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07050183 CITY OF CUPERTINO BUILDI1Ni;DIVISION PERMIT0MTIQ ' BUILDT�UDd,prss: PERMIT NO. SAN FERNANDO AV GAFFIGAN CO. 07050183 OWNER'S NAME: PERMIT LSSUE DATE BEAN RICHARD H ET AL 720 S. AMPHLETT BLVD 05/18/2007 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLACE FURNACE AND ADD A/C BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;Z m with Section 7000)of Division 3 of the Business and Professions Code,a d my license is in full force and effe �� r ? License Class C�Lie,tY S Date�� Contractor a l�Arar1 3 ARCHITECTS DECLARATION ,a < 1 understand my plans shall be used as public records >yU U.y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p Oy� following reason.(Section 7031.5,Business and Professions Code:Any city or county Ii which requires a permit to convect,alter,improve,demolish,or repair any structure zprior to its issuance,also requires the applicant for such permit to file a signed statement t' Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .tq F (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(SSW). ❑I,as owner of the property,or my employees with wages az their sole compensation, will do the work•and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of �l 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 gild 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- 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. ❑I 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: (]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 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 Worke in enation Insurance carrier and Policynu ber am: L If Cartier. Policy No.: C) J c A-6 CgRTIMCATE 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,l shall not employ any person in any manner so as to become subject to the Workcrs'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+ 1 hereby affirm that there is a convection lending agency for the performance of ai> the work for which this permit is issued(See.3097,Civ.C.) QLender's Name a z Lender's Address U C) I certify that I have read this application and state that the above information is (T� correct.I agree to comply with all city and county ordinances and state laws relating to (D U building construction,and hereby authorize representatives of this city to enter upon the (1) ahove-mentioned property for inspection purposes. L1. (We)agree to save,indemnify and keep harmless the City of Cupertino against Ht) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in cone fik granting of this permit. ►" APPLI NT UN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ( V SOU C S'-)6-0-0 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material az defined 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 44 Will the applicant or future 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 BitL� I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc,Section 25505,25533 and 25534.1 understand that if the building doesno relfft r ve a tenant that it is my responsibility to notify the occupant of the regmir errs w c mru prior to issmancc of a Certificate of Occupancy. _ Signature 4 Appl icant Date All roof coverings to be Class"B"or better Owner of authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot : APN . . . . . . . . : 35-/15045.00 DATE ISSUED. . . . . . . : 05/18/2007 RECEIPT #. . . . . . . . . : BSC00001383 REFERENCE ID # . . . : 07C50183 SITE ADDRESS . . . . . : 21S01 SAN FERNANDO AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BEAN RICHARD H ET AL ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2835 RECEIVED FROM . . . . : GAFFIGAN CO CONTRACTOR . . . . . . . : MA&GET CASTILE LIC # 23103 COMPANY . . . . . . . . . . : GAFFIGAN CO. ADDRESS . . . . . . . . . . : 72C S. AMPHLETT BLVD CITY/STATE/ZIP . . . : SAN MATEO, CA 94402 TELEPHONE . . . . . . . . : (650) 574-5740 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 11, 980 .00 1 .20 0 . 00 1 .20 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 . 94 0 .00 176 . 94 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 176 . 94 3697 --------------- TOTAL RECEIPT 176 . 94 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO t FUR.NACE/AC CUPEkTiNO PERMIT APPLICATION FORM ( /c 5 t/rK3 APN# 1 Date: Building Address: Z. i fo l 5r4---) A, o0 &V Owner's Name: Phone#: Contractor: -- --- ----- Phone: — -— --- License #:----- - � Contact: Phone: Cupertino Business License#: z5b7roo n �� 7 s-9- y-pz LLL Z- 3) Building Permit Info: Bldg ❑ Elect [ � P lumb �� Mech 0-� Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor❑ Adhere to min set back requirement Ia' S' S s.T d'0-44-w,- For '0-44-eFor Commercial Installations: .eplacement same weight ❑ Additional weight (structural calcs) ❑ / /� Structural Calculations required for new installation El New installation Planning Approval Required ❑ Cost of Project: Type of Co c':ion: Occupancy group: / 1 9y o — ' S,=4 QZ-3 Strapped ❑ On Platform Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Er,ergy BUILDING L BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfrn MECHANICAL BREMRECEPT Re:cptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE El;,c Permit Issuance ELECTRICAL L MPERMITFEE M,-ch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bl Ig Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Clllf OF Fax(408)777-3333 .,UPEkTIN0 Building Department JOB ADDRESS: PERAUT# 2,19'0 1 S-/X-J P/ /-J,00 AL4.,I . (f) ILS✓�/ OWNER'S NAME: -z A4W ,(E4.^j lqjPHONE# 6s-,a- 4-,>Y-,s-'7 0 GENERAL CONTRACTOR: �.¢�r (ice.•• ��o, FAX# 6 a-v-S,79- Z,90 u I am not using any subcontractors: S Signature Date Please check apphcable 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