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06100215 CITY OF CUPERTINO au1LD1Nc DIVISION PERMIT it WE� � I� BUILDING ADDRESS: CONDITIONED AIR PERMIT NO. 06100215 6389 COTTONWOOD CT OWNER'S NAME: PERMIT ISSUE DATE TATEINA KOSOUICHEUZ 1701 LITTLE _RCHARD ST 10/31/2006 H NE: SANITARY NO. CONTROL NO. (408) 291-2220 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z w with Section 70(1))of Division 3 of Ute Business and Professions Code,and my license is =y in full force and cf[ t. REMOVE AND REPLACE FURNACE t ? License Class '_0 Lic.k t Date Contractor ARCHITECTS DECLA A 10 i a< I understand my plans shall be used as public records >yU aLy Licensed Professional 'H OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 'CO 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 $2700 Z} prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation H$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or IRE 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 r U U Occupancy Type not more than five hundred dollars($500). ❑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 Trot 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 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 Contractor's Li- cense Law docs 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 Sec. B St P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L7 I have and will maintain a Certificate of Consent to self-insure for Workers 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 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. TU a:hQ-QM ,j2 kse s i k0licy No.:.0%f=S69�—l� CERTIFICATE OF EXEMVMN FROM WORKERS' COMPENSATION INSURANCE (This section meed 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 t" CONSTRUCTION LENDING AGENCY (�- I hereby affirm that there is a construction lending agency for the performance of Q!. the work for which this permit is issued(Sec.3097,Civ.C.) WCL. A Lender's Name z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is w r—' correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building conswction,and hereby authorise representatives of this city to enter upon the Uabove-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 U Z in consequence of the granting of this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /L SOURCE REGULATIONS. 10•31.0 G Re-roofs Signora ApplicantKofitracW Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the 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 Cotte,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 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 dcrrned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �Nu 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the quirements which must be met to issuance of a Certificate of Occupancy. Signature Of Applicant Date 44'� I '' t ' oz All roof coverings to be Class"B"or better re Orixcd agent Date Community Development 10300 Torre Avenue #` ' Cupertino CA 95014 Telephone(408) 777-3228 CIV OF Fax(408)777-3333 UPEkTIN0 Building Department JOB ADDRESS: PERMIT # OWNER'SNAME:AME: '3PHONE # GENERAL CONTRACTOR: yj I y- FAX # 14 I am not using any subcontractors: 6 Signature D Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINES ICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Me , Painting/ Wallpa r Paving Plastering Plumbin Roo ' Se c Tank eet Metal Sheet Rock Tile ��j- 0/ Io • 31-0G Owner Co actor Signa e Date CITY OF CUPERTINO 2m 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 36918015 . 00 DATE ISSUED. . . . . . . : 10/31/2006 RECEIPT # . . . . . . . . . : 36616 REFERENCE ID # . . . : 06100215 SITE ADDRESS . . . . . : 6389 COTTONWOOD CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER . . . . . . . . . . . . : TATEINA KOSOUICHEUZ ADDRESS . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE,' CA 95125 TELEPHONE . . . . . . . . : (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - -- - - - -- - - --- - - --- - - - ----- ----- ---- - ----- ---- ------ -- ---- --- - ------ ---- BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 2 , 700 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 -- -- ---- -- -- - -- ----- - --------- ---- -- -- -- TOTAL PERMIT 164 . 78 0 . 00 . 164 . 78 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 CITY OF CUPERTINO Olp��2t FURNACE/AC UPEIZTINO PERMIT APPLICATION FORM APN# 369 . I ? • O Date:\V5 Lo Building Address: C Co A-1�va.n c000k Owner's Name: Phone#: Li Contractor: Phone: License S I6 Contact: Phone: Cupertin Business License#: Lf Building Permit Info: Bldg ❑ Elect 0-- Plumb L'� Mech Job Description: (+��1 ��0 v ResidentialcEg_ Commercial ❑ For Residential Ins allations: Attic ❑ 1"floor El 2nd floor❑ Adhere to min set back requirement❑ ar Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Proje t: Type of Construction: Occupar. y group: Strapped On Platform Bonded Sq.Ft. F or Area: New Location ❑� R lacementcQ Qty. if Applicable Fee ID Fee Description Fee Gro u BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cf n MECHANICAL BREMRECEPT Recptl, Switch&Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MP ERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee., BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING