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09070157 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 22652 SILVER OAK LN CONTRACTOR:RESIDENTIAL HEATING PERMIT NO:09070157 AND A/C INC OWNER'S NAME: JACK BAUER 605 CRISTICH LN DATE ISSUED:07/22/2009 ER'S PHONE: 4088721240 CAMPBELL,CA 95008 PHONE NO:4083774073 ❑ LICENSED CONTRACTOR'S DECLARATIONC� �� OYS� 3UILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# --- ri f— ,� MECH RESIDENTIAL COMMERCIAL Contractor–�1(Jk�f[T1G�\� a 1 hereby affirm that I am licensed under the provisions of Chapter 9 IOB DESCRIPTION:REPLACE EXISTING FURNACE&A/C- (commencing with Section 7000)of Division 3 of the Business&Professions .ZESIDENTIAL Code and that my license is in full force and effect. MATING AND A/C INC RENEWED BUS LIC I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by ;iq,Ft Floor Area: Valuation:$10280 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. .\PN Number:34249003.00 Occupanc Type: APPLICANT CERTIFICATION T—7 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Q t, ssued by: Date: Signaturet v w� Date OWNER-BUILDER DECLARATION RE-ROOFS: \II roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: nspection. 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 or offered for sale(Sec.7044, ,iignature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. oompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by iafety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this additionally,should 1 use equipment or devices which emit hazardous air permit is issued. .-ontaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall fealth&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I )war or t_ �homed agent: become subject to the Worker's Compensation provisions of the Labor Code,I must �- v t/L— Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is or which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating ender's Name to building construction,and hereby authorize representatives of this city to enter ups"the above mentioned property for inspection purposes.(We)agree to save ender's Address i :ity and keep harmless the City of Cupertino against liabilities,judgments, co..__.and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section understand my plans shall be used as public records. 9.18. Accused Professional Signature Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 34249003 . 00 DATE ISSUED. . . . . . . : 07/22/2009 RECEIPT # . . . . . . . . . : BS000008244 REFERENCE ID # . . . : 09070157 SITE ADDRESS . . . . . : 22652 SILVER OAK LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JACK BAUER ADDRESS . . . . . . . . . . : 22652 SILVER OAK LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5633 RECEIVED FROM . . . . : RESIDENTIAL HEATING CONTRACTOR . . . . . . . : CATHY HAIRE LIC # 21161 COMPANY . . . . . . . . . . : RESIDENTIAL HEATING AND A/C IN ADDRESS . . . . . . . . . . : 65 CRISTICH LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : 4083774073 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 280 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 10,280 . 00 1 . 10 0 . 00 1 . 10 0 .00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 410 . 10 0 . 00 410 . 10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 410 . 10 #26106 --------------- TOTAL RECEIPT 410 . 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL S-7 CITY OF CUPERTINO FUWiACE/AC CUPEkTiNO PERMIT APPLICATION FORM APN # 3q,-) q q 0 v � �� Date:Buildin Address: Owner' Name: Phone#: I �, lO Ci'" (2)-1Z- `�-'1 C ntractor: LL t Phone#: i clew h a( Alda f 1 v;) 9 latc, , r1C Fax#: Contractor License#: Cupertino Business License#: rl�s sem-(' Contact: Phone#: •3-1-� -�IU�3 Hu\-1 Fax #: Building Permit Info: Elect rsw Plumb El' Mech Residential Commercial ❑ Job Descri tion: For Residential Installations: Attic ❑ 1St floor [l 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight QP Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): Strapped On Platform ❑ Bond(-.d New LocationEl Replacement Project Size: Express Standard ❑ Large [] Ma'or❑ 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. Revised 01/07/09 CITY OF C UPERTINO FURNA.CE/AC OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= I Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for 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 outlet. Comm/Resid IBREMAIRHAN Residential A/C units <= IOk CFM B IMRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg StandakS Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B f I EPERMITFEE Electric Permit E i 1 MPERMITFEE Mechanical Permit M I PPERMITFEE Plumbing Permit P I TRAVDOC Travel Documentation B 1 BUSLIC Business License B Community Development 10300 Torre Avenue '. Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 ,XPEkTINO Building Department JOB ADDRESS: PERMIT # w� S 1 0 l� D//f--7 OWNER'S NAME: 6XC-t— PHONE # O GENERAL CONTRACTOR: a # I am not using any subcontractors: `L �- Si E nature Date Please check applicable subcontractors and com-:lete 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