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07060170 CITY OF CUPERTINO BUILDING DIVISION PERMIT � RET+C'!R PERMIT NO. BUILTTHD BEEP CLIFFE DR J P GOFMAN INC 07060170 1 U L4� PERMIT ISSUE DATE OWNER'S NAME: BIEGHLER MELVIN C AND HILMA 0 305 VINEYARD TOWN CENTER 06/20/2007 SANITARY NO. CONTROL NO. .ONE: (408) 779-3296 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description %UI hereby affirm that I am licensed under provisions of Chapter 9(commencing z 8 with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALLATION OF NEW FURNACE/AIR CONDITIONER. y in full force and effect ? License Class Lic.N t-p Date Contractor LW ARCHITECTS DECLARATION Z 2< I understand my plans shall be used as public records )yU IL o y Licensed Professional OWNER-BUILDER DECLARATION 'r I hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county <m which requires a permit to construct,alter,improve,demolish,or repair any structure y prior tet its issuance.also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 1 O O O 0 jI-� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 3 5 6 0 4 0 C 3 ( Number Occupancy Type not more than five hundred dollars(6500). 0 1,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 Required Inspections 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 co tinct 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. 0 1 am G1OI undo sea B&PP C for ]]thh�is mason (� /t _Date�is0 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 I 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: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars(6100) 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 man so aq becorr�sub' t to the Workers'Compensation Laws of Califomi, ( oLy Ifi Applicant '. 061A d 1 MA— 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 [�- I hereby affirm that there is a construction lending agency for the performance of IZ > the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name j Lender's Address V C) 1 certify that I have read this application and state that the above information is V� "-r corcct.I agree to comply with all city and county ordinances and state laws relating to Q U building constmction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. f]. (We)agree to save,indemnify and keep harmless the City of Cupertino against o-.(c.4) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit Date ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b-t: pb C.ItE REG ATIONS. QCj�� Re-roofs Signature of Applicam/Contractor HAZARDOUS MATERIALS DISCLOSURE Type of:Zoof Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? fir, All roof:,shall be inspected prior to any roofing material being installed. C3 Yes /`e 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 I naterials for inspection. District? 0 Yeses 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 reoytia�ments which st be met prior to issuance of a Certificate of Occupancy. Signatur'of Applicant Date (� k--, J�'jA..! . (6—go—car All roof coverings to be Class nB°or better Owner or authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35604003 .00 DATE ISSUED. . . . . . . : 06/20/2007 RECEIPT #. . . . . . . . . : BS000001714 REFERENCE ID # . . . : 07060170 SITE ADDRESS 10804 DEEP CLIFFE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BIEGHLER MELVIN C AND HILMA 0 ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3955 RECEIVED FROM . . . . : CFROLINE E ANDERSON CONTRACTOR . . . . . . . : JOSEPH GORMAN LIC # 24918 COMPANY . . . . . . . . . . : J P GORMAN INC ADDRESS . . . . . . . . . . : 3C5 VINEYARD TOWN CENTER CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (908) 779-3296 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 69 .72 0. 00 69 .72 0. 00 BREMAIRHAN NO.UNITS 1. 00 41 .04 0. 00 41.04 0. 00 BREMFURN NO UNIT 1.00 57 .24 0. 00 57 .24 0. 00 BREMRECEPT NO. OUTLETS 1. 00 4.80 0. 00 4 .80 0. 00 BSEISMICRE VALUATION 1. 00 1 .00 0. 00 1. 00 0. 00 EPERMITFEE FLAT RATE 1. 00 76 .74 0. 00 76.74 0. 00 MPERMITFEE FLAT RATE 1. 00 76 .74 0. 00 76 .74 0.00 PPERMITFEE FLAT RATE 1. 00 76 .74 0. 00 76 .74 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 404 .02 0. 00 404 .02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 404 . 02 MC --------------- TOTAL RECEIPT 404 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 70 7 78 Sv 7 tvl L CITY OF C'UPERTINO U NICE!A .. CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: � � � ,rr �r 1 l 1�-�l-C te Owner's Name: Phone #: VD13 < ontractor: rho Ze: i,icense #: `tbg a�L(o- o Con t: Phone: Cupertino Business License#: ��, /oS -3 � �> 8 Building Permit Info: Bldg ❑ Elect Imo' 'lumb LAY Mech Job Description: ( S Irl -'t"VY Vl -lair Residential V: Commercial ❑ For Residential Installations: Attic ❑ 1St floor 2nd floor❑ Adhere to min set back requirement For Commercial Installations: Zeplacement same weight ❑ Additional weight(s:ructural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Constru:,tion: Occupancy group: Strapped ElOn Platform Bonded C1 Sq.Ft. Floor Area: New Location Replacement Qty. if A plicable Fee ID Fee Description Fee Group .91 BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER YJC Unit> 10,000 cfm MECHANICAL a BREMAIRHAN /JC Units<= 10, 000 cfm MECHANICAL BREMRECEPT I:ecptl, Switch& Outlets ELECTRICAL 1 BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM 'Seismic Commercial BUILIDNG a EPERMITFEE Flec Permit Issuance ELECTRICAL a ( MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK flan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC L Business License BUILDING Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT# 070 OWNER'S NAME: M vi '� PHONE # yu &- 22(p GENERAL CONTRACTOR: j F, vVyj atA FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following 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