06050048CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
COI TRACTQR�I1 MWJQN ,
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BUILDING ADDRESS:
A PERFECT CLIMATE
P°`Mrt `0605004810208
BARBARA LA
OW NERS NAME
PERMIT LShTIE DATE
CHRIS SINGER
10570 S DEANZA BLVD
05/05/2006
ONE
SANITARY NO. CONTROL NO.
(408) 861-9545
ARCHITEREA /ENGINE
_ BUILDING PEAMrtINT-O
BLDOS �-rE1FLT e MECH
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LICENSED CONTRACTORS DECLARATION
Job Descriptions @II
1 booby ,from W„ 1 . IianxL uMcr, p,oaiams of CLP,a 9 (mmmencin{
.irb Sr:Ltlan 700 of Diri Bofde Bammv and Profafno. Cade, ud mY li—V
Wfan raw .w
REPLACEMENT OF FURNACE AND AC may-
Uanm Lk.. 15�-.
2006
.
1m'a� q * /)� r��
� t4 � p �y t] � G
1jf�Ju MLT.➢•
Doc �i rs DE IL
- ARCHRECI's O
1 undLnvaW my pluf, shall bit oaf u Pak rtrudr
Llamcd Prufcssiooal
OWNER -BUILDER DECLARATION
1 bucby affirm that I an aemp frac de Conu W. Uao,c Law far de
folbrinc rcvoo. (savart 703 [S, Budncu L and Pro(Cooa CadL: My City or cmn,y
$12323
rb ,h o,u rcsa Pani, W L L des. hoP ' dcmallsh. or ropair any ammwc
priabiu inwna.also xqulro be appli rar such puma m flea siercd aramxs,
La. (C
Sq. F[. F1oorArea
Valuation
wit lx Ldp.n, ,,o pb lmn,a thu, n . w ,I . aP.9
(emunaain{ab Sadao 700M of Dir .. 7 of the Babroaa and PManora Code) or
bat ten a e pt, bemlrom .OL be bufa fm the alleged =o4or- My solation of
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Occupancy Type
saaaa7ayusyam'.PWa�,ra•p�1,�ka+�appLiarnm,LnBPmwyar
not more than fire Xundmd dolLrs (SIM
❑ L u arocr of,he prapny, a my anPb/a whh wrRa u,htr roW coepmvdm,
Required Inspections
Ll P
will W the vote ad We.brmae is not inaMN or offued for ab sm TMd. Ba,ioea
and Prefrudam Code The Cov. . Li L Iry d Det appy' b to Dana 0(
proputY.bo bund. or itn'tt—tbao , and who doeawch rote him.el(a Wrou{A hu
o.oe *,00f. XwWcd dut,mh lmpwreww are ootiron wtt o for sale 0.
- -
bor e.. be WMng or ar,,ro mmt I. aeld MiWin woe y,orofmmpiotm.Weaw,er-
bdlder wW bare be b of pro 1, that Tae did nm bwW or irn o fa pwpoa: of
.
ule.L
❑ L as o of We pvpcnY. un oclvaiNy cana,Ne{ rRh Bared m,vammf to
crmm (Sec.MW Budr rod Profcm�Code:)r, C
rd
the.,
of a hoprvres d�e�rom��a�. s�e/d .
tmt apply m o ani of propu,Y rho
La ios ror
I.ar
'
oxd p
(M]uCh pntCfh wilhaCmpaLlm(f)iCtJaid PbNW bWC yAWa,u,
woo u f
I LlwI
C1a� Lar.
❑ltoo eaemp w,de+See .Bd:PCfor bl. ream
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Dau
WORKER'S COMPENSATION DECLARATION
I hucbya .voterp,Wtr a perlory arc of the kAbw.S µlar lm^
1ha.e and wm mdmaio,Cmdlau of Cauentwsols-iv.ure foworh .Compc
udon. n pro+idM fm by Sccmn 3M of de Labor Cate. for be performance of We
wart fQ rilch bu pmnit u ivucd.
W4 punmraoce. lon Ias mlvixd by ScNm
C3 1 tease d w H winuln Wo fees Commu
.
71 a be War Cade. fa We pufarmanr'caf ha. for wL Wu permit Y iore
My WmWs mn Wavar,ce artier sed Polity nurnbo r
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.
Cnr{c Popp N0:V
- CERTIFlCATE pF EXEMMOb( FROM WORKERS
COMPENSATION INSURANCE
(ILW cmlm ssd no,wcompk¢d,(We prmH famehoMrW do0an (S I00)
or uv)
1 amts uu, W We pufamuna of b<.orX fa which dds perml, U Ivv d. 1 YW I oa,
c anyir inany mammabubbrraoe mbjmbde Wanc�n'Compvuadm
Ira ttof Cdiforma Dau
NOME TO APPUCAKR.. If. afar maidnG Ihb Ccnif o(ficmPbm, Ym, Iri
become no)= b be War l Compem.don Pm Wd ar be IAbor Code. You moa
fa tbw th..Ply .ib .1% or WU Pani, Chap be d muted.
'
CONSTRUCTION LENDING
ngapraAGENCY
I hucbYaffltm buberebated( sum for be pahvmana of
.On{.)
ur rhkh Wf pump 4 WucE (S c B(19'I, CIv. C.7
oor"
� LcMclf
lsdefa Adds
s
I a&. 0.11 rod Wia applk,tim and am Was de abme Wamadm1.W
I.&. w comply wird all Li,Y anti Loamy ordlmnaf .Mare laws np w
ply
Ul
buildin{cmwucu o'n'bc,cbyauWo,ix mpoanudro of bit city wm,a upon be
Ledo°
[1 aM.c mcaiwrd Y for i oify to purya.¢s
(Wc) ague to taa ir,,1oa sed h harmkv the City of
marc.
.1stin ts.{aim,
n OablBde,.fud{wou.coav,Meapenau whkb wry Want w,y nzrvc a{airw vid Gy
wLmCgamKi O(thejMde{C(Wl pmnlL
UNDERSTANDS AND Wl COMPLY WITH ALL NON -POINT
Issued by: Date _-J. O C
naffs
tLLICA
5/
Re -roofs
me of AppllonUCaHAZARt
HAZARDOUS MATEAIAIS DISCLOSURE
TCato ype of Roof
W U We,,, aru a fawre hulldW{ aatopwatoto a haM1• haaNa W ma,vial
u dcflxd by ,Ic Cupmbo Manklpal Code. Ctapto 9.12• and de HW W and Sa(0Y
Colic. saLdon 255324),
All roofs shall be inspected prior to any roofing material being installed.
CYa
If a roof is installed without first obtaining an inspection, I agree to remove
Wil be appliLvna fuwx buidio{mvpam urecqulpwrntaJCHau rhkh
li,y Mcm
salt haradeua air moumiruw a fingFed by We Bay A Air Quana{un
all new materials for inspection.
Di 1?
❑ Ya
`daurnvcriLLf,eq.,hvrcm,
Ihar� real ds WerGWucr 69f of de Gllfrc-
WkBrul'Cmt.Sma ed155id.l JmBbcb ofini
or .orrd
that it.15577
Jos xx asst ha.c a aaanL b., It'v my rcgmWluli,Y b eoufy de acLpm, of Nc
tioo,&
bmna!ts a.cLmfl..';
Signature of Applicant Date
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All roof coverings to be Class "B" or better
own,aaarduvudq o e a,
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
PERMIT #
SUBCONTRACTOR
OWNER'S NAME: QL
PHONE #
V- 6 5 to O
GENERAL CONTRACTOR Er
FAX # 2761
-,F6 -9
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following' ormation:
Owner/ Contractor Signature
5&110-1-110
Date
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
5&110-1-110
Date
eem 1 of 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35912021.00
DATE ISSUED.......: 05/05/2006
RECEIPT #.........: 34270
REFERENCE ID # ...: 06050048
SITE ADDRESS .....: 10208 BARBARA LA
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: CHRIS SINGER
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: A PERFECT CLIMATE
CONTRACTOR .......: SMITH, BYRON E LIC # 21144
COMPANY ..........: A PERFECT CLIMATE
ADDRESS ..........: 10570 S DEANZA BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........: (408) 861-9545
•FEE ID UNIT QUANTITY ' AMOUNT PD -TO -DT THIS REC NEW BAL
BREMAIRHAN
NO.UNITS
1.00
10.26
0.00
10.26
0.00
BREMFURN
NO UNIT
1.00
14.31
0.00
14.31
0.00
BENERGY.
PERMIT FEE
1.00
34.86
0.00
34.86
0.00
BSEISMICRE
VALUATION
12,323.00
1.30
0.00
1.30
0.00
PPERMITFEE
FLAT RATE
1.00
38.37
0.00
38.37
0.00
EPERMITFEE
FLAT RATE
1.00
38:37
0.00
38.37
0.00
MPERMITFEE
FLAT RATE
1.00
38.37
0.00
36.37
0.00
TOTAL PERMIT
175.84
0.00
175.84
0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------- -------- ------------------------
-------- ---------------------------- ----
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
WUPEII;TINO
1
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
APN #D
35q -12- 021
ate:
5 5/0-6
Building Address:
BREMFURN
loac),(R
MECHANICAL
Owner's Name:
S�
Phone #:
066
Contracto I Phone:
License #:
Contact: Phone:
Cupertino Business License #:
BREMRECEPT
Re tl, Switch & Outlets
Building Permit Info:
BSEISMICRE
Bldg ❑ Elect D Plumb D'
Mech D/
BSEISMICOM
Seismic Commercial
Job Description:
E"
EPERMITFEE
MPERMITFEE
2 G1�2 d
ELECTRICAL
MECHANICAL
Residential Commercial ❑
Plumbing Permit Issue
Permit Fees
For Residential Installations:
❑ V 2°d floor ❑
BPLANCHK
Attic Is' floor
BUILDING
Adhere to min set back requirement ❑
Gas Piping System Fee
PLUMBING
BUSLIC
For Commercial Installations:
Additional weight (structural calcs) ❑
BUILDING
Replacement same weight ❑
❑
Structural Calculations required for new installation
New installation Planning Approval R uired
Cost of P oject: Type of Construction:
Occupancy cup:
Strapped On Platform Bonded ff
Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
F ID
Fee Descri tion
Fee Grou
rk hcablc ee
BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfrn
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
MECHANICAL
BREMRECEPT
Re tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
MPERMITFEE
Elec Permit Issuance
Mech Permit Issuance
ELECTRICAL
MECHANICAL
/ PPERMITFEE
BPERMFEE
Plumbing Permit Issue
Permit Fees
PLUMBING
BUILDING
BPLANCHK
—Bldg
Plan Check Fee
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
BUSLIC
Business License
BUILDING