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07050207 CITY OF CUPERTINO " BUILDING'-DIVISION PERMIT +C�1NT7E .cTt�R INEURMATION PERMIT NO. BUILQji�t,('iR1ITA"LEBANON DR ALTON ACR CONDITIONING & 07050207 OWNER'S SJNlAME: �- PERMIT ISSUE DATE CAROL ELLIOTT 45300 INDUSTRIAL DR 05/21/2007 JNE: (510) 49 )-5655 SANITARY NO. CONTROL NO. ABUILDING PERMIT INFO ARCHITECT/ENGINEER:ECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description Wu F. I hereby affirm that I am licensed under provisions of Chapter 9(commencing :z w with Section 7000)of Division 3 of the Business and Professions Code and my license is REPLACE SINGLE SIDED WALL HEATER W/SAME SIZE <ein full force and cc j ? License Class Lic,x 35, 000 :3TU. F w Date Conttador ARCHIEcrs DECLARATI N I understand my plans shall be used as public men )WU U.F' Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for 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 Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;q.Ft.Floor Area $1500 at-$ (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 3421402 3?��Number Occupancy Type not more than five hundred dollars(5500). ❑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 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Conttactoes 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 Sea B&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. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor. ompensation InWrance carrier and Policy number are: Carrier. Portry No.. CERTIFICAT.OFEXEMP11ONFROMWORKERT 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,1 shall not employ any person in any manner so as to become subject to the Worker;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 [�Cn I hereby affirm that there is a construction lending agency for the performance of R!> the work for which this permit is issued(Sec.3097,Civ.C.) WP-4 A Lender's Name r7 9z Lender's Address U 0 I certify that I 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 Ubuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hf) liabilities,judgments,costs and expenses which may in any way accrue against said City U'Z in consequence of the granting of this permit. 0-4 APPLICANT UNDE ANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Dates SOUR E ON �- Re-roofs signatureof WicanuContractor Dare Type Of R�Of HAZARDOUS MATERIALS DISCLOSURE Will a 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 Code,Section 25532(a)? �� All roofs:;hall be inspected prior to any roofing material being installed. [:]Yes Will the applicant or future building occupant use equipment or devices which If a roof i:;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? / C]Yes �j16 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the reytomems is t to issuance of a Certificate of Oc panty Signature of Applicant Date [ ' �� G All roof coverings to be Class"B"or better Owner orized agent ale CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT' RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 34214023 . 00 DATE ISSUED. . . . . . . : 05,21/2007 RECEIPT #. . . . . . . . . : BS000001407 REFERENCE ID # . . . : 07050207 SITE ADDRESS . . . . . : 10_.28 LEBANON DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CAPOL ELLIOTT ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2646 RECEIVED FROM . . . . : AL-ON AIR CONDITION CONTRACTOR . . . . . . . : AL-ON, MICHAEL LIC # 21326 COMPANY . . . . . . . . . . : AL-ON AIR CONDITIONING & HTG ADDRESS 45_;00 INDUSTRIAL DR CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE . . . . . . . . : (5_.0)490-5655 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 BREMFURN NO UNIT 1 .00 14 .31 0 .00 14 .31 0.00 BSEISMICRE VALUATION 1, 500 .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 164 .78 0 .00 164 . 78 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 164 . 78 5871 --------------- TOTAL RECEIPT 164 .78 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 s CITY OF (; Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 '"WEkTINO Building Department JOB ADDRESS: PERMIT # 70 5 OWNER'S NAME: PHONE # GENERAL CONTRACTOR:. FAX # I am not using any subcontractors: _5 &- Si,opature Date Please check applicable subcontractors :Zd 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