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07110027 CITY OF CUPERTINO ` ' BUtLDING DIVISION pERMIT Gfi1��4.�+f�� T��3� ` ;. ;. _ _.:... ,.. . : BUILDING ADDRESS: PERMIT NO. 1187 STAFFORD DR A� FUrZNACE & AIR 07110027 . .�ER'S NAME: PII2M1T LSSUE DATE LEE ELSIE A TRUSTEE 1712 STONE AVE 11/06/2007 PHONE: SANITARY NO. CONIROL NO. ARCHITECT/ENGINEER: BUILpING PERMIT INFO REPLAC E FURNACE 10 0, 0 0 0 BTU BL�c E�.eCr PLUMB MECH 0 � 0 0 u o p LICENSED CONTRACfOR'S DECLARATION � � 1 hcrcby afGrm Uwt ! am lixnscd unJcr provisions of CAaptcr 9(commcncing Job Description v z� aiW SecGon 7000) a[Division 3 of thc Busincss and Profcssiuns Codc, and my liccnse is "? y in full Corce an � 2 Licensc Clats L�. � n F„ � Da�c Contracwr � ' AR 1TECTS DECLIRA7'I N — �� U I undcrstand my plans shall bc used u public rccorda a ; �+. y Liccnsed Rufcuional n,� � OWNER-BUILDER DECLARATION � `� 1 hcrcby allirm Ihat 1 am excmpt from ihc Contractars Liccnsc Law for Wc i p O following rcason. (Scction 7031.5, Busincss and Profcssians Cafc: Any city or caun�y �,°, � which requiccs a pertnit to conswc4 ��r. impmvc, dcmolich. or repnir any suucture � Z� prior ui ils issuancc, also tcquiccs thc applicant for such permit to filc a signeJ sulemcn� �_ � that he is IiccnscJ pursuant to thc provisiona of thc Conuactor's liccnsc Iew (Chaptcr 9 Sq. Ft. Floor Area Valuation � F- $ (commcncing wiU� Sccdon 7000) of Division 3 of thc Busincss and Profcssions Cadc) or y �.. Nu 6e ia racempt thc�efrom md the basia for the allcgcd eumption. Any violation of SaGon 7031.3 by arry applicant for a pecmit subjects �he applicmt to a civil pcnalty of APN Number Occupancy Type not more than five hundred dallars (I500� ❑ I, u owner o[ tl�e property, or my cmployces with wages u Weir sok compensation, will do the work, and ihe stcuc�uee is not intendcd or oRered for salc (Sec. 7044. Husiness Re u ired Ins ecdons end ProCessions Code: The Conuactors License Law does not spply to m owner of Q p property who 6uilds or improves thercon, and who daes sucA work himaelf or through hu own emplayces, providcd that such improvements ue not in�ended or afCered for sala If, however, �he building or improvanent ia sold wi�hin one yesr of completion, the owneo- builder wiU have the burden oC proving �hat he did not build or improvc for puryase of saleJ. Q I. as owner of the propertY. am exctusively aonuuting wi�h licensed rnnusctors to wnstruM the peojeM (Sec. 7044, Business and Professions Code:) The Coatncmr's Li- cense Law docs not apply m an owner of propcny who builds or improvrs tAe�eon, and , who contracu Cor such projeca with a conuxtor(s) licensed pursuant w thc Contracror's License I.aw. � I am exempt under Sec. , B A P C for this rcason inv Date WORKEIL'S COMPF�(SA770N DECLARATION 1 hereby affirm under penalty o[ pe�jury one af ihe following declarations: ❑ 1 hs.�e and will mainuin a Ceni6nm of Consent to ulf-inswe Cw Workcrs Compen- sation, as provided for by Section 3700 of the tabor Code, for �he performanm of thc work (or which Ihis pertnit is issued. ❑ I havc and will maimain Warkcr's Compensadon Insurana, as required by Scction 3700 oC the Labor Codc, for the performantt of �fie work fw w6ich ihis pertnit is issued. My Worke�s C ipenution Insurance cartier and Policy number Le: Cartier. Policy No.: CE 77FICAT OF EXEMPI'ION FRO W0� C•RS' COMPENSATION INSURANCE • (71iis scction rced not be complcteJ if ihe permit is for onc hundred dollus (S I00) or Icu.) • I cenify thnt in ihc performancc of Wc work for which �is permit is issucd, 1 shall not employ any pccson in any manncr so u w becomc wbject w �hc Workcrs' Compensalion Laws of Cslifomia Datc Applicam NOT[CE 7'0 APPLICAM: If, ahcr making Nis CcniCicate of Excmptlon, you shoutd bccome subject to �hc Worker's Compensation provisions of Nc Lalwr Codc, you muu , O fonhwith comply with such provisions or this pecmi� sAalt bc dccmcd revokcd. z '"'' CONSTRUC'fION LENDING AGENCY [— �-�. I hercby a�rm tlut thero is s consuuctian Icnding agcncy Cor thc perfortnancc u( p�., � �he work fur which this permi� is iuued (Scc. 3097, Civ. C.) a Q Lendcr's Nunc • � z L.ender's Addmss V 0 I cenify ihat 1 have resd �his application and sis�c ihal tAc a6ove informatiun is w�" corten. I agrce to comply wi�h all ciry �nd county onfinances and state laws reladng w 0 U buitding consuuction, and hctcby authorix mpresenuGvcs of ihis city w cnter upan ihc � W ahove-mcntioned pmpcny for inspecuon purposes. (Wc) agree to save, indcmni(y and kecp harmless �he Ciry o[ Cupcnino against �� lisbilitiu, judgmcnts, cos�s and expenscs which may in any way accn�c against said City U z'in consequencc oC U�c gnnting of ihis permi� � �"" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � '� '/ SO CE REGULATI �y Re-roofs ignaturc of ApplicanUConvactor Da HAZARDOUS MATERIALS D[SCLOSURE Type of Roof �II thc applicant or futurc building occupant uorc or handlc haiardous ma�crial 9efincd by the Cupenino Municipal Cadc. Chaptcr 9.12, and the Healih and SaCety .� .Section25532(a)? All roofs ;chall be inspeeted prior to any roofing material being installed. ❑ Ycs No wsu m� e��i��,� r futurc building accupant usc cquipmcnt or dcvices which If a roof i:; installed without first obtaining an inspection, I agree to remove cmi� harardous air conuminanu u cicfincd by the Bay Area Air Quslity Managcmcm all new m aterials for inspection. Disvict? ❑ Ycs Nu l havc rcad the ha� ous ma�crials requiremcn�s undcr Chapicr 6.95 of thc Cali(or- nis Ficalih & Safcty Cadc, 'ons 25505, 25533 and 25534.1 undcrs�v�d thu if itrc building dacs not curtently havc a �enan4lhat it is my responsihiliry to notiCy thc occupant of Uic rcyui men�s which mus� bc met prior w issuar�cc of a Ccrtificatc of Occup Signature of Appl icant Date wncrorauthori�a agcm o, All roof coverings to be Class ��8�� or better CITY OF CUPERTINO 8 ITEMS OF 14 PERMI�' RECEIPT OPER.ATOR: pdtq COPY # : 1 Sec: Twp: Rng: Sub: Bll:: Lot: APN ....... 36;:11025.00 DATE ISSUED.......: 11,'06/2007 RECEIPT #.........: BS()00003171 REFERENCE ID # ...: 07:_10027 SITE ADDRESS .....: 11f37 STAFFORD DR SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: LEI� ELSIE A TRUSTEE ADDRESS ..........: 11�37 STAFFORD DR CITY/STATE/ZIP ...: CU]?ERTINO CA, 95014-4951 RECEIVED FROM . . . . : JII? R.ANDO CONTRACTOR .......: RAIJDO, JIM LIC # 8050 COMPANY ..........: AA��: FURNAGE & AIR CONDITIONING ADDRESS ........... 17:�2 STGNE AVE CITY/STATE/ZIP ...: SAIJ JOSE, CA 95125 TELEPHONE ........: (4i)$)293-4717 FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMAIRHAi�T NO.iJNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 BSEISMICRE VALUATION 6,800.00 0.70 0.00 0.70 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 183.70 0.00 183.70 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 355.74 VISA --------------- TOTAL RECEIPT : 355.74 � VOICE ID DESCRIPTION . VOIrE ID DESCRIPTION -------- ---------------------------- -=------ ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL . ��lC��-7 , CITY OF (:UPERTINO � ; FURN.4�lEfA� CUPEt�,TINO PERMIT APPLICATION FORM APN # � �� K �Q Date: / � � _ o � � Building Address: .�f -��o� �r � ,� , � � Owner's Name: Phone #: � 'LS � L�� o�' o?3",L 0 Contractor: Phone: License #: v � � �- d - 6 �6` 7/ Contact: Phone: Cupertino Business License #: � �„� 0 - 3 �d S°-o Building Permit Info: Bldg ❑ Elect � � 'lumb � Mech Job Description: Q�.� �a.o ov T'v ��p ,3 r� fo Reside tial Commercial ❑ For Residential Inst llations: Attic � 1 St floor � 2" floor � .�dhere to min set back requirement �' For Commercial Installations: Replacement same weight ❑ Additional weight (s��ctural calcs) � Structural Calculations required for new installation New installation Planning Ap roval Re uired ❑ Cost of Project: Type of Con tru��ti�n.; Occupanc group: � � �p � , � � �-- �L— Strapped On Platform C� Bonded Sq.Ft. Floor Area: New Location � Replacement � Qty. if Applicable Fee ID Fee Descri tion Fee Grou BENERGY Energy BUILDING / BREMFURN Furnace MECHANICAL BREMACOVER ?JC Unit > 10,000 cfm MECHANICAL BREMAIRHAN �JC Units <= 10, 000 cfm MECHANICAL BREMRECEPT F.ec tl, Switch & Outlets ELECTRICAL BSEISMICRE � eismic Fee Res BUILDING BSEISMICOM � eismic Commercial BUILIDNG ' EPERMITFEE F;lec Permit Issuance ELECTRICAL / MPERMITFEE I�1ech Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE E�ldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS CTas Pi ing System Fee PLUMBING BUSLIC Ftusiness License BUILDING Community Development �` `''; , � 10300 Torre Avenue s� }�;:: , �. ��, Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�TINO Buildi:n De artment JOB ADDRESS: PERMIT # _ � � � � O!?'1—�7 O 'S NAME: � � � PHONE # ,? - GENERAL CONTRACTOR: 7 ' C # i I am not using any subcontractors: J D� G �� 6-a � Si�;nat e Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrIESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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