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07060211 CITY OF CUPERTINO CITRA�`� R IC?RMATI'QN: BUILDING DIVISION PERMIT - PERMIT NO. r,T_,)!Ess* ERRACE DR CONDITIOTIED AIR07060211 PERMIT ISSUE DATE NAM RIZZO VICTOR G AND LOUISE E 1701 LITrME ORCHARD ST 06TT YSANN/o20 CONTROL No. NE: (408) 291 -2220 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB M ECH I cd a LICENSED CONTRACTOR'S DECLARATION Job Description w(= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ?'Z' with Section 70(10)of Division 3 of the Business and Professions Code,and my license is ADD AIR OND I T I ONER s<o in full force and effgct Z License Class ('�--$ Lic.# w Datc �:1 -- Contractor F m ARCHff'ECTS DECLARATION j a.� < 1 understand my plans shall he used as public records )yU u,y Licensed Professional O a OWNER-BUILDER DECLARATION a1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to cmnswct,alter,improve,demolish,or repair any structure u"H prior to its issuance,also requires the applicant for such permit to files signed statement S Ft.Floor Area $4150 Valuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 a' YF=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Ll that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 6 2 0 0 2 C . 14 Number not more than rive hundred dollars(5500). 0 I,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.). 0 1,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- who capply Law does not ontracts r such property an owner of builds projects with a contractar(s)licensed of pursuant to the Contractor's License Law' B&P C for this reason 0 1 am exempt under Sec OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 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. 0 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's Compensation insurance carrier and Policy number are: Carrier: fji�It `gid 10t h Policy No.: 1 CERTIFICATE OF EXEMPI ION FROM CERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for one hundred dollars(5100) 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 0 forthwith 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 u! (Y,> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name D+ Lender's Address U I certify that I have read this application and state that the above information is r--d 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 ahove-mentioned property for inspection purposes. Q. (We)agree to save,indemnity and keep harmless the City of Cupertino against J �� Hliabilities,judgments,costs and expenses which may in anyway accr against said City U Zin consequence of the grating of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S URCE REGULATIONS. �/J Re-roofs L/ rc of Applicant/Contracto Dare Type of Loof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle haiardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes N �_ If a roof .s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑Ycs C3 No 1 have read the hazardoilsaw6n6als requirements under Chapter6.95 of Ute Califor- nia Hcakh&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 must be met prior issuance of a Certificate of occupancy. Signature:of Applicant 6 All roof coverings to be Class"B"or better Ow authorized agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 356 0020. 00 DATE ISSUED. . . . . . . . 06/',5/2007 RECEIPT #. . . . . . . . . : BSO(�0001775 REFERENCE ID # . . . : 07060211 SITE ADDRESS . . . . . : 216,63 TERRACE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RIZ'�O VICTOR G AND LOUISE E ADDRESS CITY/STATE/ZIP . . . : CUPiRTINO CA, 95014-4741 RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICiARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS 1701 LITTLE ORCHARD ST CITY/STATE/ZIP SAN JOSE, CA 95125 TELEPHONE (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ --------- ---- ------------- BENERGY PERMIT FEE 38.37 34 .86 0. 00 34 .86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10 .26 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1 .20 0. 00 BSEISMICRE VALUATION 4, 150. 00 0.50 0. 00 0.50 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- ---- TOTAL PERMIT 161 .93 0. 00 161 .93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 161.93 VISA --------------- TOTAL RECEIPT 161.93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------- -------- ---------- __ -------- ------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL 076 0 CITY OF C'UPERTINO FURNACEAC CUPEI�TINO PERMIT APPLICATION FORM APN# � ' �� Date: G . Z'4�•G.� Building Address: b9aM%.-rQ CA CISPILA �d r ' Owner's Name: Phone#: Vtc� � Q: �3'Ci Contractor: Phone: License#: • • z y(As16Z Contact: Phone: Cupertino Business License#: 5o L Building Permit Info: Bldg ❑ Elect 5C_ I"lumb Mech Rk Job Description: , �' Com i zvxane r` Residential IN, Commercial ❑ For Residential Installations: Attic ❑ 1' floor ❑ 2nd floor❑ Adhere to min set back requirement For Commercial Installations: Replacement same weight ❑ Additional weight(s:ructural talcs)❑ Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: O �-— Strapped ❑ On Platform tT Bonded Sq.Ft. Floor Area: New Location E]___ Replacement Qty. if Ap licable Fee ID Fee Description Fee Group BENERGY Ener BUILDING BREMFURN Fumace MECHANICAL BREMACOVER t�/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN iVC Units<= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch&Outlets ELECTRICAL BSEISMICRE ;seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE :31ec Permit Issuance ELECTRICAL MPERMITFEE ]Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE 131dg Permit Fees BUILDING BPLANCHK Man Check Fee BUILDING BPGAS ias Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development A 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY Of CUPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # OWNER'S NAME: .r G PHONE # Z5 1 0 FAX# GENERAL CONTRACTOR ( cep > Z 722-2 I am not using any subcontractors: Si mature Date Please check applicable subcontractors and comi:)lete the following information SUBCONTRACTOR BUSINESS NAME BUSINE LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring. Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Painting/ Wall er Paving Plasterin Plumb' g Roo g ptic Tank Sheet Metal Sheet Rock Tile Date Owner/ act ignatur