05110006 (2) C408) .733-6360
ITYOFCUPERTINO
BUILDING DIVISION PERMIT ,sI-',d ITR�iC cep ,.,oRNAT,I�aI�',
BU1LDpHC ADDRESS: HUSSEY BROS INC PERMrr"o'05110006
0691 CELESTE C1,
OWIT OWNER'S NAME: PERMISSUE OATS
JUDITH TADINA
5N8: SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
PLUMB MECH
1 q D O
joo LICENSED GDNTRd under Provisions
of CDN Job Description
I I hereby aLIC that 1 w OWMA voles provisions of Chapter Y(commencing P
with Section 700111 ofD sm 3afdw Buelneu d Pm(euiuns Code,and my lkeme la
LicenlmfoCw'y.,neeBeeIC-iQ Lk.« REPLACE FURNACE & ADD A/C /NOV
fDawes1- n���Cos DECD my plans shell he used W rtow ®Ne� ��yy�++��00h✓
rod�a Licensed Professional J`rvf/j �/J�t/�
b y Oat I am OWNER-BUILDER ne me CoATION (/ Hp
no 1 hereby.(Iim on 1 em exempt from the Coins Co License Law for tie L7
p o fallowing moon.(Section lion I.S.Business and Rs.dations Cade:Any city or aunry
$ which regoim Issuance.permit re emumme aur,Wpraw,d permit, fl mpolr ed t ructure 0
gement
z�+ tprior hat he its ensedprsalsarequitee pmvmoimof forsucthe Contractors
IOleaalpnnduwmr9
ppxa (commealkensnd Smile.m O).fDivision
ivisuofdwCantran..dProthw tCook) 9 Sq.Ft.Floor Area Valuation
is tom$ that MInan{whh5uftem and
bull nlof tieeged euandon,My ICode,sir
— than io I.31.5 b tM applicant
ane Nr aper it the allcat me exemption.a My it peraun of
actSession]0313 five
u hundred
lona r"a permit wbjecu me applicant w.evil pcoWyof p Occupancy Type
trot mom dun Rw huvdrtd doltsn IS300).
❑I.uscnuo[tMp scruncem,is not mmy wpteym wlNvngexuthehsek com.cuhan,
will Pr le sic"anorks.Code:
h.Consumes iorms,nded raw do fs ukpply m an cwmBusmn of Required Inspections
propertyand Ao-be lou carie:Thr conurlon,Ld who Law don net apply lf rt owner is q P
mancon wha Wlprovid mpmm tiwrom.and who amnamh w ftd oro if ordwugh his
however,the
prveh ImPmwmentssaene year fmnpledimd far cele.s.
builders,Ne"dieing or Improvement ts hold did au year or Improve
for the awneo-
builder will haw dm buNco of proving that W did net Wild"improv(or Purpose of
ick.).
❑t as Owner of the property,w exclusively contracting with licensed onamemra to
eammrn Na project(See.70".Business and PmfcWm Code)The Coetrammea Li.
cense Law does an,apply w an owner or propen ywho Wild,or Improve tureen,and.
who contracts for such projects with a camnnurs)licensed pursuing to the commences
License Law.
❑Ion exempt under See .B•PC for this moon
Ownu
Data
WORKER'S COMPENSATION DECLARATION
I hereby all=under penalty of perjury ane of the following denmatimtc
1 in.and w01 maintain a Cmtifiesu of Consent in self-iuva for Workers Compm-
urian,as provided fm by Section 3700 of the lab"Code.for Use pmlom.m of the
wart for which dor permit ie Isamu.
❑1 have and will dramatic workers compensation lunnm,u required by Sectio
3700 of Ne Lab"Cade,for tho pouamunco of Ne work("which this permit is Word.
My WmksCampemmi t bummexcaniu and Polity ober ase:�7�
Carder. h4 Policy No.:
CERT«(GTE OF EKEAIMON FILOM WORKERS'
COMPENSATION INSURANCE
(nrkxNm need net hecompkwd UtM permit is r"ane hundred douus($100)
m leu)
I certify that In the performance of the wart for which this permit k issued I shall set
employ any person in icy mevner an as as become subject to ted Workers'CampensNw
Law,of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject to the Worker,Compensation prevision,of the Labor Core,you mw
.J 0 forthwith comply with such provisions or this permit Mal W deemed reeked.
CONSTRUCnON LENDING AGENCY
(.. I thereby grim than dem is a eonstmtum lending agency for she performance of
r/7 the work far which this permit is Word(Sec.3077.CN.C.)
WE Lsnders Name
z Lenders Address
U O 1 certify that 1 have read Ni,application and sum that the aWw Information Is
aomtt I agree to comply with aI city and county aNinares and tuw laws,wining to
O SITJ building saturation,and hereby authodue tePusenutins or this city to enter upon the
W ,bow-mendaned property for inspection pugw,ec
0. (We)agree to an.indemnity ice keep harmless the City of Cuperdm against
N liabilides,judgments.cow and expe.which may In icy way warm against sok City a17
()z in eoueq'In ce of the i netting o(thts Permit.
^ APPLICANT UNDERSTANDS ANITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. I(�f�(
J Re-roofs
Signuuse o[ApplicarWCommmorDau
HAZARDOUARDOU S MATERIALS DISCLOSUR Type of Roof
Will yte applicantorforum Wall Occupantstorehuueauimateria
u defined by rise Cupertino Municipal Code,@apses 9.12,and the Health rod Safety .
ode.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yui
Will this oppressor,or lotto balding occupant me,cquiPmmt m ham which If a roof is installed without first obtaining an inspection,I agree to remove
h hu'raninu air conuminants u honed by the Bay Amo Air Quality Management all new materials for inspection.
District? /
❑Yes —vFlilu .
I haw read Ns,huardma malesidssequiwtunu under@aplerd95 of Ne Celifor- -
nklkohh&sanycode'sw 25 .25533wd25534.lunderstWthuirdw Wlldial
dm set curmmly have, e u my maponsibility w ratify the m.pam or Ne
requirements which sent t or W molecule or Signature of Applicant Date
Ownermwiltmbed.gcntD,te All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT ® ST//�GI0 61
#
Celeste C1` t'-
OWNER'S NAME: -Tv 1 e- wa PHONE # 0 ?3�-63Gb
GENERAL CONTRACTOR: vss< Bros � I FAX# Yof 32--/S-i(oj
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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 Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
De Anza Forge
550 Division Street
Campbell, CA 95008
408-540-5050 Fax 408-371-5130
October 11, 2005
Judith H. Tadina \
20691 Celeste Circle y6G
Cupertino, CA 95014-0483 7 J
REF: Architectural Application
20691 Celeste Circle d
Dear Judith H. Tadina:
Your application to install air conditioning and change existing furance at your unit
was reviewed and has been approved with the following conditions:
1. Design and construction must meet the guidelines as specified in your CC&R's,
any applicable state and federal laws, and as described in the enclosed
architectural application.
2. Please obtain design approval from the appropriate local agency if necessary.
3. Prior to the start of any work please make sure that all vendor information has
been provided including insurance certificates.
4. Any damage done to the Common Area will be the responsibility of the unit
owner.
5. Also, at completion of the work, please send to my attention, copies of any final
signed agency permit(s). If we do not receive these documents, we will
understand that you have contacted the appropriate local agency and they have
advised you that their approval is not necessary for the work.
Any additions or modifications to the above referenced work will require a new
application. Should you have any questions or comments, do not hesitate to contact me at
408-540-5026. Thank you for your cooperation.
Sincerel ,
Randy Near
Association Manager
cc: Property File: 00131-2849
Architectural Committee
Board of Directors
APPL2—Architectural Application Approved
-� CITY OF CUPERTINO
;Gec FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3 2-( -S-so ?5-
Building AyEb:, ) C_e j e s7 ,, C i
Owner's Name: // one#:
Ph
,vd lfl, Tadi�� Yo P Y�6 -3y3o
Contractor: $Sf License #:
Contact: Cupertino Business License #:
S�fVC 'N�SS�
Building Permit Info:
Bldg ❑ Elect T�— Plumb Mech E�—
Job Description: p ,
rep�Rle 4rc-ecY r.ir- l`/'vry e-t-e zZOV plc
Residential Commercial ❑
For Residential Inst Mations:
Attic F-1 I" floor ' 2'd 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: 9a' Type of Construction: Occupancy grsnp:
ILS is
Strapped ❑ On Platform . ❑ 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
BREMArRHAN 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