07050165 CITE'OF CUPERTINO
BUILDING-DIVISION. PERMIT �) � ' �IURM�TIf�N=
BUIT�lCyQj2E SPERMIT NO.
HATTUCK DR BONANZA HEATING & A/C 07050165
OWNER'S yNAME: PERMIT ISSUE DATE
RUDEN JEANNE MARIE H TRUSTEE 1098 INDEPENDENCE AVE STE A 05/17/2007
)NE. SANITARY NO. CONTROL NO.
(650) 94.3-4727
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
uF 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 REPLACE HEATER & INSTALL A/C
y in full force and effect.
License Class Lic.#
F Date Contractor
ARCHITECTS DECLARATION
7 cca I understand my plans shall be used as public records
)yU
c y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
i 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 swcutre
Z y 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 Sq.Ft.Floor Area $5995
r i= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
U 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 `CtV pj�Number Occupancy Type
not more than five hundred dollars(3500). 3561400 3 .
❑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.).
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 LaIv.
❑I am ekjrtdec. B&P for is reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby alum 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.
I have and will maintain Worker's Compensation Insurance,as required by Section
00 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 arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance ofc Zviork for wh'c is is issued,I shall not
employ any person in any manner me ser ' l rkers Compensation
Laws of California.Date
Applicant
_ 910611--
NOTICE TO APPLICANT:If,after making this Cc a o xcmption,you should
become subject to the Worker's Compensation provisi ns of the Labor Code,you must
Oforthwith comply with such provisions or this permit all be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
�+a 1 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.)
WCC.A Lender's Name
Z Lender's Address
U 0 1 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
Jbuilding construction,and hereby authorize representatives of this city to enter upon the
a above-mentiuned property for inspection purposes.
(We)ogre to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgm ts,cos and expenses which may in any way accrue against said City
U Z in consequence the g n g of this permit.
APPLICANT ER DS AND WILL COMPLY WITH AL N N-POINT Issued by Date —
SOURCE REG 10
Re-roofs
Signature of AP 1 caht/d nn factor Date
T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the pplicant 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 shall be inspected prior to any roofing material being installed.
❑Yes IO
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 r aterials for inspection.
District?
❑Yes / No
I havere rdous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&S y coons 25505.25533 and 25534.I understand that if the building
does not cu t ha ant,that it is my responsibility to notify tate Occup of the
regairementa h' met prior to issuance of a certificate of Decnpan Signature of Applicant Date
All roof coverings to be Class"B" or better
Owner or authoi ped aget Date"
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT' RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35614008. 00
DATE ISSUED. . . . . . . : 05/17/2007
RECEIPT #. . . . . . . . . : BS000001364
REFERENCE ID # . . . : 07050165
SITE ADDRESS . . . . . : 21927 SHATTUCK DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER RUI)EN JEANNE MARIE H TRUSTEE &
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4761
RECEIVED FROM . . . . : MARK RUDEN
CONTRACTOR SOETJE, ED LIC # 20499
COMPANY BOIIANZA HEATING & A/C
ADDRESS 1098 INDEPENDENCE AVE STE A
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE (650) 948-4727
FEE ID UNIT QUANTITY IiMOUNT 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, 995 .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
----------------- --------------- --------------------
CHECK 176 .34 5890
---------------
TOTAL RECEIPT 176 .34
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
CITY OF C UPERTINO
FURN�&E/AC
`STMPERMIT APPLICATION FORM c12CUPEF�TINO
APN# Date:
55� � � e��s � n
Building AddresJ
O er's Name u� � Phone#:
ontractor: , Phone: License ?V:
n � 6�t� . g4� � 7�? � 1
n ac
Contact: Phone: Cupertino Business 'ce se#:
Building Permit Info:
Bldg ❑ Elect ❑ F lumb ❑ Mech ❑
Job Description: l /' )� JtC.jbc�)
a j 7A�4 ( 4,,.
Residential Commercial ❑ _
For Residential Installations:
Attic 111" floor 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
,Zeplacement same weight ❑ Additional weight (st-uctural calcs) ❑
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project Type of Construction: Occupanc group:
5 � 00
Strapped ❑ On Platform El Bonded LJ Sq.Ft. Floor Area:
New Location Replacement Er,
Qty. if
A plicable Fee ID Fee Description Fee Group
BENERGY E:iergy BUILDING
BREMFURN Fl irnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfrn MECHANICAL
BREMRECEPT Recptl, Switch& Outlets ELECTRICAL
BSEISMICRE S-,ismic Fee Res BUILDING
BSEISMICOM S,-ismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE lv:ech Permit Issuance MECHANICAL
PPERMITFEE P umbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Pan Check Fee BUILDING
BPGAS C as Piping System Fee PLUMBING
BUSLIC Business License BUILDING