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06100089 CITY OF CUPERTINO BUI'sDING DIVISION PERMIT C�1 'rR�i } T��►N: BUILDING ADDRESS: AIR QUALITY HEATING & AIR V1.V ITNO06100089 20065 SOMERSET DR OWNER'S NAME: PERMIT ISSUE DATE STENGEL OTTO 714 NORTHR NE: SANITARY NO. CONTROL NO. (408)293-7138 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 � 0 00 LICENSED CONTRACTOR'S DECLARATION Job Description w1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z UJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is M in full force and effectG_ o L� � (o!' REPLACE FURNACE ? License Clads t Date Contractor t u M ARCHITECT'S DECLARATION i C.-.Cl I understand my plans shall be used as public records 1yU wy Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby alTirm that I am exempt from the Contractor's License Law for the 3 p O following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure 4749 Zy prior u)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 F $ (commencing with Section 7000)of Division 3 of Ute 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 3r0 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 Ute structure is not intended or offered tarsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of Ll 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. ❑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: J 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. J;Uhavc and will maintain Worker's Compensation Insurance,as required by Section 4700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance career and P .cy numbe"A ,,'./ - Cartier. yr ut, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I cenify 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY [~.t►�-� I hereby affirm that there is a construction lending agency for the performance of p�> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lender's Address V C) I certify that 1 have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rF; liabilities,judgments,costs and expenses which may in any way accrue against said City �j 7 U'z in consequence of the granting of this permit. Date r-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of ApplicanUContractor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yesu 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 -mit hazardous air contaminants as dcrrned by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the hazardous in requirements undcrChapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcqt i me@rs wh' must be met 'or to issuance of a Ccr(i141 A Q,11,11ca ofoec an Signature of Applicant Date Owner or authari. agent I Date All roof coverings to be Class 'B or better Community Development 10300 Torre Avenue i ✓`' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ^MkTINO Building Department JOB ADDRESS: PERMIT # D(� fx)M17�er Se�- 06( o 00 <F- �' OWNER'S NAME: e PHONE # 409 GENERAL CONTRACTOR: r ) FAX # d ej-f Qv I am not using any subcontractors: it%J Signatur 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 O er/Contractor gnature Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36932022 . 00 DATE ISSUED. . . . . . . : 10/12/2006 RECEIPT # . . . . . . . . . : 36415 REFERENCE ID # . . . : 06100089 SITE ADDRESS . . . . . : 20065 SOMERSET DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STENGEL OTTO ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : AIR QUALITY & HEAT CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791 COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON ADDRESS . . . . . . . . . . : .714 NORTHRUP ST CITY/STATE/ZIP . . . c SAN JOSE, ' CA 95128 TELEPHONE . . . . . . . . : (408) 293-7138 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 4 , 749 . 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 METHOD OF PAYMENT AMOUNT NUMBER - ---- ------------ ------------ ------------------ CHECK 164 . 78 52667 TOTAL RECEIPT 164 . 78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 601 ROOF TEAR OFF 604 ROOF IN-PROGRESS - CITY OF CUPERTINO OC.P1 o00a9 FURNACE/AC ,UPEkTINO PERMIT APPLICATION FORM APN# Date: 3 -3a- c�a Building Address:. E2eQ2�e4 Owner's Name: Phone#: Contractor: V Phone: License #- Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: Residential Commercial ❑ For Residential Mallations: Attic�lst floor 2nd floor❑ Adhere to min set back requiremm&2 'Vor Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required Cos of Project: Type of Construction: Occupancy group: Strapped 0 On Platform Bonded Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfin 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