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07030153 CITY OF CUPERTINO BUILDING DIVISION PERMIT CANT OCT.ORINFORMATI(IN .; -- PERMIT NO. 3UILD2INOG2ADOf$ESNW SQ AAA FURNACE & AIR 07030153 PERMIT ISSUE DATE OWNER'S NAME: NIHARA, YUKO 1712 :)TONE AVE 03/21/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE, FURNACE AND ADD A/C BLDG ELECT PLUMB MECH i p a LICENSED CONTRACTOR'S DECLARATION Job Description :uIp I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is >>w in full force an f r C9 2L) :,n? License Clas Lam• 3 F C Datc Contractor �. m ARCHITECTS DECLARATION 7 aa 1 understand my plans shall be used as public records )yV U.rF„ Licensed Professional a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the .c C following reason.(Section 7031.5,Business and Professions Code:Any city or county <,,*,ffwhich requires a permit to conswct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statementValuation ?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.FC.Floor Area c F C (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 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not mote than five hundred dollars(5500). ❑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 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 contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]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 Insurance carrier and Policy number are:_ Carrier. Q�� /,ll,�Policy No.: / �T CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 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 (moi CA I hereby affirm that there is a construction lending agency for the performance of (Y > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name az Lender's Address U 0 I certify that I have read this application and state that the above information is LL correct.1 agree to comply with all city and county ordinances and state laws relating to .J• building construction,and hereby authorize representalms of this city to enter upon the 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. /.L. r" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: Date - 2 ( 7 s R cvl�TloNs. 14- Re-roofs Signature ofAppplli'canUC tractor Dare Type of RoofHAZARDOUS MATERIALS DISCLOSURE Will the applicant or Cutum building occupant store or handle hazardous material as def ncd 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. ❑Yes 1�no c�/ ` If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant e�future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new r laterials for inspection. District? ❑Yes 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be mel prior to issuance of a Certificate of Occupancy. SLgnaturt'of Applicant Date ,, 41 D 3"� All roof coverings to be Class"B"or better Owner or authorized agent Date (�UPERTINO CITY OF k OF FURNACE/AC ':UPEtiNO PERMIT APPLICATION FORM p o 153 APN Date: 314P DAv DJ `a2 /- o Building Address: Da eO Owner's Name: Phone#: /Vi A r D -13,0J' Contractor: Phone: License#: , Ali-)� � e OC '� - �_ �� ' 7i Contact: ' Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect DU Plumb R' Mech Job Description: ry Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor 2nd floor❑ Adhere to min set back requirement❑ Vor Commercial Installations: Replacement same weight ❑ Additional weight(E ruElctural calcs) Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Constrcction: Occupancy group: v (2 Strapped ❑ On Platform Bonded Sq.Ft. Floor Area: New Location Replacement El Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN furnace MECHANICAL BREMACOVER QVC Unit> 10,000 cfin MECHANICAL BREMAIRHAN QVC Units <= 10, 000 cfin MECHANICAL / I BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE ;Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE :?lec Permit Issuance ELECTRICAL MPERMITFEE 1vIech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE 13ldg Permit Fees BUILDING BPLANCHK flan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC 3usiness License BUILDING CITY OF CUPERTINO 8 ITEMS OF 15 PERMI" RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31640016 . 00 DATE ISSUED. . . . . . . : 03121/2007 RECEIPT #. . . . . . . . . BS000000741 REFERENCE ID # . . . 07030153 SITE ADDRESS . . . . . : 20108 NW SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CU:?ERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NI]IARA, YUKO ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : LOS ALTOS CA, 94024-6609 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : RAl1DO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 17L2 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (4 )8) 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 BREMFURN NO UNIT 1 .00 14 .31 0 .00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1 .00 1.20 0 .00 1 .20 0. 00 BSEISMICRE VALUATION 5,475 .00 0. 60 0 .00 0 .60 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 176 .34 0.00 176 .34 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 338.47 VISA --------------- TOTAL RECEIPT 338.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building Department JOB ADDRESS: PERMIT # OZ V v d .�� rH &/ f r7 0 OWNER'S NAME: v PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: - ?3 L S ignture ate 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