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09010029 CITY OF CUPERTINO BUILDING DIVISION PERMIT 11' T CT R M- MOM BUILDING ADDRESS: PERMIT NO. 672 STENDHAL LN WM LIPP HYDRONTCS 0901 0029 OWNER'S NAME: PERMIT ISSUE DATE PHO E: J. PEQP-AESQ. SXNWAInefCONTROL NO. (650) 327-1943 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB 0 a O p LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description U 0 with Section 7000)of Division 3 of the Business and Professions Code,and my license is a y in full force and effect �,�3 RMV EXT &REPLCE BOILER W/NEW 80, OOOBTU 92%EFFICNT 4 License Lie.N n F p Datc Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records 7yU p w Licensed Professional n OWNER-BUILDER DECLARATION I hereby atTirm that 1 am exempt from the Contractors License Law for the in C following mason.(Section 7031.5,Business and Professions Code:Any city or county K$Pi which requires a permit to construct.alter,improve,dcmoiLah,or repair any structure y Z prior to its issuance,also requires the applicant for such permit to file a signed statement F_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of $3800 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(m). 37540032 . 00 ❑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 oroffered for safe(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law docs not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements ate 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 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 Contractors License Law. ❑1 am exempt under Sec B&P C for this reason OwnerDate 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 Workers Compen. an,as provided for by Section 3700 of the Labor Code.for the performance of the ..ork 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 Workers Compens 'on Insurance carrier and Policy number�am: Cartier a Policy No.:a(2 144 66 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 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so at to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Ccrtificatc 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 [~+ I hereby affirm that there is a construction lending agency for the performance of .7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Z Landers Address U C) I certify that 1 have read this application and state that the above information is LL.O' correct.I 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 W above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against r..t Cn liabilities,judgments.costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. J ►"I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR REGULATIONS. 1 �in,�f�/ Re-roofs — Si ature of Applican ontractor 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(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes INo Will the applicant or fur re building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove nit hazardous air contamman as defined by the Bay Area Air Quality Management all new materials for inspection. trict? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,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 of the requiremen which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date 1l`yloll All roof coverings to be Class'JW'or better Owncr authorized agent- `� Date' CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 37540032 . 00 DATE ISSUED. . . . . . . : 01/08/2009 RECEIPT # . . . . . . . . . . BS000006927 REFERENCE ID # . . . : 09010029 SITE ADDRESS . . . . . : 672 STENDHAL LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . ANIL J. DEORA ESQ. ADDRESS . . . . . . . . . . : 672 STENDHAL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WM LIPP HYDRONICS I CONTRACTOR . . . . . . . : LIPP, WM J LIC # 21986 COMPANY . . . . . . . . . . : WM LIPP HYDRONICS ADDRESS . . . . . . . . . . . 745 2ND AVE CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94063 TELEPHONE . . . . . . . . : (650) 327-1943 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BBOILERI NO OF BOILER 1 . 00 91 . 79 0 . 00 91 .79 0 . 00 1BCBSC VALUATION 3, 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00 1PPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 256 . 45 0 . 00 256 .45 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 256.45 #19975 --------------- TOTAL RECEIPT 256.45 CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: ®02 c' � O� Building Address: t)-4d, 54(ercAbal L-c)- n- 6W-e(- ' o A- '�SCS t Mailing Address (if different from building address): Owner's Name: r eo Phone f #: U Contractor: Pp y ron i cs> loc . Phone: S(,�_`?�'; 4- 19 H3 :Tq,� 5econcl�Ave Ce4 `7 d� Fax: � SCS—� r Contractor License#: 3 Cupertino Business License#: (0 Contact:TI-C7 fPso` 4q V if fe Phone: 6�-u `{L/3 Fax: _ 1 —CJ 6- Residential Residential Commercial ❑ Job Description: S�j Cw to °��,`, �'�' c;c'�7t I�u�1 ch K;✓1 �: ' � �.eri-10 Ve �?� � ��-, n� }- ��ort e �`'�'1ew o►?-e cry'- ��vim► l Building Permit Info: Bldg [U�-. Elect C Plumb B------ Mech D' Type of Construction(Usage Class): Occupancy Type: 1-A 1-B II/III/V-A II/III B, IV-HT, V-B 1_ Valuation: Square Footage: Project Size: Express [ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreep.org Revised 10/20/08 1. acF CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 BBOILER 11 GENCOM For the installation or relocation of ea M boiler/compressor to &including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw) 1BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea abso tions s over 100,000 Btu/h 1 BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h 1BBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1 BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1 BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1 ELECINSP Other Electrical Inspections (per hour) E 1 MECHINSP Other Mechanical Inspections(per M hour) 1PLMBINSP Other Plumbing& Gas Inspections P (per hour 1 MEETING 1 HR Application Meeting B CITY OF CUPERTINO Cin OF GENERAL BUILDING APPLICATION . CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E I 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P r 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1 TRAVDOC Travel &Documentation B IBUSLIC Business License B 5 of 5 Community Development 10300 Torre Avenue U1." Cupertino CA 95014 J Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS:6 7a --�y �,a,J L g n e PERMIT # 001 OWNER'S NAME: r -*MV,s /4y,',, ) ocorr , PHONE # ; — GENERAL CONTRACTOR: FAX #G S 1 q I am not using any subcontractors: 110, Signature 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