05120091•
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
gT��� i
�ON't, a,CTORIN ORMA IOss
BUILDING ADDRESS:
A PERFECT CLIMATE
05120091
OWNER'S NAME:
PERMIT LST7E DATE
EDWARD KINNEY
10570 S DEANZA BLVD
12/15/2005
NE
SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHI'IECTYFlIGINEER:
BUILDING PERMIT INFO
BIRO ELECT PLUMB MECH
0
p
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hemny affirm that I am 0ccnad udm PbvWan%of Chap= 9 (cor mmcint
p
withS tim 7000)ofDiviuon 3 of Yn Boal. and Profua . Cafe. and my l¢.is
In mu for¢ad _
REPLACE DUCT WORK
Lkest¢ Lk. t
Dia Co
RCHIIM DELI
DELLA ATION
oso
1 wQsaad my plan: sIW I w usd u pubtie nemNr
Lie.d Pmf..o%I
3
OW NER-BUILDER DECIARATION
F
1 hertby nRrm that I am uImpI from tha Canuusors Liana LAw for the
0
fallowing maven (Satiun 703 1.5, Busiwa and Pmfaaiom Code: Any dry or county
which myuires a purtnit to anomer, Alta, hnprore, di mW W, or mpWr my svucum
$2376
'y
<
prior to hs luwae, abu mini. the.pplkabrf«wchpermii to 0k. rlgad subment
Conucbri Uh. Law 9
Sq. FL Floor Area
Valuation
.p
than kis limned pwmnt b Na pmitionsbf the (Chap.
(eommemdng wilh Season TODD) of0irisian J of the Buainesr.d Pmfuurms Code) or
$
ton k u ucmpt dke. and th bub for Ur albgd esempd.. Any rlolatlm of
f Occupancy Type
Schon 7031.5 by a%appliant for a peamh aubjecn the Applicant to a ciW penahy of
nor mom than Bvc budodl dollars, ISM
❑ 1. u own of Ne propcny, or my empl% adN"I= as Nelr wkc«epeealm.
"ill do the"mk. uW the worrua is b« ieaMed or nfretd for Sale (Sm Toth. B®trs•
Re s
and Pfofaa9Ona GOdt: Tim GmVCto/a Licumse L.,, d= Mapply b an OWOCr
Wormy who builda« Imposes tla,m .nd who doesa«work rk hIrmRIfm thmo{h his
O �
own employed ponidd Nat wch Impos is art not InandeA or o1I for B.
bowever, the building «ImPmvcnvd is wad within ane ya of mmpindbn, dx owmc-
hVOd,r win hart da when of prormc Out N, did nor broad or impose forim o or
DrrsFC 2oOC
oak.).
.I
0 1, u b"rcs of the P^Party. •m uclmively awtown, with licemed contnctm or
cbeurLsthetz. pmjm Bu •od Prof. Cade_)TheC
Q '�"�{. �j e
dicomrsnd
erose taw doer tbt.pplY b w o"nc of pbpny.rho veru, «onpoau Netem, rd
pply tosm. of
BUILD
w non. for auch pojem with a emuanm(s) Rancid pu.M b the CmOacnra
6§�YR6 7jL4�/Sy �7NSVS�1
L.kcna taw.
❑ 1 am uen t ondc Sec. . B & P C fm ttia reason
Own r Due
WORKERS COMPENSATION DECT,ARATION
1 T arta. mWerlcultY M Perjury oro of Wb folb"Ing deelwirnm
K and wRl mnnain a Cenafoa d Com,mt to alf.lwue Ix W« sCunpan
tion, as pomdd for by Scum 37OD ar Out labor Cade. for We peAormanm ar the
whkh Nice permit b 1ssud
7"t and will malmain Worleh Compensation Inmrwa, is rtgxrcd by Smlm
37W of Ne Lubbr Coda, for ftpefomamc of ft work for whkh Nu pm41s loud
MY Warkd(■yCom1/�T,�,t�.lnwnrMc•nicr andPoli% nw^hcr c�
Carrie. 1 (`tel Poii y N., J 6
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(rd: swoon rood rot 4 emnpkad UNe pumb is for ee Is o@d do0ua (SIM)
«leu)
I certify Thu U the psfmm oox a the "ork for which this permh Is Lsrtsd, l slutl nor
emP1%Arty nlew auerwunbemtm wbJectntw Warkrn'Compenutim
Lawa of C Dae LL1l��\\
t
APPlkam ��
NOTICE TO XPPLICANr. IL a w robing this Cmtri . NEacnpn�'
become wbJas to the Workers Cwnpcnsaflm Monism" a! the Law CoQ, you most,
fouhwiN rnmply "i r such poriwma; or this pernit shall k dmtud rt, k .
O
CONSTRUCTION LENDING AGENCY
1 hemby aBlmi this Nen Ice • cnman Nan Imding apxy for Nc ps romoma or
Ne work f«which Nis penmh u'«..n (Sc. 3(197, fir. G)
Q
Name
uLancer: Adema
mjt(s
2
Q
I aolfy that 1 hese mad this pHead. and ruse Nu Ne .hose mformatim is
Fcoon
1 aya to rnmply wob all city ud eounry, molirmcea and mace laws reJadng In
b ildmg covvmction, ad km1by wNmin Mmat null of Nis city to cmc upon Iw
•how-000iottd Popery (« IupeAm purpsav
(We) agree In save, ibkunnify ad keep ha^nksr Ne City of Cupertino agaitut
y
ccpcmcs wild mayuwy w"yamroagalms aid Cry
Z
incoitics,)dgmcou.corumd
APPLICANT UNDERSTANDS AND WLLL COMPLY WITH ALL NON -POINT
A PLICiNT of ft NDUSTlntofthND WILL
Issued by: Dale Z�/,J- Q :.P"
SOURCE REGULATIONS.
Re-roofsn - 4i L"
SltNturt of ApplinHADal,FLIZARDOZARDO US MATERIALS DISCLOSURE
Type of Roof
Will Nc wPOswt «futurt wlldinc aavp•vt ubre «Ndk havrQur material
n Qfi by da Cupnlm Munklpl CoQ, Cdwter d N
9.11. ac Ikalth ad Safcy
de, see;asns3u•)7
[3y.43eo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
M11 the applicam or fit. wilding .'m ba fywpmem «Q.im, wlrich
emit Avsrtlbw air contion nun fmcd by Ne Bay Am• Air Quality Mmlp=nl
all new materials for inspection.
Doom?
BYO
Ihave rod lbehuml trueriahmyuirtmenu w4rChapurh 95 o(Nc C.lifor-
/
da COQ.Sasl«o2sI pmyoad15s34. 1u
opabuilding
rooffy INat
rxoctoSafey
does nol torte IY hoe • ¢aunt, dw it v mymq«Whd Y n noti(Y Ne omupwt of db
mf_rl�man not prior W. fkannfac
�A
'gna[ureofApplicant Dale
Uri.r 1 "
All roof coverings to be Class "B" or better
owns «wthm;nd.�t non
Community Development
10300 Torre Avenue
'a
J Cupertino CA 95014
Telephone (408) 777-3228
Dp Fax (408) 777-3333
UPEI�TINO �
BuildingDe artment
JOB ADDRESS:
a O9� ! r L Cr
PERMIT #
yrt.11-06Iq
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR'S ,
FAX # (-�
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Is
Owner/ Contractor Signature Date
•
11
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
Is
Owner/ Contractor Signature Date
•
11
WI
C fr OF
CUPEkTINO
��< 4\
CITY OF C UPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
JD71
APN #/ 0,3 - l
(�3
Date:
0
Building Address:
Jr kLfog,
Furnace
Owner's Name:
Phone #:
i
Contractor
License #:
7a3/sf
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
Contact:
Cupertino B
siness License #:
Building Permit Info:
Bldg ❑ Elect Plumb Mee
Seismic Fee Res
Job Description:
EPERMITFEE
Elec Pennit Issuance
Residential Commercial ❑
For Ren Insta ations:
IV2"' ❑
Mech Permit Issuance
Attic I" floor floor
PPERMITFEE
Adhere to min set back re uirenent❑ .
PLUMBING
For Commercial Installations:
Bldg Pen -nit Fees
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
Plan Check Fee
New installation Planning Approval Required EJ
Cost of Project: Type of Construction: Occupancy group:
7 • � f tJl�
Strapped LJ On Platform LJ1 BoVded Ll Sq.Ft. Floor Area:
New Location ❑ Replacement D/
Qty. if
Applicable
Fee ID
Fee Descriotion
Fee C7man
–k t
BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
EPERMITFEE
Elec Pennit Issuance
ELECTRICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Pen -nit Fees
BUILDING
BPLANCHK
Plan Check Fee
UILDING
BUSLIC
Business License
BUILDING
–k t