03110057 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTnR£INkORMATIQN: '.
BUILDING ADDRESS: A PERFECT CLIMATE PERMITNo03110057
1(0251 PARLETT PT.
OWNER'S NAME: 10570 S DEANZA BLVD PERMITISSUEDATE
LESLIE GUTTADAURO11/12/2003
NE. (408) 861-9545 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
.Op LICENSED CONTRACTOR'S DECLARATION C7 O
01 hereby affirm that 1 am licensed under pmvismns of Chapter 9(commencing Job Description
,¢w with Section lIX(hii(Division 3aft1e Business and Professions Code,snd my hear c is
pd In full force and effect.License Close Lie.M REPLACE FURNACE & ADD A/C, DUCT
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
e Lmensed Professional
g OWNER-BUILDER DECLARATION
<I 1 hereby affirm that 1 am exempt from the Contractor's License Law(or the
00 following reason.(Section 7031.5,Business and Professions Code:Any city Or county
<$� which requires a pesmil to construct,eller,improve,demnlish,or repair any structure
uZY
prior it) issuance,also rcyuiresthe applicant for such permiuo File asigncJ ammmcnt 0700
< thetheislicensed umuanuolhe rovisionsoftheConwnur'sLicenseLav,(Chapter S Ft. Floor Area
Exo p p ( d q• Valuation
al- (commencingptSection froma and fir basis fr of the alegemeas and
on.Anynvi COAG)or
Q $ Net io is exempt any applicant
li and the basis far the alleged exemption.Any vimation of 31646054 . 00
Section tan five
any applicantfor spermit subjects the applicant macivil penally of
not mom man Brc hundred dollars(fsoo). APN Number Occupancy Type
❑1,es Owner of the propcny,or my employees with wages m their sole compensaim,
will do me work,and Ne structure is nor intended or offered for gale(Sec.7044,Business
and Professions Cock:The C rnarom or'a License law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himselfor through his
awnemployees,providedtumsuchimpro
emens vent intendedmoffered forsale.r,,
ownemp thebuildingde that sch imissoldwithinone yesof completion,me le.If,
builder will have Ne burden of proving mal he did not Mild or improve for purpose of
sal..).
LasOwner of the Sm.704amexclusively confessions Cod:)TheeCntract is to / ate j
c e La the project(Sec.toad,Business and ny who
Code:)The Contractor's nd
cense taw docs not apply a an owner of progeny whe builds or improve thereon,and
who contracts for such projects with aconuacmr(s)licensed pursuant o the Contractor's
License Law.
❑lame m1. to ,Bh PCf r thio
O or Date
WORKER'S MPENSATION DECL"WT10N \Vt
1 hereby affum under penalty of perjury one of the fo'l'lowing declarations:
I have and will maintain a Cenificam of Consent to sel6insure for WorkersCompcn-
137CW
on,az provided for by Section 3700 of the Labor Code,for me performance of the
rk for which foil permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Sermon
of the labor Cod.,for the performance of Ne work for which this permit is issued.
Worker's Compensation Insurance carrier and Policy number am:
nner: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This s.ction need net be completed it the permit Is for ase hundred dollars(S la)
or less.)
1 cenify Nm in the performance of the work far which this permit is issued,I shall and
employ any person in any manner w as in become subject o the Workers'Compensation
Laws of California.Dare
Applicant
'NOTICE TO APPLICANT:IL after making this Ccrifmate Of Exemption,you should
become subject to the Worker's Camp reation previsions of Ins Labor Code,you must
JZ (ormwnth comply with such provisions or this Parini t shall be deemed mvnked.
ti O CONSTRUCTION LENDING AGENCY
r^' Ihereby affirm mat there is a construction lending agency for the performance of
the work Be which this permit is issued(Sec.3097,Coe.C.)
W� Q lenders Name
= z Lender's Address
U Q I cenify that 1 have read this application and sue that the above infmmatiun is -
ly(~ coned.1 agree to comply with all city and county Ordinances and state laws relating to
QU building construction,and hereby authorim represamadv.s of this city to enter upon the
IJl above-mentionedpmpcny for inspection which may
(We)agree to save,indemnify and keep hmmless the City of Cup.nine against
fA
liabilities,judgmentsecoarsand of this pewhich they in any way ammc agalnal said City
C..)z in consequence of the gesnting of this permit.
" APPLI ANT Ub ERSTANDS A WILL COMPLY WITH ALL ON-POINT Issued by: Dale
sGD f ;1/03
Re
SI eturcOfApphcaHAZARDOUSMATERIALLOSURE Delc Type of Roof
Will the applicant or future building occupant sures or handle Intonations material
az defined by the Chromium Mina:C.a.Chapter 9.12,and the Health and Safety
ted.,Scenes 25532ta)7 All roofs'shall be inspected prior to any roofing material being installed.
❑Yea
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
it haaamous air conlamim;n Crincd by the Bay Area Air Quality Management all new materials for inspection.
H
❑Yes Nu
1 have mad the hmanlous materials mquimmenB under Chapter 6.95 of the Califon
nia Hculth&Sumt Cod.,Sccdum25505.25533and25534.1undcmaMlhaliflhe Milding r
does are ren va a moan thm nl' y rspongihiliiy m nndfy rM c upant of the
r m a1 ausle du u ceoraccrdncaleofaypa.I Signature of Applicant Date
(tlf?6Q 1
Own amhanrcdagcm Dam All roof coverings to be Class "B" or better
CITY OF CUPERTINO 03 //
FURNACE/AC
CUPE,I�TINU. PERMIT APPLICATION FORM
APN # Date:
Building Address: l 0 S( Glomi 2 Q<
Owner's Name: I i Phone #:
Contractor: n License#:
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech Q
Job Description: J/
1Q cz e��sl—r k u�c ttc, tp ^( e w ct t - c rr•-�r" (—r.i� t 4 f�
Residential 0' Commercial
For Residential Insta ations:
51
Attic ❑ 1floor 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: k Type oTf Cons ct on Occu group:
ro• � ancy
Strapped On Platform Bonded q.Ft. Floor Area:
New Location ❑ Replacement L�
Qty. if
A U ac bl Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 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
05/06/04 THU 13:04 FAX 4082532449 W'aferFoundryServlesInc. Im001
CITY OF CUPERTINO
BUILDING [VISION PERMIT
BUILDING ADDRESS: PERMIT NO.
k10251 PARLETT PL A PERFECT CLIMATE 03110057
ON NER'S NAME PERMIT ISSUE GATE
LESLIE GUTTADAURO 110570 S DEANZA BLVD 11/12/2003
NE: SANITARY NO. CONTROL NO.
4082532449 CUPERTINO, CA 95014
ARCHITECI7ENGINEER: PNONE N; BUILDING PERMIT INFO
REPLACE FURNACE & ADD A/C, DUM ELECT PO O
OD
W •'� } 3n, "i, 7D ARRAN GE INSPECTION JOB DFSCRIPTION
INSP ION x w' g e �''` CALL 777.338 MONDAY-FRIDAY 24 HOURS URS FNTIA!
?6 f#1i' ' L �""1 "'�•r:� -RT �°�" BEFORE REQUIRED INSPECTION.JOB ADDRESS 1.1 SFDWL ❑ KITCHEN REMODEL
ys FOUNDATION/PIERS/E{.D.S.` AND PERMIT N ARE NEEDED WHEN PHONING. 11 ADDITION CI PLUMBING RE-PIPE
e� I,)MULTI-UNR O STRUC7VRAL
UFER GROUND
MODIFICATION
� PAD/SETBACK-CERT RESIDENTIAL—COMMERCIAL_OTHER_ 0INIERIOR ❑ CHIMNEY REPAIR
GARAGE SLABS/PREGUNITE IMPROVEMENT ❑ SWIMMING POOLS
• a-, r,,.„�
HAZARDOUS FIR ARE C] BATH REMODELJREPAIR C] DEMOLITION
`� ';4B' ,F�1'4ksSB' NtSfCikECS'.,
C] OTHER
UNDERGROUND/SLAB AYES Hyu-lun4erswn4 Nua Clau ArmT,..-mNly in aquirt4. '
i
€y€o UNDERGROUND PLUMBING
13$ UNDERGROUND ELECTRICAL ❑ No ronlni LaB.0.4
k "4 EXISTING ROOFCOVERINGI�
sDONOT„PO`URhFLO R (1 ,It`ABOV?Ei A$`BE ?510 1E `a: '1 - 0 NE1W BLDG/ADDrF10N 0 DEMOLITION
UNDERFLOOR PLUMBING [E]f£I�1/�N 5N5t1003 0 FOOD SERVICE
Numbnr o/exirtinS eoverinp i81Pk0
UNDERFLOOR MECHANICAL ('I OTHER
UNDERFLOOR ELECTRICAL To En removctl To Cereuiud OA�II
UNDERFLOOR FRAMING VENTS 1��IY�
UNDERFLOOR INSULATION
�rwceP+ol U$F7.(7T3 N7lsrPBBVi'`Hi s SEEN SiGn[�ii`; .�'
ROOF SHEATH/DIAPHRAGMko
PLUMBING Post-ItO Fax Note 7671 Dale I, U pages
TUBS&SHOWER PANkm
To /^ From�j
MECHANICAL l• Co,
ELECTRICAUPOOL BOND C Ce./Dept.
AMING/STAIRS/E.EGRESS C Phone R Ph°ne p
UL A7ION/VENTILATION Felt p Faap
_. . .
1.EOYERINO%. . �iika�J' "AVRl1A 'BE `SIGNE`0 «,na
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEARIHOLD DOWN INSPECTION SPECIAL INSPECTION REQ,UIRED 0 DATE INSP
SHEETROCK/SHEEIROCKSHEAR
EXTERIOR LATHIW-SCREED
SHOWER LATH
'Nf3,7AP ORP:CtSIER: 'AB V'NASBIIC; RI;
SCRATCH COAT
SEWERIWATER
TEMPORARY APPROVALS
OCCUPANCY
? ti PLANNING 777.3308
x ^> cns TEST / IMPORTANT
0 q GRADE(P.W.777-3354
3 Z FIRE-CALL(408)378.4010 /When a permit has expired, a charge totaling one-half
0 HANDICAP the fees to obtain a new permit must:be paid to
o ELECTRICAL reactivate the permit.
PLUMBING
J Z MECHANICAL /�•� -�
ENERGY W11 If a permit has been expired for mon:than one year,a
VISUAL FINAL ONLY charge totaling the full fees to obtain a new permit
BUILDING must be paid to reactivate the permit:.
c'r ?,N roe uJwt 5r I PEIi� 5 yi Initials
N� utILDIA'6-WiP7 "is'$IGN "> 11iTl a .
bt .�v136x✓ii'
kV ECT�R�, #t1 in , ..WWI�",�dy �S'��v9liCERTIFICATE OF OCCUPANCY ❑
EdNSPECTION� PLYWOOD: IN-PROGRESN:
INSP. DATE INSP. DATE INSP, DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE _ INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION