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07020154 CITY OF CUPERTINO BUILDING LtVISION PERMIT C� T � � I�1E(?RMAZI�N .' BUILDING ADDRESS: PERMIT NO. 21080 WHITE FIR CT STANFORD PLUMBING HEATING 07020154 OWNER'S NAME: TIZ-- PERMrr LSSUE DATE TOM PERRICON 1965 KYLE PARK COURT 02/28/2007 jNE: SANITARY NO. CONTROL NO. (408) 286-8931 BUILDING PERMIT INFO ARCHITECTIENGLNEER: BLDG ELECT PLUMB MECH a 0 0 a o p LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of iA ion 3 of the Business and Profession Cade,and my license is REPLACE FURNACE t y in full force and >� v�z License 1 Lic•# t- Date Contractor ARCHITECTS DEC R 710 i a< I understand my plans shall be used as public records )a. U.in Licensed Professional 0, OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the pO following reason.(Section 7031.5,Business and Professions Code:Any city or county < which requires a permit to construct,alter•improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area i I--�� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2000 L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ttDN Number Occupancy Type not more than five hundred dollars($500). 35905098 V ❑I,as owner of the property,or my employees with wages Is their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. - ❑1 am exempt under See. B&P C for this reason...._ Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: > - efoork ve and will maintain a Certificate of Consent to self-insure for Workces Compen- as provided for by Section 3700 of the Labor Code,for the performance of the r which this permit is issued. ve and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worket's Com enation Insurance artier and Policy number are: Cartier. Policy No. CERTIFICATE Of EXEMPTION Fit&WORMS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption•you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"'" CONSTRUCTION LENDING AGENCY [~-a►�-. I hereby affirm that there is a contraction lending agency for the performance of (Y > the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is t correct.I agree to comply with alt city and county ordinances and state laws relating to '7 U building construction.and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U 2 in cone a of the grave of this permit. Date APPL UNDER DS AND WILL COMPLY WI H ALL NON-POINT Issued by: SOU C UL S. Re-roofs Signature of Applican ontractor Date HAZARDOUS MATERIALS DISCLOSURE Type of F.00f Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12•and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yesbuilding occupant use equipment or devices which yu. If a roof;s installed without first obtaining an inspection,I agree to remove Will the applicant or emit hazardous air contaminants as defined by the Bay Area Air Quality Management all ne n materials for inspection. District? ❑Yes u / Aafety d the hazardous materials rcyuiremcnts under Chapter fi.95 of he Cali(or- ria HeCode,Section 25505,25533 and 25534.1 understand that if the building docs ny have a tenant,that it is my responsibility to notify the occupant of thereyuircich mmst be rior to issu c of a Ccruftca f oecupan $jgLatilre of Applicant Date All roof coverings to be Class"B"or better Owncr or authorize en Date CITY OF CUPERTINO 6 ITEMS OF 14 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl.{: Lot: APN . . . . . . . . . 35 )05098. 00 DATE ISSUED. . . . . . . : 02 /28/2007 RECEIPT #. . . . . . . . . . BS)00000565 REFERENCE ID # . . . : 07 )20154 SITE ADDRESS . . . . . : 21)80 WHITE FIR CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TO:41 PERRICON ADDRESS 21)80 WHITE FIR CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RE-'EIPT INTERFACE CONTRACTOR . . . . . . . : TRLLLO, STEVE LIC # 4269 COMPANY . . . . . . . . . . : ST.%NFORD PLUMBING HEATING &AIR ADDRESS . . . . . . . . . . : 1955 KYLE PARK COURT CITY/STATE/ZIP . . . : SAA JOSE, CA 95125 TELEPHONE . . . . . . . . : (4)8)286-8931 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 . 86 0. 00 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14.31 0. 00 BSEISMICRE VALUATION 2, 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 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 164 .78 0. 00 164 .78 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT # OIn2 ct55 -- 8 () r - OWNER'S NAME: Pe M'( U PHONE # -1- —52-6 GENERAL CONTRACTOR: -- yL1 L �--J V,* C FAX # I am not using any subcontractors: K�� i gmture Date Please check applicable subcontractors and com Clete the following information: SUBCONTRACTOR BUSI14ESS 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 MetaV Sheet Rori F--] Tile Owner/Contractor Signature Daie CITY OF C',UPERTINO 0-70.f20154 U ACE/AC CUPEi�TINO PERMIT APPLICATION FORM APN# _�/ sr5c? " V"J�13Da Ci Building Address Phone#:T � Owner's Name: .�-�� 7 _ , Contractor: o Phone: � � License#: nl vo Cont%-Ix� Phone: ,/ L Cupertino Business License#: C� R Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech Job Description: Residential Commercial ❑ For Residential Ins llations: Attic ❑ 1 st floor N 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: _eplacement same weight ❑ Additional weight(s �ctural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Proj t: Type of Construction: v i Occupancy group: y� r Dov (\ Strapped M On Platform Bonded ❑ Sq.Ft. Floor Area: New Location El Replacement Qty. if Applicable Fee ID Fee Description Fee Group [ BENERGY Energy BUILDING ( BREMFURN Furnace MECHANICAL BREMACOVER A'C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A'C Units<= 10, 000 cfin MECHANICAL BREMRECEPT R,-cptl, Switch & Outlets ELECTRICAL [ BSEISMICRE Soismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE E:ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE B;dg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC B asiness License BUILDING