09070072 CITY OF CUPERTINO Y
BUILDUG DIVIS1nN PERMIT
BUILDING ADDRESS: PERMIT NO.
10439 BONNY DR LEFCO INC
'NER'S NAME: PERMIT ISSUE DATE
PHONE: S A CONTROL NO.
(408) 732-5510
ARCHITECI7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
IZ with Section 7000)of Division 3 of the Business and Professions Code,and my license is
y in full force andeffegLC�v $3g l ,� REPLACE EXISTING FURNACE AND ADDING AC
Claw C Lic
? License f .S
•• Date -71-1 hq Contractor
t- ARCHITECTS DECLARATION LW
a< I understand my plans shall he used as public records
�0.
4 C in Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
i p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K$ which requires a permit to construct.alter,improve,demolish,or repair any structure
y Z prior to its issuance,also requires the applicant ror such permit to file a signed statement
=C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area Valuation
Y.H$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4485
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($500). 35913013 . 00
❑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 Conuactoes License Law docs 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.).
❑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 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
ner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workees Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
kI have and will maintain Worker's Compensation Insurance,as required by Section
3 of the Labor Code,for the performance of the work for which this Permit is issued.
My Workers Compensator Insurance carticr and Polity number are:
Carrier. c1h tW1_ Policy No.:
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
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
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z R CONSTRUCTION LENDING AGENCY
Er tom. I hereby affirm that there is a construction lending agency for the performance of
(Yr the work for which this permit is issued(Sec.3097,Civ.C.)
Q Lender's Name
]z Lenders Address
U C) I certify that I have read this application and state that the above information is
[L�" 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
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
C4 liabilities,judgments,costs and expenses which may in any way accrue against said City
U 2 in consequence of the granting of this permit. Date
t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
34
SOUR S� _2/ loq
1 Re-roofs
Signature of"ApplicantlContractof 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
de,Section 25532(a)?
C3 Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminaZtsdefined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 undersmd that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requiremen m t pato issuance of a Certificate of Occupan Signature t)f Applicant Date
All roof coverings to be Class's} `'or better
Owner or authorized agent Dare
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot :
APN . . . . . . . . : 35S13015 . 00
DATE ISSUED. . . . . . . : 07/07/2009
RECEIPT #. . . . . . . . . : BSC00008147
REFERENCE ID # . . . : 09C70072
SITE ADDRESS . . . . . : 10439 BONNY DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : COISNELLY SUSAN E
ADDRESS . . . . . . . . . . : 10439 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2907
RECEIVED FROM . . . . : TOLD LEFFLER
CONTRACTOR . . . . . . . : WILLIAM J LEFFLER JR LIC # 26676
COMPANY . . . . . . . . . . : LEFCO INC
ADDRESS . . . . . . . . . . : 69E E TAYLOR AVE
CITY/STATE/ZIP . . . : SUISYVALE, CA 94085
TELEPHONE . . . . . . . . : (4C8) 732-5510
FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 485. 00 1. 00 0.00 1. 00 0 .00
1BSEISMICR VALUATION 4,485. 00 0 .50 0 .00 0 .50 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 .50 0 . 00 295. 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 295 .50 master card
---------------
TOTAL RECEIPT 295.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
14
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPE�TINO
Building Department
JOB ADDRESS: 1 PERMIT#
OWNER'S NAME: S',kson PHONE # c10&7
GENERAL CONTRACTOR: l_jj��FcD \ac, FAX # L`io Q. -13;� -'Zi0 8 C�'
I am not using any subcontractors:
Si;;natur 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
} U` CITY OF CUPERTINO
FURL ACE/AC
OF
CUPEkTINO PERMIT APPLICATION FORM
0 967DQ72.
APN # 13 O l5, �J��` Date: �I–T-) I
Building Address:
Owner's Name: Phone#:
Contractor: Phone#:
UEFCC> NC Fax#:
Contractor License#: Cupertino Business License#:
13 3`A
Contact: Phone#:
Fax#:
Building Permit Info:
Elect Plumb Mech
Residential IX
Commercial LJ
Job Description:
1-� 'ac1y\ eM4% ��CCC
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor ❑
Adhere to minimum setback 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 Ccnstruction (Usage Class):
Strapped On Platform - Bonde 10–' New Location E- Replacement[�—
Project Size: Express Standard❑ Large [] Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable,inclu de in plan set& the sheet index.
Revised 01/07/09
m
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Deseript.on Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A IC Units<= l Ok CFM B
1 MCRAA Commercial N ech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICO Seismic Commercial B
1 PGASCOM Commerical fc r ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outle.. Comm/Resid
1 BREMAIRHAN Residential A/,'- units <= l Ok CFM B
/ 1 MRRAA Residential ME ch Repair/alt/add M
/ 1 BCBSC Cal Bldg Stancards Commission Fee B ALL PERMIT
I TYPES
1 BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
I
1 TRAVDOC Travel Docum,;ntation B
1 BUSLIC Business Licer se B