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07100014 CIT�' OF CUPERTINO ° > � BU[LD1NG DIVISIOt� PERMIT �� ' : < ,..: , . : ;:.;: __. BUILDI ADDRESS: PERMIT NO. ��442 ELM CT AAA FUFNACE & AIR 07100014 . PERMTT LSSUE DATE OWNER'S NAME: " MCHALE RESIDENCE 17 ; �TONE AVE 10 1 2007 SANITARY NO. CONTROL NO. JE: BUTLDING PERMIT INFO ARCHITECT/ENGiNEER: REPLAC�, FURNACE , 12 0, 0 0 0 BT HLDG E�cr PLUMB MECH C� O O 0 i p � LICENSED CONTRACTOR nEC�.aRnnox Job Description � v� I hcreby afGrm �hat [ am liccnacd un�icr provisions oC Chaptcr 9(commencing ; Z� with Scction 7000) of Division 3 of thc Businccc and Protcssions Codc, and my licensc is � � y in (ull force ands� ( � v� z Licensc Class �_� Lic. # ; � p Datc �i��_ Contractor +� ARCHITECI'S DEC A 1 N � i a a I undcruand my plans shall bc used as pubiic rccords .�jU�- )yU ' u. � Licensed Pn�Ccssional � y � OWNER-BUILDER DECLARATION r I hcrcby alTirm that 1 am cxcmpt Crom tl�c Conuactors Liccnsc Law far �fic � p O following rcazon. (Scclion 7031.5, Busincss and Profcssions Cocic: Any ci�y ar rnun�y �,°, � which requires a pcmiit ta conswc4 altcr, improvc, dcmolLsh, or eepnir any stcuctufe � Z y y, prior �o ils issuancc, also rcquires thc applicani Cor such pertnit to filc a signcJ sta�cmeni � Ft. Floor Area Valuation �_< that he is liccnxd pursuant to thc provisions o[ �hc Comracror's Liccnx Law (Chaptcr 9 Q• � t- �(commencing wiih Scction 7000) of Division 3 of ihc Busincss and Profcssions Cadc) or °�� that he is ezempt [herefrom and Ihe buis Cor the allcgcd eumptian. Any violuion of Section 7031.5 by airy applicant fot a pefmit subjecu ihe applicant to a civil pemlty of APN Number Occupancy Type not more than fiw hundred dollars (5500). ❑ I, u owncr o[ tt�e propercy. or my cmployces with wages az the'v solc compensaGon, will do Ihc wodc, and ihe swc�ure is not intended or offered forsalc (Sec. 7044. Business Required Inspections and Professions Code: The Conuactor's License law docs not apply w an owner oC propeny wha builds or improves thereon, and who daes such work himself or through his own employces. provided �hat such improvemen�s are not intended ar oRered for sak. I[. however, the building or improvement is sold within a�e year of complcdon, t6e owner- builder will have the burden of proving that he did not build or improvc [or purpose of sa�.). ❑ I, as awner of the propecty, am exclusively conhacting wilh littnsed rnntrxtors ta construct the projea (Sec. 7044. Bus'in�s and Pro[es.dons Code:)'ILe Conuaewrs Li- ccnu Law docs not spply w an owner of property who builds or improves �heieon. and . who contracts Car such pmjecls with a contrador(s) ticensed pursuant to �he Conuxwrs License Law. ❑ I am uempt under Sec . B& P C Cor �his reaton Owner Date WORKER'S COMPENSAT[ON DECLARATION 1 dereby affirm under penalty o[ perjury anc o( the fallawing declarations ❑ i have nnd will main�ain a Cenificam of Consent lo xl(-insure for Workers Canpen- sation, as providcd for by Secdon 3700 of �he Labor Code. far �he pedormance of t6c work for which this pertnit is issucd. ❑ I havc and will maintain Workcr's Compensatian tnsurance, u requircd by Smion 3700 0( the Labor Code, Cor the pedormanee o[ U�e wwic for which �his permit is issued. My Workcr's Compensation Insurancc carricr and Policy numbcr are: Cacrier. ��,L Pol'�cy No.: " - C � �ERTI EMP'!'ION FROM RKERS COMPENSATION INSURANCE (This section necd not be completed if the pertnit is far onc hundced dollars (5100) or Icss.) � I cenify that in thc performancc of thc work for which Nis permit is issucd, t shall na employ any person in any manncr so u w bccomc subject w the Workcrs' Compcnsatian Laws of Califomia.patc Applicant /�-� � ) / "� NOTICE TO�P�A�r makin ihis Ccrtifica�c of Excmption, you should bccome subjcct a thc Workcr's Compcnsation provisions of �hc laAor Codc, you muu ,� z foMwith comply with such provisions or this pccmi� shall bc dccmcd ccvokcd. � O CONS7'RUCTION LENDING AGENCY (.�.� ►�-� I hcrcby aRrm Ihu thcro is a conswction Icnding agcncy Car thc per(ormancc uf . �.Y, � ihe wark fur which �his permit is issucd (Scc. 3097. Civ. C.) W Q Lendc�s Namc ' � z Lcnder's Address U � 1 certi(Y Ihat I have cead this applica�ion and sia[e �ha� the a6ove infortnauun it w � cormct. 1 agree �o comply with all city and county ordinances and s�a�e laws rcta�ing to � U building conswetion, and hemby authome representatives of this ciry to enter u�n lAc � W aM1ovc-mcntioncd property for inspcc�on purposes. a (We) agrce �o save, indcmnify and kccp hartnless �hc Ciry of Cupertino against �� liabilitiu, judgmcnt�, cos�s and cxpenscs which may in any way accruc against said Caty U z in consequencc oC the granting of this permit. Date r"" APPLICANT UNDERSTANDS AND WiLL COMPLY W1TH ALL NON-POIM' Issued by: SOURCE REGULATIONS. Re-roofs Signaturc of ApplicandConuaclor �a� ' I ' y�2 Of R� )Of HAZARDOUS MATERIALS DISCLOSURE Will Ihc applicant or future building occupant storc or handlc harardous marc�iial as dcfincd by the Cupenino Municipal Codc. Chap�cr 9.12, and che Hcalth and Sa(ctr Codc. Section 25532(a)? ��,``` All roofs : hall be inspected prior to any roofing material being installed. �y� �No , �II thc applicant or fuwre building accupant usc equipmcnt or devices wdich If a roof i: installed without first obtaining an inspection, I agree to remove emii harardous air contaminan�s as ckfincd Ay �he Bay Ama Air Quality Managemcnt all new m, iterials for inspection. District? Q Ycs ,F�Nu �t 1 havc rcul the IwarCws matcrials rcquircmcn�s unAcrChap�cr 6.95 af ihc Cafifw- nia Hcalih & Safcty Codc, Scctions 25505, 25533 and 25534.1 undcrsund ihat iC ihc building Jocs no� curtcnUy havc a tcnant, �hat it is my responsiAility m noufy thc occupant af �he rcyui mcn�c which must be met prior to issuancc of a Ccnificatc of Occupancy. S 1gLlltUCe Jf A�7PI1C3TIt Date - p _ All roof coverings to be Class "B" or better wncr or autharizcd ag i ��'� �F ��1�ER�I�� `I l o O o 1`-� �� - �. �� 1 ��`��1�� .�; ��T'�o PE�I'�' APPIJ��::ATIOl� �O g �� # Date: �'Cl/`�) Building Address: C % � �- Owner's Name: Phone #: � �� t S - � 6 7 c S"� � �� c ��_ -- - , - -- -�- �,tcr;nsc �: - � ,: �: ,r�tr�i�,ic,r_ �� ! ��I,E�ne.: � , G'� - � � '' �� / a�� Contact: � Phone: Cupertino Business License #: , p,; 'l> Building P rmit Info: Bldg � Elect Pl �mb ❑ Mech Job Description: � Residential � Commercial ❑ For Residential Installations: Attic � 1 St floor � 2 floor � Adhere to min set back requirement ❑ For Commercial Installations: °placement same weight � Additional weight (stnictural calcs) � �tructural Calculations required for new installation C� New installation Planning Approval Required ❑ � Cost of Project: Type of Construct on: Occupancy group: '7 Strapped On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location � Replacement /� Qty. if Applicable Fee ID Fee Description Fee Group BENERGY En�,rgy BUILDING BREMFURN � Fu�nace MECHANICAL BREMACOVER A/�, Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL BREMRECEPT Recpfl, Switch & Outlets ELECTRICAL BSEISMICRE Se smic Fee Res BUILDING BSEISMICOM Se_smic Commercial BUILIDNG EPERMTTFEE EIE;c Permit Issuance ELECTRICAL MPERMITFEE Mf:ch Permit Issuance MECHANICAL PPERMITFEE � Phimbing Permit Issue PLUMBING BPERMFEE Blcig Permit Fees BUILDING BPLANCHK Pl�n Check Fee BUILDING BPGAS G�.s Piping System Fee PLUMBING BUSLIC BLSiness License BUILDING CITY OF CUPERTINO 6 ITEMS OF 14 PERMI�' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 36�;01012.00 DATE ISSUED .......: 10�01/2007 RECEIPT #.........: BS(�00002845 REFERENCE ID # ...: 07].00014 SITE ADDRESS .....: 21�42 ELM CT SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............: MC�:ALE RESIDENCE ADDRESS ......... 21�42 ELM CT CITY/STATE/ZIP ...: CUf'ERTINO CA, CA 95014-4919 RECEIVED FROM ... . : JIb[ R.ANDO CONTRACTOR .......: RADfDO, JIM LIC # 8050 COMPANY ..........: AAF. FURNACE & AIR CONDITIONING ADDRESS ..........: 1712 STONE AVE CITY/STATE/ZIP ...: SAI� JOSE, CA 95125 TELEPHONE ........: (4C8)293 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMFURN NO i7NIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 3,791.00 0.50 0.00 0.50 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 : 172.04 0.00 172.04 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 360.64 VISA --------------- TOTAL RECEIPT : 360.64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL INVOICE INVOICE INVOICE INVOICE IrfVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI7' INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36�;01012.00 INVOICE DATE......: 10,'01/2007 REFERENCE ID # ...: 07_.00014 SITE ADDRESS .... 21�t42 ELM CT SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: MC�IALE RESIDENCE ADDRESS ........... 21 �642 ELM CT CITY/STATE/ZIP ...: CU]'ERTINO CA, CA 95014-4919 CONTR.ACTOR .......: R.AIdDO, JIM LIC # 8050 COMPANY ..........: AA�� FURNACE & AIR CONDITIONING ADDRESS ..........: 17'_2 STONE AVE CITY/STATE/ZIP ...: SAIJ JOSE, CA 95125 TELEPHONE ........: (4�)8)293-4717 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- ENERGY APPLICATI�)N 34.86 0.00 34.86 FURNACE INSTALLATION PRINTING :?ERMIT 14.31 0.00 14.31 SEISMIC FEE RES PRINTING :?ERMIT 0.50 0.00 0.50 ELEC PERMIT ISSUANCE PRINTING :?ERMIT 40.79 0.00 40.79 MECH PERMIT ISSUANCE PRINTING :?ERMIT 40.79 0.00 40.79 PLUMBNG PERMIT ISSUE PRINTING :?ERMIT 40.79 0.00 40.79 ---------- ---------- ---------- 172.04 0.00 172.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development �' �� 10300 Torre Avenue � '� _ ' Cupertino CA 95014 `,� Telephone (408) 777-3228 CITY Of Fax (408) 777-3333 ''UPEi�TINO Buildim De artment JOB ADDRESS: PERMIT # �� QQ� � OWNER'S NAME: ,s"fi ; � L PHONE # � - � GENERAL CONTRACTO : FAX # I am not using any subcontractors: ,�� -- d Si€ nature Date Please check a licable subcontractors and com lete the followin information: SUBCONTRACTOR BUSIl��ESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing 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 O Owner/Co tractor Signature ate