06020147 CITY OF CUPERTINO
BUILDING DIVISION PERMIT COIVTRACmT R4I1N*,T'O_RM'A TI,N:1-
BUILDING ADDRESS: PERMfT NO.0 6 02 014 7
10744 BRODKWELL DR
OWNERS NAME: PERMTTLSSUEDATE
CATHERINE JOHNSON 02/24/2006
NE: SANITARY NO. CONTROL NO.
BLDG
ARCHI'IECTYFllGINEER: BUILDING PERMIT INPO
ELECT PLUMB MECH
I� f�
LICENSED CONTRACTOR'S DECLARATION lob Descrition
1 hucby.farm that am 1rsnacd undo WorNaru of CloaPlu 9(comounclnt P
aid,Sudan'7k/)of Dlvldm 3 of lho Bulnor.nd Pmili aabu Code,tool my licene u r3
in MIfNaand REPLACE FURNACE & NEW DUCT WORK t
ZED Lkenha❑ - IJCI' I I] 11 fel
Div; C-5 UElor b '�
k• L - nt - lARCHRELTS DECLARATION
IuMeraaM mY PIa^•abatl he uedupvbtie rurcdS 2UIJu
L$OI((((7777 Ixxncd Rofadonal
OW NFamB nDER DE CLARATION
nyny I hereby a(Rrm..I a1-stud I.th Conor'.I:My t Lax for the
my II`Nyl`-kY(�1/ yy �yy
`GO rallnwinr oeaaolori,t ]11313,BudrcaWrhofatiam Code:Anycity or 1. E,0 37
S w whkh hats a permit to wnut ft r4n bnpmm,he rmiitt fi mpa,SoC,Jo any oon=1 $4 6:5;04�
_zi primmiu o,,o,je.Woow oto,,the Spplkanl far mch permitlofik..Lrcd.uunmt �.
££i< (.l niamWpulmwlul of Did oo3aeCaunooss. Poslaont,C erg Sq. Ft. Floor Area Valuation
y1-$ (eu be ii rwith Sectionr an0)NOiWuonr of the BlSxl YdP Mye ilCodc)of
Q .. that io V....,pt any ap m anti the buiy for them Ono......W as A Wohtion of
not domby holmd"lfor.pe). ISubjeeu thc.ppBuntm.rirdpwlryN [ Occupancy Type
not mom man nK ba Wma dNlua(ssoo>.
❑L so owm of uc popvrY,or my employ=wbh wIW u ucn hale cornpenutlmi.
will do tho ..ami the.tmmuc b not vuepaed m o@aN fm.alc(S .9044.Bmlrcso Required Inspections
and P afeviom Code:The Comae ll Ll �Law a owou
cedonot.PPIy In u of q
Progenywhoz.K IXim tou,a Ihltn arw whoaoea.mAwhathimsoJf ar doe` M.
owm em.dMb,prorwNtowhach Imprawoenutoene itoo of ardfered fora B,
bole theadon�orbnpopnlrtm Vhalewithinone Seto or irn l for"tnwonr-
bmla>ww b.,e the wbm or pn,.ini that la aw not IW w«knPm.e for pvlPas or
❑I.u ownv a We paopeny.a.nefuaSr3y omnr.Nnr with liunmd cma.crar.to
coostroa Ne p.j.(S .7(344.Bu tow and Profnatau Codc)The Caatrctor'.L-
.Law don non appy In an.of p•WenY who Wikat or Impms deem,and.
who conrncts fore projem with.contractor(.)I d pumuN to the Cmuanofa
L.iccna Law.
❑lunuwpvodu Sec ,Bh PC fa dos msooa
�mr Dal
WORKERS COMPENSATION DECLARATION
I hveby air=oder prnatty of PuktrY om of the folbwin{dtalan
1 ba.eaIWw maintain a Certifow a!Camatw Self-huurefarwotW3Compcn-
•. .W on,a provwed for by ScawR 371)0 of the Labor Cade fo ton Pofmmtolm of IN,
work for wMch this pmnit u ivuLd.
I lave and will rnau m n,Wo kcel Campewtlon Imdno c,m nc#md by SeuWn
3]00 ar Ne Labor Code,for ac pelfatmtotm or the wok for wtich thV pmma u Lsoucd.
My Wurkes Conlemtoiun lane r a aic and Policy number arc o
C.niv. _tYaa\t`(4i Polky No.:
\V- CEPMEG OPTION FROM WORIKEPS
COMPENSATION INSURANCE
011a,z oo a,od not bewmplelN ifft p idLLfwa buadmd dNltoa(SIW)
1 certify do,in the porWmame of the woh for which this pump is mned.I.•Lafl nal
unplvy any pc.in any.ha as to beano.Subjccl do NC ootk CooKation .
laws a"ifomit Daae
APaloam
NOTICE TO APPLIGNT:If,after mWn,this Cenlft u a&.Plum.you.batw
be. Subject m Ila Wor ,Co,,otativn p Wtma N the Laky Cade.you must
UZ foltwith..Ply with arch Inmost.or tibia P il"I be dmmN makM
Z O CONSTRUCTION LENDING AGENCY
P4 I hen,by affirm Into Ibon,I..mnau .Smdtnr atom,,I.Ila porono.or
=7 the w for which'ha Panni.b rood(Sc 309].CM.C.)
WQ Landly' .Name
.�Z L<Mer'.Add=
U Q I a fy that I lave rnd this application aM Stole that t abmc inrarmadun bt
comet l arra m c Ply with all dty and county otdloanc..W Nw laws rtlatinr m
OU bulwinj coon dioo,and bembyauthodm mprucamima of thu city W color upon uc
'LLQ ahmc-.ni pmny far iupcNon popact
(W,).Crm w sore,indemnify and trap harmless the City of Cupmino aµmr
Fy IiaMlida.jud,.i.s.cnu and upcua whim may in any way at u atalnn aid Cly
U Z incmlYgmccoft ,lanfi rofthuperm1L
^ APPLICANT UNDERSTANDS AND WI COMPLY WfT11 ALL NON POINT Issued by: Date
SquRc REGULATIONS.
OQ ,`-14%OG Re-roofs
SiynYiac Applitsn u.nor - - - - - " --D.
S MATERIALS DISCLOSURE Type Of Roof
WIII tk aMb.,ar fmuc NMI,occupant Yom or hardk bamdau nutoriel
u defined by the Cupenlno M.nidp.l Code,Chapter 9.12.and the N atth and Safety
.smtim M32(a)T , No All roofs shall be inspected prior to any roofing material being installed.
Oh
Will ae.pplicml or rat budding aevpaN=egoipmeol m ae.im wbkn If a roof is installed without first obtaining an inspection,I agree to remove
It harardma air ronumlum.so dcRraM by the Bay Arta Air Quality Manapcmelu all new materials for inspection.
aYrictl r�I
Cl Y. <�N%
I bm,o toad ua h nkou.n ou"mqulmmew unthr Chape695 of the Uifm-
oaa Slralth k S.feey Coda.S¢9mo 25505.25533 aru125534.1 urtdo.wd thYirlbo tanidi ly
doe.
no,c .I,bale•amant that it u my rraponubility M odJ,Inc as l M the
myw'ri hmtm mapdor araC fkacafonvprcy.. Signature of Applicant Date
ui
All roof coverings to be Class"B"or better
0 rte authvrvrola - D.to
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C OF Fax(408)777-3333
�UPEf�TINO
Building De artment
JOB ADDRESS: PERMIT #
20 /
OWNER'S NAME: 5 PHONE # 9L 109 63
GENERAL CONTRACTOR: Con FAX #
I am not using any subcontractors: Ce
Si tore Date
Please check applicable subcontra om lete the following information
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 T
Sheet Metal
Sheet Rock
Tile
f," A
Own r/Contractor Signature Date
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # 3Date:
6�i � �t - 63�i � • �y • oG
Building Address:
10 44 c�ool� wdt Qom• �' n��:ro CF'a 9 (bOt tl
Owner's Name: Phone #: 8 9 6 3
ha r �`3S
Contractor: License #-- "
516� ,
Contact: Cupertino Business License#:
5�n;.r�a V • � 3 3
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech q2—
Job Description: 7_
Fly \ C & 1, W I•C
Residential ED, Commercial ❑
For Residential Installations:
Attic ❑ 1" floof51�1 2nd 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 Approval Required
Cost of Project: _Type of Construction: Occupancy group:
$ y , 650 •
Strapped ❑ On Platform El Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
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 Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License 2 3, BUILDING