06100138 CITY OF CUPERTINO7777777777
BUILDING DIVISION PERMIT +C� 'JCjEQR E?R . 4T�€)N:
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BUILDING ADDRESS:1674 S STRTJ,TNr4 Rn AAA FURNACE & AIR CONDITIONING 06100138
OWNER'S NAME: PERMIT ISSUE DATE
MARIE CANTLEY
)NE: SANITARY N
C NTROL NO.
4
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� 0
O O LICENSED CONTRACTOR'S DECLARATION
III I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z w with Section 7000)of Division 3 of Ute Business and Professions Code,and my license is
!=H in full force and c tett
License Class Lic.x REPLACE FURNACE 8 0 0 0 0 B TU
F a Datc Contras r
A HITECTS DECLAR O
a.
U ` 1 nderstand my plans shall be used as public records
o y Licensed Professional
h rq OWNER-BUILDER DECLARATION
j< I hereby affirm that I am exempt from the Contractor's License Law for the
D O following reason.(Section 7031.5,Business and Professions Calc:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
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
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 3, pfpr. 0 0 Occupancy Type
not more than five hundred dollars(5500).
❑1,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 does not apply to an owner of Required Inspections
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 Cale:)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.
❑1 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:
t]1 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.
❑1 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:
Cartier. n t g Policy No.: 4 1 4 27 �1
-CMTIFICATE OF EXEMPTION FROM R CERS'
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
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
z '"" CONSTRUCTION LENDING AGENCY
E-t►�-� I hereby affirm that there is a construction lending agency for the performance of
(Y the work for which this permit is issued(Sec.3097,Civ.C.)
Wi. Q
Lender's Name
a z Lender's Address
U 0 I certify that I have read this application and state that the above information is
k,r-' correct.I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
Rr (We)agree to save,indemnify and keep harmless the City of Cupertino against
,may to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCE REGULATIONS.
Re-roofs
S' re f App r ano for J 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
Code,Section 25532(a)?
❑Yes ?turc
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orbuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
No
1 have read the hazard us materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty 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 or the
req rements.�which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date
/0 fzi-4
caner or authorized agni Date All roof coverings to be Class "B"or better
Community Development
570
pkaw. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
flffkTINO
Building Department
JOB ADDRESS: PERMIT #
S-- �~ -l's C l a 3
O R S NAME: L C A PHONE # ate- WE2-- J,492
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: ��-
Sighature 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
em 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36624043 . 00
DATE ISSUED. . . . . . . : 10/18/2006
RECEIPT # . . . . . . . . . : 36486
REFERENCE ID # . . . : 06100138
SITE ADDRESS . . . . . : 1674 S STELLING RD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MARIE CANTLEY
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE (408) 293-4717
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 3 , 500 . 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
0kvICD � 38
a ' FURNACE/AC
:UPEkTINO PERMIT APPLICATION FORM
APN# a4 C93Date:
Building Address:
/6 Phone#:
Owner's Name:
Co tractor: Phone: License#:
PF 71
Contact: Phone: Cupertino Business License#:
L
�,wZE
Building Permit Info:
Bldg ❑ Elect L'`� Plumb Mech
Job Description:
u
Resi [inti al Commercial ❑
For Residential Installations:
Attic ❑ 1 st floor EK 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of`action: Occupcy group:
Strapped ❑ On Platform ❑ Bonded L'J_ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
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