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07060239 CITE'OF CUPERTINO 7����+ �ry BUILDING DIVISION. PERMIT 1�� �� �������r� l��N' PERMIT N0. BUILDING ADDRESS: 22438 S WALNUT CIR JACK r[YERS CONSTRUCTION 07060239 PERMIT ISSUE DATE OWNER'S NAME: PATTY ARAKAKI 27610 r:ATOMA D 06/27/2007 SANITARY NO. CONTROL NO. IE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE EXISTING FURNACE. BLDG ELECT PLUMB METH 0 D D D i c c LICENSED CONTRACTOR'S DECLARATION Job Description iU 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z tri with Section 7000)of Division 3 of the Business and Professions Code,and my license is ? y in full force and effect License Class Lic.# t 0 Dam Contractor ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records 1aU U.y Licensed Professional a OWNER-BUILDER DECLARATION 3 a 1 hereby affirm that 1 am exempt from the Contractors License Law for the p o following reason.(Section 703 1.5.Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure ?z r prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.F1000 Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq a F= (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 any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will dothework,andthestructureisnotintendedorofferedforsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs 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 forsake.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.). It 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 contractor(s)licensed pursuant to the Contracwes License Law. ❑I am exe pt under Sec B&P C for this reason Owner ^n Date 4 L WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: v I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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 Workees Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($I0a) 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 mann sQ as lolr come subject to the Workers Compensation Laws of Califo []to �'f h Applicant NOTICE TOA CAM:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you mug ,J. 0 forthwith comply with such provisions or this permit shall be deemed revoked_ z" CONSTRUCTION LENDING AGENCY (ter 1 hereby affirm that there is a construction lending agency for the performance of l Y the work for which this permit is issued(See.3097,Civ.C.) aQ Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is — correct.1 agree to comply with all city and county ordinances and state laws relating w building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ���� 2'L2 ►^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b j: SOURCE R ULATIO 1. d� U11:;40-i_ Re-roof: Signature of Applicant/Comractor Date T of hoof HAZARDOUS MATERIALS DISCLOSURE Type 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)? All roof;shall be inspected prior to any roofing material being installed. ❑Yes To � If a roof is 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 materials for inspection. District? ❑Yes No I 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 docs not currently have a tenant that it is my responsibility to notify the occupant of the rcyuircm is which must be met prior w issuance of a Ccnificatc of Occupancy. Signature of Applicant ' '1 Date --��e ��1 10� �� All roof coverings to be Class 'B or better Owne—utthorized agent Date CITY OF' CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 3E703035 .01 DATE ISSUED. . . . . . . : OE /27/2007 RECEIPT #. . . . . . . . . . B::000001811 REFERENCE ID # . . . : 0-, 060239 SITE ADDRESS . . . . . : 22438 S WALNUT CIR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . Pl,TTY ARAKAKI ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2742 RECEIVED FROM . . . . : DON ISAMU TOKUNAGA CONTRACTOR . . . . . . . : JI,CK MYERS LIC # 24312 COMPANY . . . . . . . . . . : Jl,CK MYERS CONSTRUCTION ADDRESS 27'610 NATOMA RD CITY/STATE/ZIP . . . : LOS ALTOS HILLS, CA 94022 TELEPHONE . . . . . . . . : (4:08) 761-1185 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 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BSEISMICRE VALUATION 2, 000. 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. 00 --------- ---------- ---------- ---------- TOTAL PERMIT 164 .78 0. 00 164 .78 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 164.78 #774 --------------- TOTAL RECEIPT 164 .78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Dat.), 35�- n-3-p��`� � i G Building Address: Owner's Name: Phone#: — _— - — License 4: Contractor: n't ��j Phone: J�at- ��s � uc� Contac : Phone: Cupertino Business License#: 5"z 12— Building 2 Building Pe it Info: h� Bldg ❑ Elect [ ?lumb 8 - Mech " Job Description: Residential ID ❑ For Residential Installations: Attic ❑ 1" floor © 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: keplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: Strapped ElOn Platform ElBonded 11 Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN F urnace MECHANICAL BREMACOVER YJC Unit> 10,000 cfm MECHANICAL BREMAIRHAN YJC Units<= 10, 000 cfm MECHANICAL BREMRECEPT I:ecptl, Switch& Outlets ELECTRICAL BSEISMICRE seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE I?lec Permit Issuance ELECTRICAL ( MPERMITFEE Mech Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE EETBIdg Permit Fees BUILDING BPLANCHK Ilan Check Fee BUILDING BPGAS (Jas Piping System Fee PLUMBING BUSLIC I3usiness License BUILDING