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06100204CITY OF CUPER1llV ) BUILDING DIVISION PERMIT BUILDING ADDRESS: OWNER'S NAME: RALPH QUALLS NE: ARCHITECT/ENGINEER: p O LICENSED CONTRACTOR'S DECLARATION V P 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 70(10) of Division 3 of the Business and Professions Code, and y license is h y in full force and effec , Licen Mass Lto• 8 p Date V Contractor F r ECCS DECLAR I i a.� � I understand my plans shall he used as public records >yU C h Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 3 no 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 structum y prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 t, (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 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 and Professions Code: The Contractor's License Law docs not apply to an owner of 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 tic did not build or improve for purpose of sale.). Q 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. Q 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- i4hir( as provided for by Section 3700 of the Labor Code, for the performance of the lvorjrfor which this permit is issued. 7ilhave 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. y Worke m tion Insu cc carric and Policy number are: Carrier. olicy No.: 6 RTIFICATE OF EXEM ON FROM ORKERS 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. 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 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.) Lender's Name Lendees Address 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 building construction, and hereby authorize representatives of this city to enter upon the 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 in consequence o granting of this permit. APPLICA AN' AND WI COMPLY WITH ALL NON -POINT SOUR?!E O L C, 12 c (p Signature of Applicanor Dific HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mimicirral Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Yes ko 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 District? ❑Yes�./ih� 1 have read the hazardous materials requirements under Chapmr6.95 of the Califor- nia Health & , Sections 25505, 25533 and 25534.1 understand that if the building docs not cu t ave a tenan t it is my responsibility tonotify the occupant of the require i must et prior to i cc of a Ccrufica f Occupancy. (� \ Owner or authorized agent Date S 1. TANFORD PLUMBING HEATING 9NIW-06100204 1965 KYLE P (408)286-8931 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. Job Description REPLACE FURNACE AND.ADD A/C Sq. Ft. Floor Required Inspections Issued by: Re -roofs Type of Roof BUILDING PERMIT INFO • m e Valuation Type Date /C> - Z 7- l All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36230097.00 DATE ISSUED.......: 10/27/2006 RECEIPT #.........: 36598 REFERENCE ID # ..: 06100204 SITE ADDRESS 7482 SHADOWHILL LA SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER RALPH QUALLS ADDRESS ........... CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: ATLAS TRILLO CONTRACTOR .......: TRILLO, STEVE LIC # 4269 COMPANY ..........: STANFORD PLUMBING HEATING &AIR ADDRESS ..........: 1965 KYLE PARK COURT CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)286-8931 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW ---------- -- BAL ----------------------- 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 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 6,000.00 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 38.370.00 ---------- 38.37 -------------------- 0.00 TOTAL PERMIT ---------- 176.34 0.00 176.34 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------------ ----------------- ------------ CHECK 176.34 8248 TOTAL RECEIPT 176.34 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL aITYF c:UPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM cc,,) 1Q)2,o� APN # , 3d��l Date: Building Address: BREMFURN Owner's Nam V AGS L l l � Phone #: --1 )-/ (P . � Contractor:0 Yv C Phone: �3 � ^ o j l t,License (� J l A/C Unit > 10,000 cfm Contact: Phone: Cupertino Business License #: U U MECHANICAL BREMRECEPT Recptl, Switch & Outlets Building Permit Info: BSEISMICRE Bldg ❑ Elect Plumb Mech Job Description: , � 4 Seismic Commercial Residential Commercial % EPERMITFEE MPERMITFEE For Residential Installations: Attic ❑ 1St floor ❑ 2nd floor ELECTRICAL MECHANICAL Adhere to min set back requirement Plumbing Permit Issue For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ BPERMFEE Structural Calculations required for new installation ❑ BUILDING New installation Planning Approval Required ❑ Plan Check Fee Cost of Prect: Type of Construction: ' Occupancy grou . C�-- "(.)0 v PLUMBING Strapped On Platform . Bonded Sq.Ft. Floor Area: BUILDING New Location Re lacementp Qty. if wn_m a W FPP T)Pccrintinn Fee Group t�t.iYii\IQU16 1 VV iY BENERGY - - - - Energy - BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG % EPERMITFEE MPERMITFEE Elec Permit Issuance Mech Permit Issuance ELECTRICAL 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