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09070088 CITY OF CUPERTINO B,ILDIN'G DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10455 HENEY CREEK PL RMI MECHANICAL CONTRACTORS VNER'S NAME: PERMIT ISSUE DATE egg PHON A 2=TL4 A O. CONTROL NO. (650) 5:33-6200 ARCHITECIYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 a o a O p LICENSED CONTRACTOR'S DECLARATION MC I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z w with Section 7000)of Division 3 of the Business and Pro/feLssi�ons and my license is H in full force and effect ? I(V ADD AC iLicense Class Lic.N ✓ r v p DamContractor 3W RCHITECTS DEC RATION 1 understand my plans shall be used as public records D U C Licensed Professional yOWN" R-BUILDER DECLARATION < 1 hereby affirm that 1 am exempt from the Contractor s License Law for the in O following reason.(Section 703 1.5,Business and Professions Code:Any city or county K$V which requires a permit to construct,alter^improve,demolish,or repair any structure n zprior to its issuance,also requites the applicant for such permit to file a signed statement _< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 5q.Ft.Floor Area Valuation yt—$ (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or 7 8 4 5 y 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 APN Number Occupancy Type not more than five hundred dollars(5500). 34248015) . 00 0 I,as owner of the property,or my employers 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.). 0 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 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. 0 1 am exempt under Sec B&P C for this reason twner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insum 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. 0 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 Workneees co_�m"/�p�nsayyf��ioltn,,IInsur�a,n cam�/�,r and Polity numbers/C{, Carrier I'ZI L/Jfzi��/ `PoliryNo.: ��✓� CERTIFICATE OF EXEMP 7ON 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 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 [~- Q1 1 hereby allirm that there is a construction lending agency for the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) OWi Q Lender's Name ]z Lender's Address V 0 I certify that I have read this application and state that the above information is 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 upnn the a above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permitDate y 1"4 APPLICANT UNDERSTANDS D Wl LY WITH ALL NON-POINT Issued b Q g SOURCE E LA 0 - Re-roofs S' APplicant/Cm to Difte R�Of H ARD S 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 'ode,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof i:,installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? 0 Yes <No 1 have read the hazardous materials requirements under Chapter 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 ten at it is responsibility to notify the occupant of the rcgni a df which tprior -fncateofOccu © Signature AApplicant Date V -7mraotnmri ate All roof coverings to be Class'%"or better CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk:: Lot: APN . . . . . . . . : 34248016 . 00 DATE ISSUED. . . . . . . : 07/ 08/2009 RECEIPT #. . . . . . . . . : BSC00008155 REFERENCE ID # . . . : 09C70088 SITE ADDRESS . . . . . : 10455 HENEY CREEK PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CYNTHIA SMYTH ADDRESS . . . . . . . . . . : 10455 HENEY CREEK PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0828 RECEIVED FROM . . . . : MIC'HAEL BRIGHT CONTRACTOR . . . . . . . : RONALD MATRICI LIC # 30650 COMPANY . . . . . . . . . . : RMI MECHANICAL CONTRACTORS ADDRESS . . . . . . . . . . : 13E5 LOWRIE AVE CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080 TELEPHONE . . . . . . . . : (6E.0) 583-6200 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 845. 00 1 .00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 7, 845. 00 0 .80 0 . 00 0.80 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00 1MRRAA UNITS 2 . 00 126 . 00 0 . 00 126 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 295 . 80 0 . 00 295. 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 295 . 80 visa --------------- TOTAL RECEIPT 295 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue "bq,. i Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: H� Wg;CUX- - PERMIT# �o � � V OWNER'S N :G• iGi. 5'^ PHONE # 6 -3 ' zo© GENERAL CONTRA TOR: FAX # 65 O S 3g/// I am not using any subcontractors: -7 Zcq i, tore 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 C UPERTINO FURNACE/AC CUPEkTINO PERMIT APPLIC"ATION FORM APN # ; Date: 34C Building Address: 1 Ii 5 1 roc Ger Own 's Name: Phon #: Contractor: Phone #: U2 UV I C�Yt� ( C_ -rte Fax#:U Contractor License #: Cupertino Business License #: Contact: Phone #: (fir S el (_ Y n—Tv1 l 'm �Y�t �/ � � Fax #: Building Permit Info: Elect ©/ Plumb Mech Residential Commercial ❑ Job Description: H dl d F�- For Residential Installations: Attic ❑ 1 st floor 2"a floor ❑ Adhere to minimum setback requirement El For Commercial Installations: Replacement same weight ❑ Ac ditional weight(structural calcs) ❑ Structural Calculations required for new installation [] New installation Planning ApproXal Re uired ❑ Cost of Project: A74gtfs 0 Type of Consti uction (Usage Class): Strapped El On Platform 5� Bonded [] New Location F1 Replacement Project Size: Express ❑ Standard &F Lar e ❑ Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. j Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CUPEk INO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,at,sorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for t1te repair of alt/add to M ea heating appliuce,refrigeration unit,cooling unit,'17AV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of conlrols regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for e a gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not in-,1 in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,abso:ption unit,or ea heating,cooling,a)sorption or evaporative cooli Zg system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Instal l/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FUP24ACE/AC COF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not ir.cl in an appl permit. FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES r 1BSEISMICR Residential Se.smic B 1 MECPLNCK Mechanical PI in Check M 1MFR=<100 Furnace Syst =100k BTU install or M relocate ea for.ed-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include l 00,OC 0 Btu/h 1MFRN>100 Furnace Syst 100k BTU install or M relocate ea forged-air/gravity type furnace/burnet, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permi:Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P ITRAVDOC Travel Documentation B 1BUSLIC Business License B