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07050230 CITY OF CUPERTINO BUILDING DIVISION PERMIT ' �GTVZ }'FF1Y �O + PERMIT NO. BulLD1 ,�i� bUIREW00D WY A PERFECT CLIMATE 07050230 OWNER'S NAME: PERMIT L95UE DATE VIDYASAGAR PREM 10570 S DEANZA BLVD 05/22/2007 .ONE: (408) 86119545 SANITARY NO. CONTROL No. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description U" 1 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 FURNACE WITH 100, 000 BTU 94% AFUE. t y in full force and eff L. r�z License Class REPLACE UJ Date b'n CHr1Crs DECLARATIW WITH 3 .5 TON 14 SEAR i < I understand my plans shall be used as public records )qU w y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the `ZOO following reason.(Section 7031.5,Business and Professions Code:Any city or county < 9 which requires a permit to construct.alter,improve,demolish,or repair any structure o Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area $9657 Valuation Z f (commencing with Section 7000)of Division 3 of the Business and Professions Code)or lu 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 3 6227014?(��Number Occupancy Type not more than five hundred dollars(5500) Q I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and thestructureisnotintendcdorofferedforsalc(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs 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.). Q 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 U- cense Law docs not apply to an owner of property who builds or improves thereott,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. Q I am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q 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. Q 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' CompensateInsurancegirrier and Policy number are: Cartier Policy No.: �O I ' CER ICATE F EXEMPTION FROM WORMS— COMPENSATION INSURANCE (This section need not be completed if the permit is Cor 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 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 [� 1 hereby affirm that there is a construction lending agency for the performance of (�.7 the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name z Lender's Address V C) 1 certify that 1 have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to rJ U building construction.and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (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 V Z in consequence of the granting of this permit. Date 2-2 r—� APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by: S44_�(a SOURCE REGU ONS. Re-roofs Signature ofApplicant/ContreAtor Date HAZAR19OUS MATERIALS DISCLOSURE Type of R)of Will the applicant or future building oceupantstorc 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. QYu []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 Area Air Quality Management all new In.Iterials for inspection. District? Q Yes Q No I have read the hazardous materials requirements under Chaptcr 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 met prier to issuance of a certificate of Occupancy. Signature A Applicant Date Owner or authorized agent Date All roof coverings to be Class"B"or better CITY OF CUPERTINO 8 ITEMS OF 22 PERMI" RECEIPT OPERATOR: kiersaw COPY # 1 Sec : Twp: Rng: Sub: Blh: Lot : APN . . . . . . . . . 36227014 . 00 DATE ISSUED. . . . . . . : 05/22/2007 RECEIPT # . . . . . . . . . : BS000001432 REFERENCE ID # . . . : 07050230 SITE ADDRESS . . . . . : 76'19 SQUIREWOOD WY SUBDIVISION . . . . . . CITY . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VII)YASAGAR PREM ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5054 RECEIVED FROM . . . . : A PERFECT CLIMATE CONTRACTOR . . . . . . . : SM-'TH, BYRON E LIC # 21144 COMPANY . . . . . . . . . . : A PERFECT CLIMATE ADDRESS . . . . . . . . . . : 10570 S DEANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 86119545 FEE ID UNIT QUANTITY liMOUNT 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 9, 657 . 00 1 . 00 0 . 00 1 . 00 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 . 74 0 . 00 176 . 74 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# otu�vas OWNER'S NAME: PHONE # o GENERAL CONTRACTOR: C4VK FAX # I am not using any subcontractors: i;nature Date 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 _ �'r22-oma Owner/ ntractor Signature Date