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07110097 CITY. �F CUPERTINO ' ` BU[LD[NGD�VISION PERMIT ��`' .. .,.,� ;.., <;: , _::_ PERMIT NO. BUILDING ADDRESS: 7634 KIRWIN LN CONDITICNED AIR 07110097 . r�ttt�n'r tsstrs oax� „vVNER'S NAME: MILLER DOUGLAS R AND KATHRYN 1701 LI'ITLE ORCHARD ST � 11/16/2007 SANffARY NO. CON7ROL NO. PHONE: (408)291-2220 BUILDING PERMIT INFO ARCHI'i'ECi/ENGINEER: BLDG EI.ECT PLUMB MECH � � � � u p p LICENSED CONTRACfOR'S DECLARATION IOU D6SCi1pt10I1 � 1 hcrcby aCfirm �hat 1 am licenscd under provisions oC Chap�cr 9(commencing � z� wiih Sccuon 7olw) ot Division 3 0( ihc Susincss and Pro(cssions Codc. and my licensc is REMU & F'.E P LAC E FURNAC E& ADD A/ C �� y in full Corce and effect. v� z Licenac ass L'�. � n t- � Dale Controclnr � ARCHITEC['S DEC e -� [ undcrstand my plans shall be used as pu6lic exords /� �� ?�U � w Q y Liccnsed Prufcssional y 3 OWNER-BUILDER DECLARATION �' 1 hcrcby affirtn ihat I am ucmpt Crom �he Coniraaors Licensc Law for �hc � p O Cotlowing rcason. (Scction 7031.5, Business and Profc.ssions Cafc: Any city or munty �,°, Pi which requires a permit to conawct, altcr. improve. dcmolLsl�. nr repnir any swcturc y� y rior �o ils issuancc, alsu requires ihc applicant for such permit io file a signed sta�cmcnt i, Valuation _ Z�- � ,, q. Ft. Floor Area $ 1 2 5 0 0 < t hat he is license d pursu a n l t o l h c p r o v i s i o n s o f t h c C o n l r a c t o r' s L i ce n s e L a w ( C h a p t c r 9 Y t = -� �(commencing wiU� Scction 7000) of Division 3 of thc Busincss and Profeuions Cadc) or y�� hat he ia e:empt thercfrom �nd ihe basis for the allcged eumpdon. Any violaGon ot SecUon 70313 by ury applicant tor a pecmit subjecu ihe applicant to a civil penalty of 3 5 9 2 2 01 • E�(� Number Oeeupancy Type irot more than five hundmd dollars (5500� ❑ i. u owncr of ttie propaty. or my employces with wages u the'v solc compensation, wiUdo�heworku+d�hesuuctweisnotimm�dedorofferedforsale(Sec. Required Inspections md ProFessions Co�: The Conuactors License Law dacs nat aPP1Y m sn owna of propeny who builda ar improves Wercon, and who does such work himultor thmugh his own employces, ptovidcd �hat such improvemrnu s2 not intended or offercd tor sala I[. houvever, the building or impmvemenl is sold within one yeu of compkuon, the owner- bui�der wip have �he burden of proring Wat he did not build ar improve [or pu�pose of sak.). ❑ I. u owner o[ ihe properry. am exelusively convacting with licenaed rnnvactors W consuuct the projea (Sec. 7044. Business and Profcssions Cade:) 7trc Conuacmr's Li- cenx Law docs not apply lo m mmer of property who builds or improves Uieeeon, and . who conUacis for such pmjects wilh a conlwctor(s) Iicensed pursusnt w Uie Contncwr's . `^ense Law. l am exempt undu See. . B& P C For this reuon Owner Dale WORKER'S COMPENSATlON DECLARA170N I dercby s(tvm under penalty of pery'ury one of the (ollowing declsradons: ❑ I hs+e and will mainuin a CeniGcate of Conaent W ulf-insuee (ar Workcrs Compen- sation, u provided (or by Section 3700 0[ the (abor Code, for the performance of the work for whieh this pertnit is issucd. ❑ I have and will mfinuin W r's Compensation Insunnce, as �cquired by Scction . 3700 of thc Labar Codc Cor rformance ot the work for which �his permii is issued. My Wor om li �rti and Policy ar5: `/�s�'/� %) � Cartier. 1'�cy N / �;� J G�� CE]t77F1CATE F EXEMPITON FROM WORKERS' COMPENSATION INSURANCE (This scction necd not bc completed if the permit is fw onc hundred dollars (S I00) or Icss.) I cenify that in the performancc of �hc work for which this permi� is issucd, ! shall not employ any person in any mamxr so u m bcrnme wbject to the Worlmrs' CompcnsaUon Laws oC Califomia. Da�c Applicant N077CE 7'O APPLICAM: 1f, aftcr making this CcrtiGca�c of Excmption, you should becane subject to the Worlcer's Compensation provisions of the Lalwr Cade, you muu �,Z fonhwiih comply with such pravisions w this permil shall be dcemcd mrokcd. z O CONSTRUGTION LENDING AGENCY (� i-�+ 1 hcre6y a�rm �hat Ihcre ia a constnxlion lending agency Cor thc {+erCormance u( . p(, � Uu work for which Utis pem�it is issued (Sec. 3097, Civ. C.) , W Q Lendcr's Nanc � Z L.cnde�s Address V 0 I cettiCy �l havc Ihis applieation and suic that thc ahovc infarmatiun is w F cortcc�. I agrc,�O comply '�h all city and county ordinances and suk laws reladng w 0 U building co ction, he�eby amharia ccp ntativcs of this city to cnter upon Ihc � W alwve-mc oned p�o rty for inspection pu s. a e) a rce sare. indcmnify and humless �he Ciry o[ Cuperti against �„H,� � liabili ', ju ts, costs and expenses w h may in any way acccuc agai t said City in co of the granGng of this pc 4 Date � �Z� U z AP 1 NDERSTANDS AND ILL COMPLY WITH AL NON-PO1M Issued by: � S REG TIONS. / • c/ Re-roofs `'—� Signatu �icanuContracar °1C T of R�of HAZARDOUS MATERIALS DiSCLOSURE J�� 11 ihe applicant or futurc building oaupant sarc ar handlc hanrdous matcrial iefined by thc Cupertino Munui al Codc. Chapmr 9.12. and the Health and Safcty �«k Section 25532(a)1 All roofs ;;hall be inspected prior to any roofing material being installed. � Ycs No Will �hc applicant or future buil vccupant usc eyuipmcnt or Jcvices which If a roof i:; installed without first obtaining an inspection, I agree to remove emit hai.ardous air conuminants mcd by Uie Bay Arca Air Quslity Managcmcn� all new materials for inspection. ��;�� ❑ Ycs ❑ Nu ► h ha»ardcws maicrials requimmcn�s undcr Chap�cr 6.95 of ifor- nia Flcal afct odc. Sectiau 25505. 25533 and 25534.1 undcrsmnd tha iC building dacs t rtcn havc a tenan4 �at it is my respoasibilily w nodfy �hc pant nf the �cqu' nu ich musi hc met priorm issuancc ota Ccnil�ca of Occu Signature of Applican[ Date Da � All roof coverings to be Class "B" or better r aut ori d a CITY OF CUPERTINO 7 ITEMS OF 7 PERMI7' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 35��22014.00 DATE ISSUED.......: 11�16/2007 RECEIPT #.......... BS(100003263 REFERENCE ID # ...: 07�.10097 SITE ADDRESS .....: 76;�4 KIRWIN LN SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: MII�LER DOUGLAS R AND KATHRYN A ADDRESS ..........: 76:�4 KIRWIN LN CITY/STATE/ZIP ...: CU]�ERTINO CA, 95014-4357 RECEIVED FROM ....: COIdDITIONED AIR CONTRACTOR .......: RI(:HARD READ LIC # 22334 COMPANY ..........: COIdDITIONED AIR ADDRESS ..........: 17�)1 LITTLE ORCHARD ST CITY/STATE/ZIP ...: SAI7 JOSE, CA 95125 TELEPHONE ........: (4i)8)291 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 BREMAIRHAN NO.LTNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO LTNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 12,500.00 1.30 0.00 1.30 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 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 : 183.10 0.00 183.10 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 183.10 VISA --------------- TOTAL RECEIPT : 183.10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL D��l ��`� CITY OF (;UPERTINO r , � � , ��J��.��/�.� �:��. - CUPEf�T1N0 PERMIT APPLICATION FORM APN # � _ -��--,� � � i � � Date: �� Building Address: C� C,� c j0 1�..� 6 � C(.� `) � Owner's Name: Phone #: ' �� (`(1 � \ � c� r _ � �Z�� ^ ��l � 3 � �ontractor: ` Phone: Licens� �#: h�i`' ' C. 2� l 1� ZZZ U L-1 �(. S l F, Z- �� ` Cupertino Business Licen e #: Contact: Phone: ��m � �;a 3� Building Permit Info: Bldg ❑ Elect � Plumb ❑ �164ech ❑ Job Description: �� 4 � � � �� E' y�� Residential� Commercial ❑ For Residential Installations: 4ttic � 1�` floor � 2� floor � Adhere to min set back requirement � For Commercial Installations: Replacement same weight [� Additional weight (structural calcs) � Structural Calculations required for new installation � New installation Planning A roval R uired � Cost of Project: _ Type of Construction: Occupancy group: i2 � �� Strapped ❑ On Platform ❑ Bonded C7 Sq.Ft. Floor Area: New Location � R lacemen� Qty. if Applicable Fee ID Fee Descri tion Fee Grou / BENERGY l:ner BUILDING g��U� l � urnace MECHANICAL BREMACOVER ��/C Unit > 10,000 cfin MECHANICAL / BREMp►IRHAN ,�/C Units <= 10, 000 cfin MECHANICAL BREMRECEPT :2ec tl, Switch & Outlets ELECTRICAL BSEISMICRE 3eismic Fee Res BUILDING � BSEISMICOM 3eismic Commercial BUILIDNG � EPERMTTFEE Elec Permit Issuance ELECTRICAL j MPERMITFEE :viech Permit Issuance MECHANICAL PPERMTTFEE :?lumbing Pernut Issue PLUMBING BPER1v�EE :31d Pernut Fees BUILDING BPLANCHK ?lan Check Fee BUILDING BPGAS Gas Pipin S stem Fee PLUMBING BUSLIC Business License BUILDING Community Development • � � �. 10300 Torre Avenue �� . � � �;. Cupertino CA 95014 • ,�° ,�:: Telephone (408) 777-3228 C1TY�OF Fax (408) 777-3333 CUPEf�T1N0 Buildin De artment JOB ADDRES PERMIT # n � r � � � .� .. . �� lf i O R'S NAME: 1 ` � PHONE # - GENERAL CONTRACTO ' P i/l FAX # - 2�2 � I am not using any subconisactors: Signature Date Please check a licable subcontractors and com lete the followin i.nformation SUBCONTRACTOR BUSIrJESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical Excavation Fencing Flooring: Carpeting Linolewn / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry prnamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet ock f Tile , � � Date � r er/Contractor Signature