06050231 CITY OF CUPERTINO °�'" T ate^""r" VI ;
BUILDING-DIVISION PERMIT �CfrrrR egolk�IIV;�UR�VIA'T.10,
qct So e .vim. «�• Fr ' S;Ew &
BUII-DING ADDRESS: A & H HEATING 0605 0231
11043 FIRETHORNE D
OWNER'S NAME: PERtAT L4UE DATE
MARSHALL LILLIAN L TRUSTEE 770 CHESTNUT ST 06
NE: SANITARY NO. CONTROL NO.
(406) 279-0722
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT UMB MECH
O D PLIC O
too LICENSED CONIRACTOWS DECLARATION Job Description
I hamby affirm that I am licensed under prevision of Chapter 9(commencing P
�� with Section 70D)Of Division 3 of the Business and Pwfeadom Code.and my lkeesuu
±�N in O u ra ce ami nff t. REMOVE AND REPLACE FURNACE AND ADD AC
pMZ LicenroCI . o L.Ie.ss a 9471-
Dam - Contractor MEETS SETBACK REQUIREMENTS
ARCHITECTS DECLARATION
fns
I understand my pb Nall shouted u public records,
ata Licensed Professional
kis OWNER-BUILDER DECLARATION
C of hereby.(Sere 11. ,nope Imre the Contractor's License Law for the
p o following hickac moon.(Sectionin 700 1.5,Business and Professions Cade:Any city or mune
3 which requires a permit to construct.)Ne improve.demnitsh.o mpalr any tuuctum
prior to In inuanco.alsatequiras dcappliam scratch pennittonleasigredatatoment
E that he Is llccmed pursuant m the previsions or do Contnctors license Law(Chapter 9 Sq.Ft. Floor Area C a 000
e�
tomato emingwiNSed.70D0)dDividan3ofde Budneloand ProfcniomCade)or o
$ dot becis eumpt Neadrom and the hada fm the alleged mempliM Mr violWon of
Section 7031.5 by any appliceet for a permit subjects de applicant to a civil penalty of pppp g e
tet mare Nan raw hued'sd dollars 0500). 32344012.00 y P
❑I,as owner of tle property.or my employees with wages as their sale comminudan,
will do the work,and W aVumme is not lntonded or offered for who(Sec.7044.Business Re uired Inspections
and Professional Cade The Contractors Lkame law daces not apply to an owner Of q P
property who builds or improves dnrmn,and who doea ouch work himself or through his
awn employers,provided thmauch Improvements artnot inNMed mustered farmthe IL
however,the building orimprovement is sold within am year of completion,to comer•
builder will have to burden of proving that he did not build or Improve for purpose of
O 1.u owner of the property,am reclusively contracting with Reeved conuacuua to
camtroct the project(See.7041.Businra and Professions;Codc)The Contractors Li-
come Law dam not appy to an Owner of property who builds or improv derean.and.
who conuuufor such projects with a eonuutar(s)flared pan am to ft CommeMeel
License Taw.
❑lamaemptunderSee .BBPCfmthamessae
Owner cats
WORKERS COMPENSATION DECLARATION
1 humby affirm under penury of perjury m of the fallowing acclandam:
I have and will maintain a CeNOan of Consent to mlf-imum far Workers Compse-
un ion,as provided for by Section 370D of the Labor Cade,fm the Performance of the
work for which this Permit is issued
1-11 have aM will maintain Worker,CompemWan Insurattce,u tequirad by Section
37()often labor Cade.fa the pedanemee of Ne work ferwhich Nis permit 4 lured. '
My Workers Compensation Irnsurance earlier and Polley number ale:
Cartier. EA,-,fPolicyNo.:joNisr/g1o2081
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thtssunks,ted notbaeompkNd little permit I,foram htmtheddelWa($10)
or Ices)
1 unity that In the performance of the work for which this permit is!attend.I shall not
employ any person in my mannerm as N become subject te um Worken'Compemation
Laws of California.Dan
Applicant
NOTICE TO APPLICANT.IL cher making Nis Certificate of Exemption,you Nauta
become subject to the Worker's Compensation provision,of the labor Code,you mut
.J 0 forthwith comply with mrd provisional o Nu permit shall be deuned rooked.
Z� CONSTRUCTION LENDING AGENCY
'F I hereby alarm Nu dem lea comuuccou leading agenry,ror the Performance:of
!x,>-, the .it for which this permit Is Issued(Sm.3097.Civ.C.) '
W A lenders Name
az Under$AddM.a
V Q I cenify dust I have lead this application end sum that the above informatlun is
lag F correct.I agree to comply wit all city and county Grain..and Ask Hws'shoing to
par building construction,and hereby authorize representatives or this city to enter upon the
W shove-mentioned Pmperty for inspection purposes.
(We)agree to love,indemnify and tcep harmless the City of Cupcnino against
y Ii1hit itlu,Judgmcnu,c nand tare^ass wMch may In any wayamuc a{dmtuid City �y�(
(„) 3 in co meat ngoft dammed.. Issued by:9 Date w -
tr
PILL NT U ANDS AN RH ALL NON-POINT SOU N
Re-roofs
SiSTNumof AppliaDato
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WilltheteCupentar fMuniipal oaceupantnmcoamthandle Health and
m dented by the Cupertino Municipal Code.Chapter 9.12.sed the Health amt Safety
Code,Section 25332()7 I/ All roofs shall be inspected prior to any roofing material being installed.
❑YesWNa
Will the applicWn of future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous ale cmtamimnu at dcnmd by the Bay Amo Air Quality Management all new materials for inspection.
Dlstrict7 — /
❑Yen Ip/ars
I have mal the heardata rtwedaihmeN emcmts umkr .CLapmrd.95ofthe Califor.
n. Ha1N& afmycade,Seed 25505.25533 W2553a.I urders"Uut lfte building
Jou twt c n0Y haw x t.doss respemlwliiy to nudfy the occupant or the
reyuim ta nen t a==ofacenlfeneorOca ty. Signature of Applicant Date
F gird� All roof coverings to be Class"B"or better
suatanzedet Do.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
O _ 060 So'z3 i
OWNER'S NAME: PHONE # -7,42-96'F-5—
GENERAL
7 — 6rtSGENERAL CONTRACTOR: FAX # yp 9 27
I am not using any subcontractors: S�rZG^G�o
Signature Date
Please check applicable subcontractors and complete the following information:
60 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 Date
• COMMUNITY MANAGEMENT SERVICES, INCORPORATED
May 17, 2006
Lillian Marshall
11043 Firethorne Drive
Cupertino, CA 95014
Re: Cupertino Countrywood Homeowners Association
Dear Ms. Marshall:
The Cupertino Countrywood Homeowners Association has approved your architectural request to
install an air conditioner condenser unit on the roof subject to:
1. The installation being performed by a licensed contractor.
2. Any necessary City of Cupertino permits being obtained.
3. Any damage or maintenance, including roof leaks, resulting from the air conditioner
installation being your responsibility to repair.
4. Any exposed plumbing and electrical lines being enclosed in a duct that is painted to match
the building.
5. The air conditioner being a very quiet model compatible with a townhouse community, City
• noise ordinances, and close proximity of neighboring residences.
6. The condenser unit must be mounted on sleepers. The roof cannot be penetrated. The
sleepers must be redwood or pressure treated 4"x4" wood. A piece of roofing material must
be placed under the sleeper to protect the roof surface from getting marked up.
Please be advised that when the Association replaces the flat roof on your unit, you will be
responsible for any additional cost to remove and reinstall the condenser unit. I don't anticipate the
flat roof needing to be replaced for approximately 9 years, since it was just replaced about 6 years
ago.
Thank you for submitting your architectural request to the Association.
Sincerely,
Community Management Services, Inc.
Bob Soares, Senior Association Manager
Cupertino Countrywood Homeowners Association
BS/S
cc: Board of Directors I
File: 4 MAY 2 6 2006
1935 Dry Creek Road, Suite 203 + Campbell CA + 95008-j631 • voice (408) 559-1977 • fax (408) 559-1970
' CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32344012 . 00
DATE ISSUED. . . . . . . : 05/26/2006
RECEIPT # . . . . . . . . . : 34583
REFERENCE ID # . . . : 06050231
SITE ADDRESS . . . . . : 11043 FIRETHORNE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MARSHALL LILLIAN L TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . : A & H HEATING & AC
CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A & H HEATING
ADDRESS . . . . . . . . . . : 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 279-0722
�EE 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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 176 .24 MASTERCARD
TOTAL RECEIPT 176 . 24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO
TURN(lE !:�C
�cUPEkTiNO PERMIT APPLICATION FORM
---
Buildim. Address:
- f A,�e'r
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Owrcr's an:e: Phone # -
C:onuac or. t Lii:unsc
cont.:a:
pho #:
RAS pHEups -
PA
Building Pa:,:,it Inco: -
Bldg LIecC Plumb Me:h
Job DescriPucm: cx- S f::--D Con O o
Residential:
-onunercial:
R�12 �—IS7_!4C�'�D f4!_�°-_�1��Sq.Ft. Floor F.rea: Qu/t2+a 7 .Ft.:
Archiim/ErTineer: --------- --- Valuati
.l'ype of Coesiruction -------- --------- Occupant Group: --- ---- ---
-----.�ppV�j-� -- sem— --- ------- -- ---- — --- ^-2 -- -- - --
Qty. is
Applica.blu Fee ID Pe,- Dcscfiption _ Fee G_rou� -
- � BENLRGY Ener«y
BREMFURN Relocation of Furnace VILCIIANICA.I_
---- BREMACOVER- --- -A/C Unit_> 10,000cfm MECHA:`iICAI
—� BREMAIRHAN _--_—_-- - A/C Uniis <_= 10, 000 cf n j ,V1ECA-1A-N[CAI,
_— BREMRECEP`1 --_ - Recptl_ Sv:itch & Outlets _ ELECTRICAL-
-- 177 BSE15M1CR11 Seismic Puu Res --BUILIDN -
_ ! EPERMff17EE Dec Pcrin;t Issuance ELECTI:?—CA l
IMPERMITFEE Much Permit Issuance NIECEIANICAI.
PPERMITFIil3 PhunbinzPern,it Issue PLUMBING
—_ BPER:.MFEE -- -Bld-a Pcrn;it_Pees — _ BUILIDN(G - -
BPLANCHK Plan Check Fce BUILID.NG
--- TBUSLIC --_ --Business Licensc -- _ BUILID,�(;