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07050206 7777 7777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT .� `�Tq IEQtM4TION . BUILDI G D ESS: PERMIT NO. 1� �7 FARALLONE DR COMFORT AIR HVAC INC 07050206 OWNER'S NAME: PERMIT ISSUE DATE BARZILLIE 1715 JU14CTION AVE, #B 05/21/2007 NE: SANITARY NO. CONTROL NO. (408) 21.3-0777 ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p Q LICENSED CONTRACTOR'S DECLARATION Job Description vF 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 ADD A/C UNIT IN BACKYARD y in full force and effeeq �) j ? License Class l 2 Lic.i/ V tp Date S` Contractor M ARCHITECTS DECLARATION 7 a< 1 understand my plans shall be used as public records )yU e U.y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the p O following reason.(Section 703 L5,Business and Professions Code:Any city or county < rL which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior to its issuance,also requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft. Floor Area $2995 Valuation r Fz- (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 ofNumber Occupancy Type not more than five hundred dollars($500). 3693101 3M 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 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 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 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. 0 1 am exempt under Sec. B&P C for this mason 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. 0 1 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 yart Policy number ate: Carrier_n1�G Z�vJ(�1e+f,tClley No:S 03 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be 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,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 F-o CA 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.) CW A Lender's Name .7Lender's Address U C) I certify that I have read this application and state that the above information is LL t" correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the U ahove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against HV) 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 ITH ALL NON-POINT Issued by: Dale SOURCE REGU TION % I-��_� T-_�1�7 Re-roofs Stgnaturc of Applicant/Contractor Dare Type of R sof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupam stom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed. [:1 Yes [+J�No 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 Arca Air Quality Management all new in iterials for inspection. District? 0 Yesu 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 requirement%W met prior to issuance of&Certificate of Occupancy. Signature of Applicant Date Date All roof coverings to be Class "B"or better owneorauthorizedagen i CITY OF CUPERTINO L 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 36S31018 . 00 DATE ISSUED. . . . . . . : 05/21/2007 RECEIPT #. . . . . . . . . : BSC00001408 REFERENCE ID # . . . : 07C50206 SITE ADDRESS . . . . . : 10=75 FARALLONE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BARZILLIE ADDRESS 10-75 FARALLONE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CONFORT AIR CONTRACTOR . . . . . . . : DAVID VAN DEVEN LIC # 24263 COMPANY COMFORT AIR HVAC INC ADDRESS . . . . . . . . . . : 1715 JUNCTION AVE, #B CITY/STATE/ZIP . . . : SAD' JOSE, CA 95112 TELEPHONE . . . . . . . . : (4C8) 213-0777 � r FEE ID UNIT QUANTITY FMOUNT 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 2, 995.00 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 161. 93 0 .00 161 . 93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 161. 93 9236 --------------- TOTAL RECEIPT 161. 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL