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06100216CITY OF CUPEKIIINU BUILDING DIVISION PERMIT BUILDING ADDRESS: CONDITIONED AIR PERMIT NO - 06100216 20115 SUISUN DR PERMIT ISSUE DATE OWNER'S NAME: JEAN WITT 1701 LITTLE ORCHARD ST 10/31/2006 SANITARY NO. CONTROL NO. NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. # Datc s A / 1 Contractor ARCHITECTS DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 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 prior to its issuance, alsu 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 (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 ($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 and Professions Code: The Contractor's License Law docs root 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, i 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 U - 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 z O Z � r.a W? a„ A �z UO w� OU U I hereby affirm under penalty of perjury one of the following declarations: ] 1 have and will maintain a Certificate of Consent to self -insure for Workces 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 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. q Policy No.: % 1 �CERT1 CT F EXEM ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 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 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 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name L.endces Address I certify that I 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 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 of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature f Applicant/ ntrac Dale C HAZARDOUS MATERIALS DISCLOSURE 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 Code, Section 25532(a)? ❑ Yes , rNo— Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as dcftncd by the Bay Area Air Quality Management District? ❑ Yes p No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cock, Sections 25505, 25533 and 25534. I 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 poor to issuW of a Certificate of Occupancy. ^ Date (408)291-2220 Job Description BUILDING PERMIT INFO ELECT PLUMB MECH REMOVE AND REPLACE FURNACE AND ADD A/C Sq. Ft. Floor Area Required Inspections Issued by: Re -roofs Type of Roof I R Valuation Type Date /Q 7 /�/V 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 -.UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department .:... 21 SUBCONTRACTOR BUSINESS NAME VOLUMINOUS go WAr 61 I am not using any subcontractor . l ignature Dat Please check applicable subcontractors and complete the following information: Aikt� LLO ,� 1-4fa Ow!Ker/ContractiWSignature Date 21 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 Roofin Sep ' Tank eet Metal Sheet Rock Tile Aikt� LLO ,� 1-4fa Ow!Ker/ContractiWSignature Date CITY OF CUPERTINO ,m 2 of 2 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36928008.00 DATE ISSUED.......: 10/31/2006 RECEIPT #.........: 36616 REFERENCE ID # ...: 06100216 SITE ADDRESS ...... SUBDIVISION ....... CITY .............. IMPACT AREA ....... OWNER ............ ADDRESS .......... CITY/STATE/ZIP ... 20115 SUISUN DR CUPERTINO JEAN WITT OPERATOR: amyw COPY # : 2 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 ---- 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 2,700.00 0.50 0.00 0.50 0.00 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 ---------- ---------- TOTAL PERMIT ---------- 176.24 0.00 176.24 0.00 METHOD OF PAYMENT AMOUNT NUMBER -------------- ----------------- ------------ OTHER 341.02 VISA TOTAL RECEIPT 341.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL iviDrryNn � OLO, C)D2� U CITY OF CUP FURNACE/AC JPERTINO PERMIT APPLICATION FORM Date: I I.3l�O�O FBuild;in-- g Address: s Name: o�act n � 0� Cupertin i Contact• Phone: Building Permit Info. Bld ❑ Elect Plumb Mech J escription. rFor idential Commercial ❑ R dential Installations: ic 1 Sc floor ❑ 2nd floor ❑ lh ere to set back requirement .)r Commercial Installations: Replacement same weight �K, Additional weight (structuralcalcs) 11StructuralCalculations requirefor new installation New installation Planning Approval Required I Occu Cost of Project: Type of Construction: I D O Sq.Ft. Strapped On Platform Bonded New Location Replacement Qty. if Fee Description Fee ID BENERGY BREMFURN BREMACOVER BREMAIRHAN BREMRECEPT BSEISMICRE BSEISMICOM MpERMITFEE PPERMITFEE BPERMFEE BPLANCHK BPGAS BUSLIC Furnace A/C Unit > 10,000 cfm A/C Units <=10, 000 cfin Recptl, Switch & Outlets Seismic Fee Res Seismic Commercial Elec Permit Issuance Mech Permit Issuance Plumbing Permit Issue Bldg Permit Fees Plan Check Fee.: Gas Piping System Fee Business License License #: I P: Area: Fee Group BUILDING MECHANICAL MECHANICAL MECHANICAL ELECTRICAL BUILDING BUILIDNG ELECTRICAL MECHANICAL PLUMBING BUILDING BUILDING PLUMBING BUILDING