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07030151 CITY OF CUPERTINO T 7�T BUILDING DIVISION PERMIT � �� �� PERMIT NO. eu1LDP8 gDWsNATHANSON AV AAA FURNACE & AIR 07030151 PERMIT L%UE DATE OWNER'S NAME: UPTON, ALEX 1712 STONE AVE 03/21/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: ADD A/C AND 2 DUCTS BLDG ELECT PLUMB MECH 0 0 i p a LICENSED CONTRACTOR'S DECLARATION Job Description V F I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z u with Section 70(X))of Division 3 of the Business and Professions Code.and my license is r y in ful���A 21 r z LicenClLic.0 o DatcContractor F• CI"S DECL j s i I understand my plans shall be used as public records >yU U.f- Licensed Professional :O< OWNER-BUILDER DECLARATION GHJ 1 hcrchy alTinn that I am exempt from the Contractor's License w or the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq K F G (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 APN Number Occupancy Type not more than five hundred dollars($500). 0 1,as owner of the property,or my employees with wages as their sole compensation, willdo thework,and the structure is notintended oroffered forsale(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.). 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- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractoes License Law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: L]1 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 mbe7r are: p / Carrier. 6&&4O z i r7 Policy No.: CERTIFICATE O XEMPTION FROM W R ERS COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 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 Er .�•� 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.) W Q Lender's Name Z:) Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to J building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against 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 by: SOURCE ULATIONS. Re-roof: Sign a of AppIFcan1M596kt61 Date T of Roof HAZARDOU ATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hayardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof 3 shall be inspected prior to any roofing material being installed. C Yes No (o/� If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant r future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new -materials for inspection. District? 0 Yes o 1 have read the hay ous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code, ections 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 require is which m St be met prior to issuance of a Certificate oOccupancy. Signatul e of Applicant Date All roof coverings to be Class"B"or better 04ner or aulho xcd agent ate CITY OF CUPERTINO 7 ITEMS OF 15 PERMIT RECEIPT OPERATOR: bethe COPY $# 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32643074 .00 DATE ISSUED. . . . . . . : 03/21/2007 RECEIPT #. . . . . . - - . : BS000000741 REFERENCE ID # 07030151 SITE ADDRESS . . . . . : 10649 NATHANSON AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER UPTON, ALEX ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1330 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 293-4717 FEE ID UNIT QUANTITY AMOUNT 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 7, 000.00 0.70 0 .00 0 .70 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 162 .13 0 . 00 162 .13 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC f:UPEkTINO PERMIT APPLICATION FORM © 7030/51 APN# Date: 7 310 Building Address: Owner's e. Phone#: /00 07 Contractor: Phone: License#: 4 t D . �7���'7 Contact: Phone: Cupertino Business License#: z .� fo - 21 Buildingermit Info: Bldg ❑ Elect IR Plumb ©" Mech Job Description: G Residential Commercial ❑ For Residential Installations: Attic ❑ 1 st floor ❑ 2nd floor❑ Adhere to min set back requirement 'Tor Commercial Installations: Replacement same weight E] Additional weight(A Octural calcs) El Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancyoup: Strapped ❑ On Platform BondeNJ Sq.Ft. Floor Area: New Location �gf Replacement ❑ f i Qty. A y. f e Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, 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 Business License BUILDING Community Development s_a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # /( `, .76) T6 ( S l OWNER'S NAME: y -'z _ PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: A6 �� z- Signature I Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIESS 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