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07100161 CITY OF CUPERTINO ` f `'� ` �7 ` BUILDING DIVISION PERMIT ��`"'�� ,::. ,>. _:. . : BUILDING ADDRESS: PERMIT NO. 1234 BUBB RD PELLE HE,ATING & AC INC 07100161 . PERMIT LSSUE DATE iER'S NAME: ALICE BAKKER 3728 C C 'HARGER PARK DR 10/22/2007 SANITARY NO. COM[ROL NO. PHONE: (408) 97��-7060 BUILDING PERMIT INEO ARCHTIECiYENGINEER: BLDG ELECI' PLUMB MECH �� 0 � 0 i p Q LICENSED CONTRAGTOR'S DECLARAT[ON JOb DeSCilptlOfl � v� 1 hcreby �rm tha� I am liccnxd undcr provisions of Chapicr 9(commcncing ; z� wiih Sccuon 70(w) of Division 3 of thc Busincss and Pro� f�� C o d c� y and my liccnse is FURNAC E C HANGE �U'1' ;� y in full force and e!f (�� O �, � � ? Licensc CI ��• � ; F p Datc Con�racwr � HITECI'S DECLARA N 7 a a 1 undcrstand my plans shall Ac uscd u public records )4U � w <<-'„ Liccnsed Pcu(cssional � y � OW NER-BUILDER DECLARATION } 1 hcrcby a17rm �hat 1 am cxcmpt Crum ihc Contraaar's Liccnsc Law Car thc � o o Coliowing reason. (Scction 7031.5. Busincss and Profcssions Ca1c: Any city or county <„° � which rcquims a pc�mit w conswc4 altcr. improvc. dcmolish, or �epuir any structucc ° Z} prior w i�s issua�c, aisu rcquims ihc applicam for such permit to filc a signcd statcmcnt Valuation �= o Ihat hc is liccnxd pursuan� to thc provisions ot ihc Comracar's Liccnsc Law (Chaptcr 9 ; iq. Ft. Floor Area $ 4 8 7 6 r E- (commcncing with Scction 7000) of Division 3 of Ihc Busincss nnd Profcssinns Codc) or y�� that he is exempt thcrcfrom and the basis (or t6e allcged exemption. Any violatlon o( Section 703I.5 by a�ry applicant Cor a pertnit subjecu the appiicant to a civil penaity of Number Oceupaney Type not morc than fivc hundred dollazs (5500). 3 6 2 11 � 5�-.�� ❑ I, as owncr of tlie property, ar my cmployces wiN wages u their solc compensadon, windo�nework ,andihesaucweeisnoiintendcdorolleredforsa�(Sec. 7044 .s�siness Required Inspections and Professions Code: The Conuacror's License Law docs not apply w sn owner of property who builds or improvu Wereon, and who does such work himself or Uuough his owa employces, providcd �Aa� such improvemenls are no[ iNen&d or o[fered Cor sala IC, hawever. Uie building or improvement is sold within one year of completion. �he owner- builder will have the burden oC proving that he did not build or impravc fo� pwpose o[ saleJ. Q I, az owner of the propeny, am ezclusively conuuting wi�h limnsed mnvactors w constnxt Uie projett (Sec. 7044. Businas and Protcttions Cade:)1Yie Convacto�s Li- cc�e Law docs not apply w an ownu o( proper[y who huilds or improves ihereon, md , who conuac�s Cor such projects with a contractor(s) liaiued pursuant to �he Convacror's License Law. � I am exempt under Sec. , B� P C for this �cason � Date _ .. _: WORKER'S COMPENSATION DECLARATION I heroby �rm under penalty of pujury one o[ the follawing declantions: ❑ I luve and will mainwin a CertiGcate of Consent lo sel(-insure (or Workefs Compen- aatian, as provided for by Section 3700 a[ che Labor Code. for the pcdormar�cc a( the woric (or which ihis permit is issued. ❑ I havc and will maintain Worker's Compensation Insunna, as �equired by Scction , 3700 0( �hc Labor Codc, Cor thc performancc of the worlc for which this permit is isqued. My Worke Compensauon Insurance carticr and Polity numbcr are: Carrier: IA��Poliry NoW C��i�[�('� CERTIFICATE OF EXEMPIION FROM WORKERS' COMPENSAT(ON INSURANCE (ihis sectian nccd not bc complcted if drc permit is for onc hundred dallars (S 100) orlcssJ 1 cenify ihat in the performance af the work [w which �his permit is issued, 1 shall not employ any person in any manncr so as w becomc subject to the Workcrs' Compensa6on Laws of Califomia. Datc Applicant NOTICE TO APPLICAM: l[, afYcr making Ihis CcniGca�e o( F.�ccmpuon, you should become suAject to �he Worlcer's Compensation provisions of �he Labor Code, you muu �,Z foMwith comply with such provisions or this pccmi� shall bc dcemcd revakcd. Z O CONSTRUCTION LENDING AGENCY (-�-i � 1 here6y affirm that there is a consuuctian knding agenry for the perCormance uf _ �., � thc work far which ihis permit is issucd (Scc. 3097, Civ. C.) W Q Lendcr's Narnc � = z L.cnder's Address V � I cenify �hat I have rcad this applicuion and sutc that thc above infortnatiun is w �-" cortcct. 1 agrce �o comply with alI city and county onlinances and sute Iaws rcla�ing to � U bui]ding conswction, and heteby authori�c represen�atives of Ihis city to enter u{xm ihc � w alwvo-mcntioncd pmperry fot inspccuon purposes. a (We) agrce to save, indcm�ify and kccp harmless Ihe Cily o( Cupertino against E' � liabilitiu, judgmcn�s, costs and ezpenscs which may in any way accrue against said City (,j z in conuqucnce of thc granting of this permit.� D3LE I� � 1 �' —J � �+ APPLICANT UNDERSTANDS ANi1YiLL COMPLY WITH AL NON-POINT Issued by: TlONS. / r ' � n ,� l , �� `�t v Re-roofs � Sign pplidnUConu or �a� T of Roof � HAZARDOUS MATERIAIS D[SCLOSURE y� Wil( the applicant or futurc building accupantstore or handk Aarardous marcrial dcfined by thc Cupenino Municipal Codc. Chap�cr 9.I2, md Nc Hcatth and SaCety xlc, Section 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Y� �° , Will thc applicant or futurc 6uilding occupan� usc cquipment or dcviccs which If a roof i� installed without first obtaining an inspection, I agree to remove cmit ha'r.ardous air conlaminants az dcfincd by thc Bay Arca Air Quslity Managcmcnl all new m aterials for inspecr.ion. asv�� ❑ Ycs Nu 1 havc rcaJ the ha�arGcws matcrials rcquiremcn�t undcrChaptcr 6.95 o(�hc Califor- nia Hcalth & Safcty Codc, Scctions 25505.2553 and 75534. l undcrs�v�d that iC ihe 6uilding y �� lly havc a Icnan�, that i' y ccsponsibilily m notify �hc occupant nf Uic rc u n�s ' h uu be m ' u �ssumc f a Ccnifica f �� Signature of Appl icant Date All roof coverings to be Class "B" or better Owncr or wihorizcd agcnt �� . � ��--- � c� �s��- , - , � ,. , �1c��i�� < <�> CITY OF C'UPERTINO �`�.:�:� _� F� ��/d��:` ��t�� PERMIT APPLJ[CATION FORM Date: APN # � �Po� 1 � � � I � i,f� (,� G'� Building Address: 1 a.�� b� T�� . Owner's Name: Phone #: /�1 C G� �, ��L.�,� Q•C� �. ��-c co. � rl �' ` Contract : s � � License #��. O � � �-�«� �,��1 � Contact: , , Cupertino Business License #: `�..JcL ( e✓ i� G tn v i �,-1-G� �J �✓ �- � S`1 3 Building Permit Info: Bld ❑ Elect �� ' 1'lumb � Mech � / Job Description: �ti1, ✓ Y�GL �/� ��L � % v w ��1� Residential Commercial ❑ For Residential I st llations: Attic � 1 St floor � 2" floor � Adhere to min set back re uirement �. For Commercial Installations: Replacement same weight ❑ Additional weight (s :ructural calcs) � Siructural Calculations required for new installation � New installation Plannin A roval Re uired Cost of Project: p Type of Construction: Occupancy group: 4 O t .� �� ! w �� Strapped ❑ On Platform � Bonded C1 Sq.Ft. Floor rea: New Location � Re lacemen� Qty. if Applicable Fee ID Fee Description Fee Group BENERGY F;ner y BUILDING BREMFURN F:elocation of Furnace MECHANICAL BREMACOVER E�/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN f,/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE P✓Iech Permit Issuance MECHANICAL PPERMITFEE I'lumbin Permit Issue PLUMBING BPERMFEE 131d Permit Fees BUILDING BPLANCHK 1'lan Check Fee BUILDING BUSLIC Business License BUILDING � CITY OF CUPERTINO 6 ITEMS OF 6 PERMI`[' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN .... ..... 36:?11051.00 DATE ISSUED.......: 10�22/2007 RECEIPT #.......... BS)00003047 REFERENCE ID # ...: 07L00161 SITE ADDRESS .....: 1234 BUBB RD SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OWNER ............: AL:CCE BAKKER ADDRESS ........... 1234 BAKKER CITY/STATE/ZIP ...: CU:?ERTINO CA, 95014-4966 RECEIVED FROM ....: V �t CHRISTENBERRY CONTRACTOR .......: ST:�VE PELLE LIC # 27593 COMPANY ..........: PE:�LE HEATING & AC INC ADDRESS ..........: 37;?8 C CHARGER PARK DR CITY/STATE/ZIP ...: SA]1 JOSE, CA 95136 TELEPHONE ........: (4)8)978 FEE ID UNIT QUANTITY .�MOUNT. PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMFURN NO LTNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 4,876.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 172.04 0.00 172.04 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 172.04 VISA --------------- TOTAL RECEIPT : 172.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development �� '� 10300 Torre Avenue � �� ' Cupertino CA 95014 ;as� Telephone (408) 777-3228 , CITY OF Faz (408) 777-3333 CUPEI�,TINO Buildin De artment JOB ADDRESS: PERMIT # f�Z3 � Q �. �`�1 � U C 6( OWNER'S NAME: ,,;�r- ;z�- � PHONE # �8 �t'1 g ."ficscva GENERAL CONTRACTOR: �,tG �� S .� FAX # � g � �'1$ -�fR �C� I am not using any subcontractors: �� Si Date Please check a licable subcontractors and com �lete the followin inforniation SUBCONTRA.CTOR BUSIr1ESS 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/Contr ctor Signature Date