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06030181 "CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION %<: BUILDING ADDRESS: PERMIT NO. 20157 SUISUN DR isM'S NAME: PERMIT ISSUE DATE SIEVERT GLENN F AND ANN A RUS1701 LITTLE ORCHARD ST 03/31/2006 PHONE: SANITARY NO. CONTROL NO. (408) 291-2220 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 0 0 0 ±o a LICENSEDOatIam ON sed and R'S DECLARATION wC 1 hereby affirm Net 1 am licenacd under provisions of Chapter 9(commencing lob Deseri ��® �� iu, wim Section 7frit of Division 3 of the Business and Professions Code.and my license I, FURNACE REPLACEMENT ADD A C� L in full farce and effect. t2i License Class (-.9/) Lic.x 44%(fob _ p Dae 9/� Cunlracmr �Gl1�AI pty A0.CNTIECTS DECLARATION APR t r 2006 C.a I understand my plans shall b,used u public records JaU s o Licensed Professional a e�� OW NER-BUILDER DECLARATION ■■Vtpi <� I hereby af0nn that 1 am exempt Item the Coneanoh License Law for rine p o following reason.(Section 7(1.5,Business and Profouiota Code:Any city or County 8 O 5 m which requires a permit to construct,alter,u niumm.dcmolmh,or repair any structure UN -�< Inform its iso moc alit.requires the applicant for such permit m 01,a signed nammcnt mat he is licensed punotrum line proviamn.fthe Contractor's U..Law(CMpter9 Sq. Ft. Floor Area Valuation ex (commencing with Section 70M)of Division3 ofthe Businasand Professions Codc)m y $ mat M is eampt domfrom and Be buis for the alleged exemption.Any violation of Seeder 7031.5 by any applicant fon permit subjects de applicant to a civil penalty of Number QGGU not mom mOccupancy five hundred dollars(SSW). P Y Type ❑I.uowner of tlrc Propmy,or my employcu wim waguu Meir sale mmpenuuon, will do the work and the swnum is not mumdcd or offered formic(Sec.7044,Business and Pmfessiom Code:The Contracture Liana Law does not apply man owner of Required Inspections propertywho WiIdsmimpraws thereon,and who dosstachcaret himselfor through his own employees,provided Nal such improvements are not intended oroRered forose-IL however4 the building or improvement is sold within am year of mmpletian,the owner builder will haw the burden of proving mal he did not build or improve for purpose or sale.). ❑1.Is owner of the property,am c.clusivcly contracting with licensed Contractors in cotowm the project(Sec.7044,Business and Professions Cade:)The Con factor's U. tie Law does not apply to an owner of propeny who Wilds or improves mamas,and who contracts for such projects who a comacmr(a)licenced pursuant to de Conwnats License Law. ❑1 am exempt under Sec. B&P C for this reason ar Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I haw and will maintain a Cuufiare of Consent to ulf-moumfor Worketscompcn- stamn,Is provided for by Section 37M of me Labor Code.for de Performance of Inc work for which this permit is issued. ❑1 haw and will maintain Worker Compensation Insurer¢,as requimd by Section 3700 of the Labor Codc,for thc performance of the work for which this Permit is issued. My Workcts Compemadon Insurance carrier Ind Policy number an: Carder: Nplkftak r,t s tEpliey No.: O 1 1 CERTIFILATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not W completed if the Permit Is foram,hundred dollars(SIM) or less) 1 certify Out in the performance of the work for which this Permit is issued.I shall not employ any person in any rearm,In Is to becomesubjecl to use Workcri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,aper making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J z forthwith comply won such provisions or mus Permit shall W deemed revoked. ZO CONSTRUCTION LENDING AGENCY [r I hcrebytifon run them is a autruentm lendingagcnry for the pmurmanceuf the work for which this permit If issued(Sec.309],Civ.C.) I[7 lender's Name =z Lender's Address U Q 1 cenify that 1 haw mad this application and sum that the above information is Ice. F Cortmt.I agree to comply with all city and county ordinances and state laws testing to 0U building construction,and hereby authome representatives afmus city to enter upon be W above-mentioned Property for inspection purposes. F P. (We)Igree 1.save.indemnify Ind keep harmless the City of Cuperline Ignitor rq liabilities.judgments,costs Inde.K.which may in any way aecrm agaitol said City zz V Z In eonuquencc of the granting of this permit. APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: 6a Date WIRICE REGULATIONS. 3 Re-roofs ueof Appl UConuac Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building omopantstore or handle hvaNaus material as defined by the Cupertino Municipal Code.Chapter 9.13.Ind the Health and Safety o c.Sccdon 25532(¢)?❑Yes All roofs shall be inspected prior to any roofing material being installed. No Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hvardnus aur contaminants as defined by the Bay A.Air QLNOLY Management all new materials for inspection. District? ❑Yes I have mad the ha>aNms material,imp ircmcntsum Im Chaper6,95.ribs Califon ria Hca W&Safety Code.Seedou25505,35533 and 25534.1 undamand that if IM building does not currently have a emnl that it u my responsibility in Coufy,du occupant of the mgat hichmustb,mn nmmiu a aCcnuhneofOcapant, Signature of Applicant Date t o � f '� lfi6 ownerbm ma.gent �-' D,e All roof coverings to be Class"B"or better CITY OF CUPERTINO l�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36928011 . 00 DATE ISSUED. . . . . . . : 03/31/2006 RECEIPT # . . . . . . . . . : 33809 REFERENCE ID # . . . : 06030181 SITE ADDRESS . . . . . : 20157 SUISUN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SIEVERT GLENN F AND ANN A TRUS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4427 RECEIVED FROM . . . . : RICHARD READ CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 • TELEPHONE . . . . . . . . : (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 8 , 780 . 00 158 . 76 0 . 00 158 . 76 0 . 00 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 9, 000 . 00 0'. 90 0 . 00 0 . 90 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 335 . 40 0 . 00 335 .40 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 .y Community Development RwJ 10300 Torre Avenue = Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 PEI�TIN0 Building Department JOB ADDRESS: PERMIT# 0,5 OT-- �o 3 0 / e/ OWNER'S NAME: C)\a r PHONE # S3 _ -9 H 3t-1 GENERAL CONTRACTOR: FAX I le" I am not using any subcontractors: 5 /3006 Signature Date Please check applicable subcontractors and complete the followinginformation: 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 Tar�c/ Sheet Metal Sheet Rock " iTile Owner/Con actor Signature Date CITY OF CUPERTINO bbb I� I ' FURNACE/AC 16CUPERTINO PERMIT APPLICATION FORM APN # Date: 3Wc"1ll Building Address: � 0015 Srvson I�UCJ¢ + G°� �/ 5oi4 Owner's Name: Phone #: °d53 -9& -5 Contractor: License #: coral; �`,c-„ad �A�rS�oc . 4y516 `oZ . e 90 Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect CK Plumb ❑ Mech G©_ Job Description: vr,r, a3 0 CL Residential OJ Commercial ❑ For Residential Installations: Attic ❑ 1" floor<_22 nd floor❑ dhere 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: p Type of Construction: Occupancy group: I$ ao- 00 � Strapped ❑ On Platform H- Bonded Sq.Ft. Floor Area: New Location Er Replacement 0 Qty. if A licable Fee ID Fee Description Fee Group BENERGY . Energy BUILDING BREMFURN • Furnace MECHANICAL BREMACOVER A/C Unit> I0,000 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 BUILDING