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07100170 CITI' OF CUPERTINO C�.3�1'I'k� �Ti I��`�R��TIf�l�f : BUII,DING DIVISION PERMIT :: _: _ -_ .: ;. :. _ . PERMlT NO. BUILDING ADDRESS: 7(� Fi ri �l CT-IF'�� 7c TTZ�� ER'S NAME: YOLANDA A �. CONTROL NO. PHON . BU►LDING PERMIT INFO ARCHITECT/ENGINEER: BLDG E(.ECT PLUMB MECH � 0 0 C� > p LICENSED CONTRACTOR'S DECLARATION JOU DCSCTlPt10❑ � r' I hcrcby affirm �hal ( am licenscd undcr provisions of Chap�cr 9(commcncing ; V wi�h Sccuon 700()) of Division 3 of Ihe Business and Protcssiuns Code, and my license is ;�; infullforecandetfec� REPLACE FURNACE, RELOCATE TO ATTIC � ? Licensc Clazs Lic. # � o pa� Contrac�or = � ARCHITECi'S DECLARATION % � 1 undcrstand my plans shall bc uscd as public rcrnrds -< �% t' Liccnscd PtoCcssional � a OWNER-BUILDERDECLARATtON �a t hcrcAy al'firm that I am excmp� frum thc Contractor's Liccnsc Law for �hc � O following rcasoa (Sccuan 7(131.5, Business and Profc.ssions Codc: Any city nr couniy ; t which requires a permit tu conswct, altcr, improvc, demolish, or rcpair any swcturc " y prior �o iLt issuancc, also rcquircs thc applicant for such permit io filc a signcd sta�cmcni ,. Valuati on � � that hc is liccnxd pursuant to thc provisions of �hc Contracwr's Li��cnsc Law (Chap�cr 9 ,>q. Ft. Floor Area -� (commencing with Section 7000) of Division 3 0[ the Business and Profcssions Code) or C.. that he is ezempt thcictrom and the basis for �e allegcd exemption. Any violauon o[ Section 7031.5 by airy applicant for a pertnit subjects the applicant to a civil pcnalty o( APN Number Oceupaney Type not more than five hundred dollars (5500). . ❑ I, as ownu oC ttrc property, or my employca with wages az their sole compensation, 3 5 9110 2� . � � will do �he work, and ihe stcucture is not intendcd or offered for salc (Sa. 7044. Business Required Inspections and Professions Code: The Conuactor's License Law docs not apply to an owner of property who builds or improves �hercon, and who does such work himsel[ or �heough his own employccs, providcd that such improvemen�s are not intended or o[Cered for sale. IC, however, the building or improvement ia sold within one year oC compledon, ihe owncr- builder will have the burden aC proving ihat he did not build or improve for purpose of salc.). 1, as owner of Uu property, am exclusively conuacting wilh ticensed rnnvac�ors to trua the projen (Sec. 7044. Business and Protessions Coda:) The Contracwr's Li- ccnse Law docs not apply �o an owner of property who builds or improves Wereon, and , who con cts for such projects with a contractor(s) licensed pursuan� to �hc Convactar's License w. ❑ I n eacempt under S F , B& P C tar this rcason � Dxie � � ORK COMPENSATION DECLARATI I hereby affi�m under penalty of perjury onc of the (ollowing declarations: ❑ I hsve and will mainuin a Ccrtificatc of Consent to sel6insurc for Worker's Compen- sation, u provided for by Section 3700 of the Labor Code, for Ihe perfortnance ot the work for which Ihis permit is issucd. ❑ I havc and will maintain Workcr's Compensauon lnsurance, as �cquired by Scction . 3700 0[ thc Labor Code, for tAc performance of the worlc for which this permit is issued. My Worker's Compensaoon Insurance cartier and Policy number are: Cartier. Polity No.: CERTIFICATE OF EXEMPT70N FROM WORKERS' COMPENSATION ItiSURANCE � (This secuon necd not bc comple�ed i( the pecmit is for onc hundicd dollars (S 100) or Icss.) I certify that in c performance a( thc work fw which �his permit is issued, l shall not employ anp pc n in any man so u �p�j the Workccs' Compensadon Laws ot Calif ia. Datc ' v Appticant NOTICE C M , a mg is Ccnilica�e of mpGon, you should become subject to �he Wo er's Com nsation ptovisions of �c Labor Code, you must � O forthwith comply wi�h such provisions or this permit shall bc dccmcd revokcd. i ""� CONSTRUCTION LENDING AGENCY �►�-� I hcreby aftirm ihat thero is a conswction Icnding aEcncy for thc performan� uf �� thc work (or which this permit is issucd (Scc. 3097, Civ. C.) . I Q L.endcr's Namc z Lender's Addrcss l ) Q I certiCy Ihat 1 havc rcad �his application and statc �hat thc abovc in(o�matiun is �+ cortcc� 1 agrce to comply with all ci[y and county onlinances and state laws relaung to j U building consuuction, and hercby suthori�e reprosentativcs of ihis city to cntcr ��n thc W atwve-mcntioned property fot inspecuon purEwses. � a (Wc) agree �o save, indcmni(y and kecp harmless ihe Ci�y of Cupcnino agains� �� Iiabilitiu, judgmcnts, costs and expcnscs which may in any way acccuc agains� said City ) z in onsequcncc oC thc granting of this permiG Date ►� A LICAM UNDER AND WILL C�MPLY W1TH ALL NON-POINT Issued by: S URC REGUL I"�- d� �� ' Z�✓' 0 Re-roofs Signaturc of pplicanUCo or De � Type of R�of HAZARDOUS MATERIALS DISCLOSURE wll lhc applicant or futurc building occupant storc or handlc harardous malcrial �cfincd by 1hc Cupenino Municipal Codc. Chaplcr 9.12. and thc Hcal�h and Safcty s, Section 25532(a)? �] All roofs ;;hall be inspected prior to any roofing material being installed. ❑ Ycs (�Q No ��1 If a roof i:; installed without first obtaining an inspection, I agree to remove Will thc applicant or futurc building accupant usc cyuipmcnt or Jcviccs which cmit harardous air contaminants as dcfincd by lhe Bay Arca Air Quality Managemcnt all new m 3terials for inspec `30I1. District? � ❑ Ycs � 1 havc rcad the hvardous matcrials rcquircmcntt undcr Chap�cr 6.95 of �hc Califor- nia Hcalih & Safcty Codc. Sections 25505, 25533 anJ 25534. I undcrstand U�az i( ihc Miilding d not cwTCntly a icnant, that i� is my rcsponsiAility 10 notiCy drc occupant of Ihc r uirements m��xme��;o�wi��orac�tir��8�ora� Signature ofApplicant Date �� '"'S'� �� All roof coverings to be Class "B" or better Owncr or authoria.cd agcnt Datc INVOICE INVOICE INVOICE INVOICE ITNOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI�' INVOICE OPER.ATOR : patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 35��11024.00 INVOICE DATE......: 10,'23/2007 REFERENCE ID # ...: 07:_00170 SITE ADDRESS ..... 20E;59 SHELLY DR SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: SQIJARCIA LARRY G AND YOLANDA ADDRESS ..........: 20�i59 SHELLY DR CITY/STATE/ZIP ...: CU]?ERTINO CA, 95014-2923 CONTR.ACTOR .......: OWIdER COMPANY ..........: SQIJARCIA LARRY G AND YOLANDA ADDRESS ..........: 20�i59 SHELLY DR CITY/STATE/ZIP ...: CU]?ERTINO CA, 95014-2923 TELEPHONE ......... FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------�------- ---------- ---------- ---------- ENERGY APPLICATI()N 34.86 0.00 34.86 FURNACE INSTALLATION PRINTING :?ERMIT 14.31 0.00 14.31 SEISMIC RESIDENTIAL PRINTING :?ERMIT 0.50 0.00 0.50 ELEC PERMIT ISSUANCE PRINTING :?ERMIT 40.79 0.00 40.79 MECH PERMIT ISSUANCE PRINTING :?ERMIT 40.79 0.00 40.79 PLUMBNG PERMIT ISSUE PRINTING :?ERMIT 40.79 0.00 40.79 ---------- ---------- ---------- 172.04 0.00 172.04 VOICE ID DESCRIPTION �.70ICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF C UPERTIliTO � C �� ` ��J�.1��/�.� �:UPEf�TINO PERMIT APPL]:CATION FORM APN #-, ,�. Date: � �, Z�• Q 7 �� e� �`�. � � Building Address: � �-'9 ,S j�)Z) V(�� Owner's Name: ��{��/ s"� h/9/Z C 1� Phone #: �p� 3! �� 7�''? S"� Contractor: --- Phone: License ;#: — Contact: ( _�j��Cf � Phone: �dl� .. 3/ , �S � �'" Cupertino Business License #: r. � Building Permit Info: Bldg ❑ � Elect ❑ Plumb Mech Job Description: �(,"" L!'1 CU" J—h,�'Ln/�j Ci� , i�c.,oe�� r0' � C Residential � Commercial ❑ For identiallnstallations: Attic� l floor � 2 floor � .dhere to min set back requirement ❑ �or Commercial Installations: Replacement same weight ❑ Additional weight (s ��ctural calcs) � Structural Calculations required for new installation New installation Planning Ap roval Re uired ❑ Cost of Project: Z3 O 0 ,Q.�, Type of Construction: Occupancy group: Strapped ❑ On Platform Bonded ❑ Sq.Ft. Floor Area: New Location � Replacement � Qty. if Applicable Fee ID Fee Description Fee Group ) BENERGY Er�ergy BUILDING J gRErqFURN Fl.mace MECHANICAL BREMACOVER A, C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A� C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R�;cptl, Switch & Outlets ELECTRICAL BSEISMICRE Sf:ismic Fee Res BUILDING BSEISMICOM Sf:ismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL ! MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Pl�n Check Fee BUILDING BPGAS G�s Piping System Fee PLUMBING BUSLIC B�zsiness License BUILDING