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07030094 CITY OF CUPERTINO BUILDING DIVISION PERMIT CNTgt�G�C)R ItF( RMTIN: i BUILDING ADDRESS: PERMIT NO. 22024 BAXLEY CT AAA FURNACE & AIR 07030094 OWNER'S NAME: NG PERMIT ISSUE DATE LENTFER, JIM 1712 STOPIE AVE 03/13/2007 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ADD 5 TON A/C BLDG ELECT PLUMB MECH Op LICENSED CONTRACTOR'S DECLARATION LU P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is H in full force and 7 ? License C1�s Lic.I p Dalc Contractor v F a r A cHrmcTS DECLA A l r L, 12-4 R< I understand my plans shall be used as public records )yU o Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 703 L5.Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.F:. Floor Area Valuation Z f (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 AP N Number Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to 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 We.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. ❑I am exempt under Sea B,A P C_for this reason Owner Date WORKER'S COMPENSATION DECLARATION I 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. ❑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 In urance carrier and Policy number arc: Carrier. Policy No.: -� CIERTIFI ATE F CEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for rine hundred dollars($100) 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 NO'T'ICE 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 �Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY (--� 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.) QLender's Name a z Lender's Address U Q 1 certify that I have read this application and state that the above information is U. o- correct.I agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F"C4 liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO RCE REGULATIONS. Re-roofs Signature ofApplicant/ConLraqor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Cede,Section 25532(a)? All roofs shall le inspected prior to any roofing material being installed. ❑Yes u Will the applicant or,uturc building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove 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 harardo s materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCodc,Sections 25505.25533 and 25534.1 understand thatif the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcgiu menu which must be met prior to issuance ofa certificate of Occupancy. Signature of Ap)l ieant Date cr or authori.cd agent' 'Date f'` All roof coverings to be Class "B"or better CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lct: APN 356060:2 . 00 DATE ISSUED. . . . . . . : 03/13/2007 RECEIPT #. . . . . . . . . BSOOO000680 REFERENCE ID # . . . : 07030054 SITE ADDRESS 22024 f;AXLEY CT SUBDIVISION . . . . . . CITY CUPERTJ NO IMPACT AREA . . . . . . OWNER LENTFER, JIM ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERT::NO CA, 95014-4744 RECEIVED FROM . . . . : RECEIPT' INTERFACE CONTRACTOR RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 :)TONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (408) 2!33-4717 FEE ID UNIT QUANTITY AMOUIT 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 BREMRECEPT NO. OUTLETS 1.00 1.20 0 .00 1.20 0 .00 BSEISMICRE VALUATION 11, 000.00 1.10 0 .00 1.10 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 132 .53 0.00 162 .53 0.00 METHOD OF PAYMENT AMOUNT ZEFERENCE NUMBER ----------------- --------------- -- ------------------ CREDIT CARD 162 .53 VISA --------------- TOTAL RECEIPT 162 .53 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS CITY OF CUPERTINO FURNACE/AC D 703 .UPE TING PERMIT APPLICATION FORM D� �. 9 Date: APN# 5510 —0 `1,7'z9 7 Building Address: �j �a y `� if Phone#: Owner's Name: Le e Contractor: Phone: License#: ',� d°r2% Contact: Phone: Cupertino Business License#: LG, Buildi g Permit Info: Bld ❑ Elect Plumt D- Mech Job Description: Residential Commercial ❑ For Residential Inst llations: Attic El I" floor 2nd floor❑ Adhere to min set back requirement[9-- For AYFor Commercial Installations: Replacement same weight C] Additional weight(structural calcs)❑ Structural Calculations required for new installation New installation Planning Approyal Require J ❑ Occupancy Cost of Project: Type of Construction: P Y group: Strap ed' On Platform Bonded Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if Fee Group Applicable Fee ID Fee Descri tion BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C L:nit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C L:nits<= 10, 000 cfm MECHANICAL / BREMRECEPT Rec t 1, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG / EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing PermPLUMBING it Issue BPERMFEE Bldg:'ermit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Fi in System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF -UPERTINO BUjj4injr De artment JOB ADDRESS: / PERMIT # � !,� C Civ fO OWNER'S NAME: PHONE # - - GENERAL CONTRACTOR FAX# I am not using any subcontractors: 4 3 'i3 no 7 Si al ure Date Please check applicable subcontractors and complete the followinginformation: 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