07110144 CITx OF CUPERTINO '
BUILDINC DI'VISION PERMIT _ ::�������� ��������
, : . . . ,.: ,:.... .... ,........ :;
PERMIT NO.
sui �� t � v � DR ��TLEW00D DR CONDIT ONED AIR 0'7110144 ,
NER'S NAME: �� �� DA �
SABADO ANTONIO A AND 1701 L:=TTLE ORCHARD ST ' 11/27/2007
PHO F�T. T n T ��mu SAMTARY NO. CONTROL NO.
(408) 2'.�1-2220
ARCHITECT/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
� 0 0 0
� O p UCENSED CON7'RACfOR'S DECLARATION JOU DCSCTIpt10I1
� �� I hcrcby a[lirm tAa� I am liccnsed undcr provisions o[ Chaptcr 9(commcncing
z� wiih Sccdon 7000) of Division 3 of �hc Busincss and Protcssions Codc, and my liccnsc is RM�J & t E PLAC E FURNAC E
�� y in full force and c L
n � Z Licensc Clus Z Lic. k-
�, p pe�c i C� Contrac�nr Q�!
� ARCHITECCS DECLARATIO � � r
1 undcrsund my plans shall be uxd u public records
W
a
U
L � y Liccnsed Rufessional
y � OWNER-BUILDER DECI.ARA'CION
I►�creyy a(Tirm ihat 1 am excmpt Gum �hc Con�rssctor's Liccnsc Law for thc
� O O following rcuon. (Scctian 7031.5. Busincss and Profcssions Calc: Any ciry or county
�$�i which requires a pe+mit to cansuvc� alter. improve. demalish. or mpair any strucwre
y Z y prior w i�s issuancc. also rcquims U�c applicant for such permit to filc a signcd sta�mcnt
� � � tha� he is liccnsed pucwant to thc provisions of Uic Conuactor's Licensc Law (Chap�cr 9 Sq. Ft. Floor Area $ 4 7 5 0 Valuation
y t- $ (commencing wiih Sccuon 7000) o( Division 3 of lhc Busincss and Profcssions Codc) or
y �.. that he ia exempt therefrom and Ihe buis for ihe allegcd exemplion. My violauon af
Secdon 7031.5 by airy applicant (or a pecmit subjecu the applicant to a civil penalty o( 3 6 917 0) 3.� Number Oceupancy Type
not more than five hundred dollars (5500�
❑ I. u owner of tt�e property. or my employces with wages u the'v sole compensation,
willdoiNework.�ndthestnuwreisnotintendedoroffeeedforsale(Sec.7044.Business Re uired Ins ections
and Professiorm Co�: The Conuacwr's License Law da� not sppty to sn owner of 9 �
property who builds or improves thereon, and who does such wwk himsel[ or Uuough his
own employxs, provided tAat such impmvements ue not imm�ded or otfered for sala 1[, �
hawever, the building or improvement ie sold wi�hin one yesr of compleuon, the owner-
builder wiR have the burdao of penving �hat he did not huild or improvc for purpoae of �
saleJ.
❑ I. as owner o[ the propettY. am eaeclwively conuacting wilh licenaed conuactnrs W
wnsunct the p�oject (Sec. 7044. Husiness and Professions Code:) The Coa�racwr's Li-
cense Law docs nol apply w an owner of propeny w6o builds or improves Weieon, ind ,
who wnvacts tor such projects with a conuactor(s) licensed pursusnt to �he Convactor's
Licenae I.aw.
� I am exempt unda Sec . B Ac P C for this rcuon
Nner Daie
WORKER'S COMPENSATION DECLARATION
I hercby �rm under penalty of peryury one o[ �he folbwing declareGons:
❑ I hsve and will mainuin a CeniGcate oC Consent to self-insme for Workefs Compen-
sation, u providcd (m by Section 3700 of the labor Code. [or �he performancc of �hc
work for which Nis permit is issucd.
❑ I have and will muntain Workcr's CompensaUon Insurona, u �equired by Scction
3700 0( We Labar Codc, Cw thc pedormance of the vrork for which �his permit is issued.
My Worker's CompenaaGan L�surance nrricr and Policy number am: �� �'
c ,� ; � : l''�Ir I`� ve.r ��m No.: ZZ.1 O 018b
CER77FICA7E OF EXEMPrION FROM WORKFRS'
COMPENSATION INSURANCE '
(This xctian necd irot bc compktcd if the permit is for onc hundred doliars (S I00)
or Icss.) �
i cenify �hat in thc performance of the work Cw which Wis permit is issucd, 1 shall nat
employ any person in �ny manner w u m bccomc wbject to the Wortcrs' Compcnsauon
Laws of Cslifomia Datc
Applicant
N�17CE TO APPCJCANT: 1[, aticr making �his Ccrtiticam of ExcmpGon, you shoulJ
becane subjcct w ihc Worku's Compensadon piovisions of Nc Labor Codc, you muu
, O for�hwilh comply with such provisions w this permit shall 6c dxmcd icwkcd.
z ""' CONSTRUCTION LENDING AGENCY
E r�-�. 1 hereby s[lirm Uut thero ia a constcucuan knding agenry for ihc perfortnancc uf ,
p; � �hc work for which ihis permit is issued (Scc. 3097. Civ. C.)
W� Q Lendcr's Namc '
� z C.cnder's Address
(� 0 I certify thai 1 have rcad ihis application and statc �hu 1hc abovc informatiun is
w �"� cortcc� I agea to compty wiU� alt city and county oniinences and sute laws reladng to
0 U building consuuction, and hereby authoria represemaGvcs of ihis ciiy to cntcr upon tAe
� W atavc-menGo�d p�openy for inspenian purposea
a (Wc) agra �o save, indcmnify and kecp Mam�less ihe Ci�y oC Cupertino against
H � liabilides, judgmcnts, costs and expenses which may in any way accruc againsi said City
V`�" i� conseque�e a[ thc granting af this permi� Date �_'L � -��
►'� APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued t y:
SOUR U .
l Z7 a Re-roof � ,��
Signuure of A IicanUContrac�or �e� T of Roof
• HAZARDOUS MATERIALS DISCLOSURE J��
�ll Ihc applicant or (uwrc building acupant storc or handlc ha•rardous matcrial
dcfincd by thc Cupertino Municipal Codc. Chap�cr 9.12, ond thc Hcallh and Safcry
�. s��uo� zssszc=�� All rooi s shall be inspected prior to any roofing material being installed.
❑ Ycs � No ,
�11 the applicant or future building occupant use equipment or Jevices which
If a roo; is installed without first obtaining an inspection, I agree to remove
cmit ha air contaminanu u dcfincd by �he Bay Arca Air Quali�y Managcment all new materials for inspeetion.
a3I71��� . .
❑ Ycs �p(o
1 havc rcad the hv�rd�ws ma�crials rcquiremcn�s undcr Chepmr 6.95 of �c Califor-
nia Flcalth & SafcryCodc. Sectiong ?5505, 25533 and 25534.1 undcrstand ihat iC ihc building
�facs no� curtenUy havc a tcnant, �hat il ia my res nsibiliry m nodfy the occupa�t nf ihe
rcyuiremcn�s which muu be f a Ccrtif of Occup �r. Signatu; •e of Applicant Date
Z U 7 All roof coverings to be Class "B" ar better
Owncr or au�ha .c gcnt D��
- p�lt o1�`t
CITY OF CUPERTINO
�` FURlJACE/AC
CuPE� �NO PERMIT APP:LICATION FORM
APN #� '� C � O 3` O C� Date:
� � � �
Building Address: � � /�.
� 7 u � � � C 9 S�v � �1 �
Owner's Name: P one #:
�, � o z�z �I bg
Contractor: Phone #: Z,�' �.Z2 ZQ
��r` e� �� SSOC . �! 1-ZZZO Fax #: �2i1- ZZZ' - f
Contractor License #: Cupertino Business License #:
� � � �a33�
Contact: Phone #: �� � �
�-� Fax #:
Building Permit Info:
Elect Plumb �� Mech
Job Description:
K2w�ve Q v��. �e ac e 1�� c� .
Residential Commercial
For Residential Installations:
Attic ❑ lst floor ��C] 2" floor ❑
Adhere to minimum setback re uirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of ��onstruction (Usage Class):
`�� ? S� ' Os� v`�
Strapped ❑ On Platform ❑ Bonded New Location Replacement
Valuation:
.��s �-� G s o H �� e e ���
Green Building: ust attach Green Building Check list to this application
CITY OF C�UPERTINO -
FURNA.CE/AC
CuPE��NO � FEE SC��EDULE
FURNACE:
Qty. if
A plicable Fee ID Fee Descri tion Fee Grou Permit T e
MCR.AA Furnace M FURN/AC
�
MCREPALT Commercial Mech Repair/altladd M
MCSUSHTR Commercial Sus��end WalUfloor M
Heater
PGASCOM New Gas Piping �3ystem 1-4 Outlets P
Commercial
BSEISMICO Seismic Commetcial B
MRRAA Residential MecY, Repair/alt/add M
MRSUSHTR Residential Susp�.nd WalUfloor M
Heater
/ BSEISMICRE Seismic Residen�:ial B
(
MFLRFURN Install/relocate FLoor Furnace M
MECPLNCK Mechanical Plan Check M
MFR=<100 Furnace Syst <li)Ok BTU M
MFRN>100 Furnace Syst > 100k BTU M
1VIR�,IRHAN Comm/Res < 100k BTLJ M
� EPERMITFEE Electric Permit I�ee E
f MPERMITFEE Mechanical Pennit Fee M
BREMRECEPT Electric Recepta cles E
PGASRES New Gas Piping System 1-4 Outlets P
Residential
BPGAS Gas Piping Systrm 5+ Per Outlet P
�' TR.AVDOC Travel Docume:ltation B
BUSLIC Business Licen� e B
CITY OF' CUPERTINO
5 ITEMS OF 5 PERM]T RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B7.k: Lot:
APN ......... 3E �917003.00
DATE ISSUED.......: 1=./27/2007
RECEIPT #.......... B:�000003332
REFERENCE ID # ...: 0"110144
SITE ADDRESS .....: 6;�75 MYRTLEWOOD DR
SUBDIVISION .......
CITY .............. Ci7PERTINO
IMPACT AREA .......
OWNER ............: S��BADO ANTONIO A AND ELIZABETH
ADDRESS ..........: 6:375 MYRTLEWOOD DR
CITY/STATE/ZIP ...: C17pERTINO CA; 95014
RECEIVED FROM ....: C�)NDITIONED AIR
CONTRACTOR .......: RCCHARD READ LIC # 22334
COMPANY ..........: C��NDITIONED AIR
ADDRESS ..........: 1'101 LITTLE ORCHARD ST
CITY/STATE/ZIP ...: S.�N JOSE, CA 95125
TELEPHONE ........: (�08)291
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------
1MCRAA iTNITS 1.00 122.38 0.00 122.38 0.00
BSEISMICRE VALUATION 4,750.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
TR.AVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 245.25 0.00 245.25 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 245.25 VISA
---------------
TOTAL RECEIPT : 245.25
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL . 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
10300 Torre Avenue
� �, Cupertino CA 95014
� � Telephone (408) 77'7-3228
`� ` Fax (408) 777-3333
CITY �0�
CUPEt�T1N0
Buildin De artment
JOB ADDRESS: PERMIT #
6 - �f �
OWNER'S NAME: c d. PHONE # '7 ' �`L � ° _
GENERAL CONTRACTOR C �� - Y N` �_ FAX # 25=� t• �
, .��. � 1 1 Z-� ��.
I am not using any subcont�'actors: '�. �_ Date
� �. Signature
Please check a lica.ble subcontractors �iid com lete the followin � tiOn` CENSE #
S �C�NT��'pR BUSINESS NAME BUSINESS LI
Cabinets & Millwork
Cement Finishing
IIectrical
Excavation
Fencing
Flooring: Carpeting
Linolewn / W�d
Glass / Glazing
Heating
Insulation
,
Landscaping
Lathing
Masonry
prnainen,tal Sheet Metal
Painting / W�PaP�'
Paving
Pl�stering
; I'Iumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile �
� _ ' i_.--:.�-- � � �-;' / �,�---
��, --- Date
�� � er/ Contracto Si � �'e
� _._