07060245 CITE'OF CUPERTINO
BUILDING DIVISION PERMITS
PERMIT NO.
BUILDING ADDRESS:
10326 WESTACRES DR TBD _ TCBE DETERMINED 07060245
PERMIT ISSUE DATE
OWNER'S NAME:
VENTURA GLENN J AND DOROTHY M SANITARY NO. CONTROL NO.
ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p Z LICENSED CONTRACTOR'S DECLARATION Job Description
U
affirm P I hereby that I am licensed under provisions of Chapter 9(commencing
z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is CHANGE E;0, 000 BTU FURNACE & ADD 3 TON AC.
in fullforeeand f Lic.N �� APPLIED BSL, DESIGN HEATING & AIR CONDITIONING,
vn Z License Class
actor
Lu °arc -tom ARCHITECL"SContD�puhlic
R N 1820 BASS S LAKE AVE, TULARE, CA.
i a< 1 understand my plans shall be used as ords
iyU
U,y Licensed Professional
O a OWNER-BUILDER DECLARATION
3< I hcroby alTirm that I am exempt from the Contractors Licensc Law for the
p o [ollowing 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
ti prior to its issuance,also requires the applicant for such permit to file a signed statement • ,Ft. Floor Area Valuation
?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 78001;
tz (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
,a,5§ that he is exempt therefrom and the basis for the alleged exemption.Any violation of O
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A��l Occupancy P Y TYPe
not more than five hundred dollars(5500). 3591401.) .591401.) . V U
❑I,as owner of the property,or my employees with wages as 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 Contrxtors License Law docs not apply to an owner of
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 salt:.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
sate.).
❑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 Contractors
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as Provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Cade.for the performance of the work for which this permit is issued.
My Work
erfs Cope tion Ins$rance,ccarrier and Policy n tuber
CarierJ I^>` Polity No.: 7
CERTIM TE OF EXEMPTION FROM WORKERS'
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 Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
LY > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
2 Lenders Address
U 0 1 certify that I have read this application and state that the above information is
fit ► correct.I agree to comply with all city and county ordinances and state laws relating to
J building construction,and hereby authorize re rescntativcs of this city to toter upon the
` above-mcntiuned property for inspection p ses.
(We)agree to save,indemnify an p harmless the City of Cupertino against
,Hy liabilities,judgments,costs and expense ch may in any way accrue against said City
fJ z in consequence of the granting o!This it. Date 7
'— APPLICANT UNDERSTAND ILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS. r) —J--,i-7
Re-roofs
Signature of Applicant/Contractor Dare Type Of Roof
MATERIALS DISCLOSURE YP
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.
❑Yes U'° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment ordevices 'ch all new r)aterials for inspection.
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑Yes \)D No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health WSafetyC tions 25505.25533 and 25534.1 understand that if the building
does not cant.that it is my responsibility to notify the occupant oC the Date
requirememet prior to issuance of a Certificate o acup�rncy.�n Signaturt: Applicant
V ppLl�l / All roof coverings to be Class"B" or better
Owner or authorized agent Date
CITY OF CUPERTINO
9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35914019 . 00
DOTE ISSUED. . . . . . . : 06/27/2007
RECEIPT #. . . . . . . . . . BE000001818
REFERENCE ID # . . . : 07060245
SITE ADDRESS . . . . . : 1C326 WESTACRES DR
SUBDIVISION . . . . . .
CITY CL PERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : VENTURA GLENN J AND DOROTHY M
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2939
RECEIVED FROM . . . . : DESIGN HEATING & AC
CONTRACTOR . . . . . . . : TED - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TED - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 38. 37 34 . 86 0. 00 34 .86 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
BREMRECEPT NO. OUTLETS 1. 00 1 .20 0. 00 1.20 0. 00
BSEISMICRE VALUATION 7, 800. 00 0.80 0. 00 0.80 0. 00
BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 .00 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 283 .54 0. 00 283 .54 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 283 .54 #4237
---------------
TOTAL RECEIPT 283 .54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF C'UPERTINO 07
U NACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APNDate:
/ /91
Building Address: �o
Owner's Name: Phone #:
Vcl
contActor. Phone: S License #:
(k,5 AA . 4 ,4- C. 3 -2 74
Contact: Phone: Cupertino Business License#:
Ax 6(56 37 7,4/-
Building Permit Info:
Bldg ❑ Elect Y] Plumb EZL -'`" Mech
Job Description: 1
Residential V] Commercial ❑
For Residential Installations:
Attic ❑ 1St floor' 2nd floor❑
Adhere to min set back requiremen
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project: _7d DD 'c5z> Type of Construction: Occupancy group:
e�
Strapped Fxl On Platform Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN F arnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL
BREMRECEPT R.ecptl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE E lec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE E Idg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gras Piping System Fee PLUMBING
BUSLIC Business License BUILDING