06100071 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT � VTfl#` � fT�Q .
BUILDING ADDRESS: STANFORD PLUMBING HEATING P '� ° 0 610 0 0 71
10577 FARALLONE D
PERMIT ISSUE DATE
OWNER'S NAME:
RAHN RICHARD 1965 KYLE PARK COTTET 10'
/10/2006
ONE: SANITARY NO. CONTROL NO.
(408).286-8931
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MCE—C7H
p p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:zLu with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and �;CL= REMOVE AND REPLACE FURNACE & ADD A/C
tn? License C LM•M
Contractor (/
ARCHITECTS DECLARATION
im
a< I understand my plans shall be used as public records
)WU
u.H Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
iciOoC following reason.(Section 7031.5,Business and Professions Code:Any city or county
$ti which requires a permit to construct,alter,improve,demolish,or repair any structure 8 0 0 0
?Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
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 arty applicant for a permit subjects the applicant to a civil penalty of i 0 Occupancy Type
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 Required Inspections
and Professions Code:The Contractor's License Law dos 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 arc not intended or offered for sale.It,
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
sate.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractors
License Law.
❑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:
L]I 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 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 Work ;f Compensation Insutanc,carrier and Policy number are:
Cartier. e and
No.:
CERTIFICATE O EXEMPTION FROM WORT S'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foranc hundred dollars 1$100)
or less.)
I certify that in the performance of the work for which this permit is issued,l 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"' CONSTRUCTION LENDING AGENCY
Fr►�-� I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lcndees Address
U 0 1 certify that I have read this application and state that the above information is
U3 " correct.1 agree to comply with all city and county ordinances and state laws relating to
0 V 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 anyway accrue against said City
V z in consequence a granting of th' mit. Date
►" APPLICA TAND WILL COMPLY 1TH AL NON-POINT Issued by:
SOURC AT10
Re-roofs /lam
Signatu rcamt/Contractor Do-
HAZARDOUS T Of Roof
MATERIALS DISCLOSURE Type,
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertin unit' Code,Chapter 9.12,and the Health and Safety
Cock,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
C]Yes No
Will the applicant or roturc banding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
_mit hazardous air conLarnin Vsfied by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs
I have m the,h�a�dous materials requirements under Chapter 6.95 of the Califor-
nice Health&Safct ode coons 25505,2553 and 25534.1 understand that iCthe building
docs not curie y ave tenan4 that it' y sports y notify the occupant of the
requiremen which ust be me w is a certify a,c qr�c panty. Signature of Applicant Date
l All roof coverings to be Class 'B or better
Owner or authorized Efate
CITY OF CUPERTINO wioocf7i
FURNACE/AC
OCUPEkTINO PERMIT APPLICATION FORM
APN# Date:
�31 - �- 0%
Building Address:
C �
I � --I F0Yat ( � v�-e >L
Owner's Name: C k-cu Phonel.,
Contract r/.���� � „ Phone(/():�A
I;C[ - G� I� License #:
Contact.*, (- Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect LY Plumb 0-- Mech C�--
Job Description: -� n ciC
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1St floor ❑ 2"a floor❑
Adhere to min set back requiremen
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy up:
V2
Strapped ❑ in Platform Bonded CY Sq.Ft. Floor Area:
New Location Replacement � U u
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
41 BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE 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