfy - I'm–. COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I cerifv 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Nance Lender's Address 1 certify that 1 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APP.LmANT UNDERSTANDS AND WILL COMPLY WITH ALL NON,PO{NT Signypfre of Applicam/Contractor state ' HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes Will the applicanor future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Ycs I ha&w: read the hazardous rials requirements under Chapter 6.95 of the Califor- nia Health Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building docs not cunently have a tenant, that it is my responsibltty to notify the occu�tit of the requircmcA which must be,pkt prior to issuan5p CA cu u}r ly Lt— BUILDING PERMIT INFO ELECT PLUMB MECH iq. Ft. Floor Area $9000 Valuation 3164000). Number Occupancy Type Required Inspections Issued by: Re -roofs Type of Roof All roofs :hall be inspected prior to any roofing material being installed. If a roof iE installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signat re AApplicant Date All roof coverings to be Class "B" or better Owner r autharized..crit CITY OF CUPERTINO 8 ITEMS OF 16 PERMIT F.ECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 3164C005.00 DATE ISSUED.......: 06/OE/2007 RECEIPT #.........: BSO00001584 REFERENCE ID # ... 0706C058 SITE ADDRESS .....: 10991 NORTHSKY SQ SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: BENJAMIN, ROY & SIMONA ADDRESS ..........: 10991 NORTHSKY SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: bethe COPY # : 1 RECEIVED FROM ....: AIR QUALITY & HEAT CONTRACTOR .......: MATTHEW FARBER LIC # 22791 COMPANY ..........: AIR QUALITY HEATING & AIR ADDRESS ..........: 714 NORTHRUP ST CITY/STATE/ZIP ...: SAN JOSE, CA 95128 TELEPHONE ........: (408)293-7138 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 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 9,000.00 0.90 0.00 0.90 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 ---------- 176.64 ---------- 0.00 ---------- 176.64 ---------- 0.00 METHOD OF PAYMENT AMOUNT ----------------- --------------- CHECK 353.08 --------------- TOTAL RECEIPT 353.08 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL REFERENCE NUMBER -------------------- 53267 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC UPERTINO PERMIT APPLICATION FORM APN # Date: Building Address., BREMFURN Llr� I NO LA�A� MECHANICAL Owner's N _ Phone #: Co tor: ' ^g� Phone: � _ License #: _ Contact: Phone: Cupertj i5 42P ss License #: Building Permit Info: Rec tl, Switch & Outlets Bldg❑ Elect P tomb C�' Mec S :,ismic Fee Res BUILDING Job Description: S -lismic Commercial U Ce— Fu 60 EPERMITFEE Resid ntial Commercial ❑ ELECTRICAL For Residential In tallations: 11 LJ ❑ Attic Is' floor 2"d floor MECHANICAL Adhere to min set back requirement Pumbing Permit Issue PLUMBING BPERMFEE nor Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) BUILDING Structural Calculations required for new installation Plan Check Fee New installation Planning Approval Required BPGAS Cost �Projec�:�� _ Type of Co�a�str,�ucLion: Occupan group: Strapped On Platform Bonded-- Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if RPP Tlac�rintinn Fee Grout A ticabie rum iL BENERGY -- - --- ----- Ejiergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER AIC Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cf n MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE S :,ismic Fee Res BUILDING BSEISMICOM S -lismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Vech Permit Issuance MECHANICAL PPERMITFEE Pumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Cfas Pi in S stem Fee PLUMBING BUSLIC E usiness License BUILDING Community Development k 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 ,UPEkTINO Building Department JOB ADDRESS: PERMIT # 070W058 OWNER'S NAME: �PHONE # U 57' GENERAL CONTRACT R -cwt AX # I am not using any subcontractors: ignature Date Please check applicable subcontractors and complete the following information: (3(b2 Owne /Contractor Sign Date 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 (3(b2 Owne /Contractor Sign Date