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07060093 CITY OF CUPERTINO BUILDING DIVISION PERMIT 07 � ortTIN. PERMIT NO. BUILDLITAn"bAN FERNANDO AVE ALLIED IRE SERVICE INC 07060093 OWNER'S NAME: PERMIT ISSUE DATE JUN MA 661 SINCLAIR FRONTAGE RD 06/12/2007 NE: (408) 939-8844 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 O p LICENSED CONTRACTOR'S DECLARATION w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE & ADD A/C y in full force and flee. w`6 -'— Lic.>t License 1 e'a t Date Contractor `I.ttr $fX ARCHITECTS DECLARATION < I understand my plans shall be used as public records )WU U.H Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 3 C O following reason.(Section 7031.5,Business and Professions Code:Any city or county 01 which requires a permit to construct.alter,improve,demolish,or repair any structure ?z r prior u)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 Sq.Ft.Floor Area Valuation 1=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4500 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 Q��j Number Occupancy Type not more than five hundred dollars(5500). 35715043 :AMNumber ❑I,as owner of the property,or my employees with wages az 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 Contractors License Law does not apply m 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 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 contractor(s)licensed pursuant to the Contractors License Law. ❑1 am exempt under Seo. ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers 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' Compensation Insurance carrier and Policy number are: Carrier. T �aw w10 Policy No.:DO CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so az 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 F-t CA I 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.) ALenders Name Lender's Address U O I certify that I have read this application and state that the above information is V,O- correct.I agree to comply with all city and county ordinances and state laws relating to O U 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 c/) liabilities,judgments,costs and expenses which may in any way accrue against said City U'z in corse c of a granting of this permit. i r ►- APPL A U WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU C E Re-roofs Signature of Applicant/Contractor batc HAZARDOUS MATERIALS DISCLOSURE Type of Ro)f Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs stall be inspected prior to any roofing material being installed. E3 Yes 17J No If a roof is Will the applicant or future building occupant use equipment or devices which .nstalled without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mal erials for inspection. District? ❑Yes lQno I h re xi the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heal & afcty C ,Sections 505,25533 and 25534.1 understand that if the building does t cu nily ha a at itis my responsibility to notify the occupant of the rcy' me whii be nt prior to umcc of a Ccrtifrcae of cupan . Signature o F Applicant Date G I3 07 All roof coverings to be Class"B"or better or authorized agent Date CITY OF CUPERTINO 7 ITEMS OF 15 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35715043 .00 DATE ISSUED. . . . . . . : 06/12/2007 RECEIPT #. • . . . . . . . : BS000001628 REFERENCE ID # . . . : 07060093 SITE ADDRESS . . . . . : 21865 SAN FERNANDO AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . JUN MA ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ALLIED AIRE SERVICE CONTRACTOR . . . . . . . : STEINER, ARNOLD R LIC # 19207 COMPANY . . . . . . . . . . : ALLIED AIRE SERVICE INC ADDRESS . . . . . . . . . . : 661 SINCLAIR FRONTAGE RD CITY/STATE/ZIP . . . : MILPITAS, CA 95035 TELEPHONE . . . . . . . . : (403) 934-8844 FEE ID UNIT QUANTITY AvIOUNT 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 4, 500 .00 0 .50 0 . 00 0 .50 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 137. 87 0 .00 137.87 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 314 .11 19062 --------------- TOTAL RECEIPT 314 . 11 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO `UR.NACEAC CU11 PS 401F PERMIT APPLICATION FORM o 7, 13 APN# Date: 3 Building Address; J a r S 5 -,-a A-,)tc) A V Owner's Named Phone#: Contract s Phone: License 4: ��a 3`f'��`-ls� (�L(e 003 Phone.,[,,., c Cupertino Business License#: Contact: 7 j g Building Permit Info: �/ Bldg El Elect C� F lumb Mech 1f Job Description: Residential Ef Commercial ❑ For Residential Installations: Attic ❑ 1"floor ❑ 2na floor❑ Adhere to min set back requirement For Commercial Installations: .teplacement same weight ElAdditional weight (st-uctural calcs) ❑ Structural Calculations required for new installation 0 New installation Planning Approval Required ❑ Cost of Project: Type of Cortrgction: Occupanc gr Strapped ❑ On Platform CJ' Bonded Sq.Ft. Floor Area: New Location �' Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY E iergy BUILDING BREMFURN F-imace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cftn MECHANICAL BREMRECEPT R ecptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC F�usiness License BUILDING Community Development 10300 Torre Avenue a Cupertino CA 95014�.,,tc1i"t Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;tJPEkTINO Buildin' De artment JOB ADDRESS- PERMIT# p4laz"�-;13 c OWNER'S NAME: 777 LAO V0 Q PHONE # 8 4-4 - G 8 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation SUBCONTRACTOR BUSIrIESS 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 4 1ao� Owner/Contractor Signature Date