07110026 CITY OF CUPEI2TIN0 ' ` `
BUILDING DIVISION PERMIT ���� ��� �������� '
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BUILDING ADDRESS: PERMIT NO.
10425 CALVERT DR AAA FURNACE & AIR 07110026 .
rIER'S NAME: PERMIT �SUE DATE
SHERI WARDLE 1712 �TONE AVE 11/06 2007
PHONE: SANITARY NO. CONTROL NO.
ARCHTCECT/ENGINEER: BU(LDING PERMIT INFO
REPLACE WALL FURNACE B��c E�.ec�' PLUMB MECH
� � � 0
� o p LiCENSED CONTRAC7'OR'S DECLARATION JOb D6SCi1PLlOI1
� v C I hcrcby �rm tlut I am liccnscd unJcr provisions aC Chap�cr 9(commencing
_ Z t� j with Secdon 7000) of Division 3 of ihc Business md Profcssions Codc, and my licensc is
'� y in full focce an f6 J 7
,v� 2 Licenac CI � Lic. N
' M � Datc - � Conlractor
A CHiTEC1'S DEC R ON �
��< 1 undcrstand my plans shall 6c uscd as public rccorda
a
4 O y Licensed Pcufessional �
A y � OWNER-BUILDER DECLARATION
I hcrcyy a�rm Ihat 1 am raccmp� Crom thc Contnctors Liccnsc Law for �hc
� p O following rcason. (SccGon 7U31.5, Busincss and P[ofccsiona Ca1c: My city or caunty
K° � which requi�cs a pccmit to cnnswc4 a�tcr, improvc. dcmnlish. or iepair any slcuctum
�`� prior ui i�s issuancc also rcqu�rcs ihc applicant for such permit io lilc a signcd sta�cmcni �' , F[. FIOOC Aiea Valuation
� _ � ihat he is liccnscd pursuant ta thc pmvisiona o[ ihc Conuactor's Liccnx Law (Chaptcr 9 •�q
y t- $ (commencing wiih Scction 7000) of Division 3 of �hc Busincss and Profcssions Codc) or
y �... �hat he ia exempt themfrom �nd the basis Cor the ailcgcd exempdon. Any violauan o(
Section 7031.5 by a�ry appiicant for a permit subjecu �he applicant to a civil penalty of APN Number Oeeupaney Type
not more than five hundred dollars (5500).
❑ I, u owner o[ tlie propecty, ar my employca with wages u the'v sole crompensaUon,
wiA do thc work, and ihe atnuwro is not intended or afteced for sale (Sa. 7044. Business Re uired Ins ections
and Professions Code:'It�e Conuacwrs License Law docs not apply w an ownu of Q p
propeny who builds a improves �hercon, and who does such work himult or through his
own employccs, providcd that such impmvements ue not inten�d or otCered (or sala I[,
however, the building or improvanent ia sold wi�hin one year oC compleuon, �he owner
builder will have the burdee of proving �at he did noi build or improvc [or purpose of
sak.).
❑ 1, as awner of �he property, am exclusively conuacting with licensed rnnuutors w
consuuct the projea (Sec. 7044. Business and Professions Code:) The Coavuwr's Li-
cense [aw does not apply to an owner of property who builds or improves We+eon, md ,
who contncls Cor such projects wilh a conuactor(s) licensed pursusnt to thc Convactor's
License Law.
] am exempt under Sec , B dc P C far �his rcason
mer Date
WORKEIt'S COMPENSAT[ON DECLARATION
I hereby affirm under pcnalty o[ pery'ury ane of the [ollowing declarations:
❑! hsve and will main�ain a Cenificam of Consent to xlf-insure for Workers Compen-
sation, as provided for by Section 3700 of the labor Code, for ihe performance of the
worlc for which Uus pemiit is issued.
Q I Aave and will maintain Worker's Compensation Insurance, ss requircd by Scnion
3700 of the Labor Code, Cor the pedormance of the work for which ihis permit is issued.
My Worke�s Co penaati n Inw nce carticr and Policy numbcr arc�
Cartier. Policy No.:
C IF CATE CEMPIION FRO ORKFRS'
COMPENSATION INSURANCE '
(This scction necd not bc complctcd if tAe permit is for onc hundred dollars (f 100)
or Icu.) �
1 cenify thet in thc performancc of i6c work for which ihis pertnit is issucd, l shall not
employ any person in any manncr so u m becomc subjat to the Woriccrs' Compensatian
Laws of Califomia. Da1c
Applicant
NOTICE TO APPC.ICANT: If, at�r makingi �his Ccrtilicate of Excmpuon, you should
bccome subjat w thc Workcr's Compensation provisions of �c I.sbor Codc, you must
� z forthwi�h comply wi�h such provisioru or this pewni� shali bc dccmcd mrokcd.
Z O CONSTRUGTION LENDING AGENCY
[- ►�-i I heccby aff rm Uut there is s conswctinn Icnding agcncy Cor the performance of .
a� ihc work (or which ihis permit is issued (Scc. 3097, Civ. CJ
a Q L.endcr's Namc '
� , Lcnder's Address
(� � 1 ceni(Y ihat I havc rcad this application and sutc that Ihc abovc informadun is
w � cortcc� I agrce w comply wiih all city and counry onlinences and sute Isws relating w
� U building consuuction, and hcreby wtho�ie ecprc.ceniauvcs of Uiis ciry to entcr upon the
� w aAove-mcnuoncd pmperty for inspenion purposes
a (Wc) agiee �o save, indcmnify and keep ham�less �he City of Cupertino against
�� liabililia, judgmcnls, costs and expenses which may in any way acctuc against said City
V,'� ia consequence oC thc granting of ihis permiG
�"� APPWCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO1NT Issued by: Date ���CJ �
SOURCE REGULATIONS.
Re-roofs .�
� u o ppli co�� ° of R� �of
HAZARDOUS MATERIALS D[SCLOSURE TYPe
Will �he applicant or future building accupant storc ar handlc ha•rardous matcrial
efined by the Cupenino Municipal Codc. Chaptcr 9.12, and thc Heal�h and Safety
x. Scction 25532(a)? , All roofs : hall be inspected prior to any roofing material being installed.
❑ vcs o
Will thc applicant r ture building accupant use cquipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
cmit harardaus air con inanls az cicfincd by the Bay Area Air Quality Managcmcnt all new m; �terials for inspection.
Distric�?
� Ycs No
1 havc rcad �he hei au ma�erials requircmenls undcr Chap�cr 6.95 of Ihc Cali(or-
nia Hcalili & Satcty Codc, Sec�ioaa 25505, 25533 anJ 25534.1 undcrsund ihaz iCthc building
dacs no� curtently havc a �cnan4 �� it ia my responsibility w notiCy ihc occupani nf the
rey 'rcmcn�s which muu be met prior w issuarKC of a Ccnificatc of Occupancy. S 1gIISLL1IC �)f ee►PP� IC2Ilt Date
' � All roof coverings to be Class "B" or better
wncr or authari d gcm ��
CITY OF �UPERTINO
6 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 37517031.00
DATE ISSUED.......: 11/06/2007
RECEIPT #.........: BS000003171
REFERENCE ID # ...: 07110026
SITE ADDRESS .....: 10425 CALVERT DR
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OVJNER ............. SHERI WARDLE
ADDRESS ..........: 10425 CALVERT DR
CITY/STATE/ZIP ...: CUFERTINO, CA 95014
' RECEIVED FROM ....: JIN RANDO
CONTRACTOR .......: R.ATDO, JIM LIC # 8050
COMPANY ..........: 7-1AF. FURNACE & AIR CONDITIONING
ADDRESS ..........: 1712 STONE AVE
CITY/STATE/ZIP ...: SAI� JOSE,-CA 95125
TELEPHONE ........: (4C8)293
FEE ID UNIT QUANTITY FMOUNP PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00
BREMFURN NO tTNIT 1.00 14.31 0.00 14.31 0.00
BSEISMICRE VALUATION 1,700.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT RATE 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 RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 172.04 0.00 172.04 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
- CITY OF C�UPERTINO
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CITY OF
LUPE�,TIND PERMIT APPLICATIUN FORM
Date:
APN # � l � � � Q ...L � ' J� �"� 7
Building Address: —
� L I�E � Gg ,
Owner's Name: Phone #:
,�`��r� ��1� a�'- `1'9� ���'d�P'
' C:oni:ractai: 1''I�oneo .c° �� ` ?�° y7�� -- I�icense #��: �E��f'7/
o �ixy'� y¢y ��
Contact: Phone: Cupertino Business License #:
� — E� a - - - 1/ o �
Building Permit Info:
Bldg ❑ Elect l� P.umb � Mech
Job Description:
�
Reside tial � Commercial ❑
For Residential Installations:
Attic � 1 St floor � 2 floor �
.dhere to min set back requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) �
Structural Calculations required for new installation ��
New installation Planning Approval Re uired ❑
Cost of Project: �, � Type of Construc:ion: Occupancy oup:
� , �.
Strapped ❑ On Platform ❑ Bonded Sq.Ft. Floor Area:
New Location � Re lacement �
Qty. if Fee Grou
Ap licable Fee ID Fee Description P
BENERGY Eiiergy BUILDING
gREMFURN Furnace MECHANICAL
BREMACOVER A,'C Unit > 10,000 cfin MECHANICAL
BREMAIRHAN A,'C Units <= 10, 000 cfin MECHANICAL
BREMRECEPT R �cptl, Switch & Outlets ELECTRICAL
BSEISMICRE S�;ismic Fee Res BUILDING
BSEISMICOM S�;ismic Commercial BUILIDNG
EPERMITFEE E.ec Permit Issuance ELECTRICAL
MPERMITFEE 1V. ech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK P: an Check Fee BUILDING
BPGAS G as Piping System Fee PLUMBING
BUSLIC Business License BUILDING
Community Development
�` ' .°:�, � 10300 Torre Avenue
� ;�;�;= , Cupertino CA 95014
Telephone (408) 777-3228
CITY Of Fax (408) 777-3333
CUPE(�TINO
B1111C�111 De artment
JOB ADDRESS: PERMIT # � � /
D � �i�J �- U �" v � �� (
� �--6
OWNER'S NAME: � ,� � PHONE # 5/D - � - ,�'
GENERAL CONTRACTOR: " - FAX #
;
I am not using any subcontractors: 2 l�� ��°�
Sig natur Date
Please check a licable subcontractors and com lete the followin information:
SUBCONTRACTOR BUSIN ESS 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