06050097 CITY OF CUPERTINO ate ` '
BUILDIING DIVISION PERMIT kCONTRACTC),RINkORMATIO�N .
BUILDINGADDRMS: CONDITIONED AIR PERMIT NO 06050.097
22995 STANDING OAK CT
OWNER'S NAME: PERMIT ISSUE DATE
AllillillillikRING KURT K AND ERIKA A 1701 LITTLE ORCHARD ST 05/11 /9,006
NE: SANITARY NO, CONTROL NO.
(408) 291-2220
ARCHITECT/ENGINEER: '
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.0, LICENSED CONTRACTOR'S DECLARATION Job Description
ZC I thereby affirm that 1 am RcenseL under provisions of Chapter 9(commencing
<U with Section7")of Division 3 of Ne Business and Prafearinns Code,monylitmacis
.oH in full fo¢cand af`ect ``'�tom�. FURNACE CHANGE OUT AND A/C CHANGE OUT
aa— License Class ' 3171 g .
c F C Dow 4 �n l Contrxwr -
ARCHITECTS DECLARATION
1 a I undenund my plans shall he used as public records
eaU
C,t; Licensed Pmfcadonal
OWNER-BUILDER DECLARATION
3 M I hereby alrirm that 1 am exempt frum Ne Convectors License Law for the
❑O following reason(Section 7(n1.5.Business and Pmfcsshms Code:Any city or county
m which requires a permit re cansruct cher.improve.demalLN,or repair any structure $6900
_Zi prior wits issuance.manurequires themplieam forseth permitto fileasigzdswement
< Nathcisliccvedpurswnttadepmvisiomof Ne ContrmwrsUm=law(Clupmr9 Sq.Ft.Floor Area Valuation
YFG (commencing with Suction 700(f)of Division 3 of Ne Businras and Prorceemns Coate)or
i Nes he h exempt themfmm and the baso for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant w a civil penalty of r Occupancy Type
iwm more Nan five hundred dollars($.500).
❑L m owner of the proleny,0r my employees with wages as dtek sole eompenmtian.
will do the week,and mhemmcus.is not intended ar offered for aak(Sec.7W.Business Required Inspections
and Professions Cada:The Comsuwrs License law does ret apply w or e an mmof q P
martam he builds; i improves;NeImpr andwhoents asuehendedomu3far Waugh his
own employees.provided that such improvements are notchw ort moffemd termite.ughhis
however.Ow building or improvement Is sold within one year of completion.IN owneo-
builder will have the burden of proving that M did out Mid ar improve for pump.of (1/
NEC.). /Vt
❑1.as owner of the progeny..B sine sins and
Pronsiing Cod:)The
CUnrumrs t.
construct.Ladte es Cut (Sec.7G14.so.Business and Professions Cade:)The es therwra rad e /�
who contracts
law does not apply w an owner of property who builds or art,to ea Compa and. 7
whence Laces fm such projects;with a cansracwr(s)Raved pursuant w ltr Conuaewh
License law. 6
❑lore ezemptunder See .Bd:PC(ar Nu reason
Owner Data
WORKERS COMPENSATION DECLARATION
I Enmity mind under penalty of perjury one offt following declarations.
1 Inwood will maintain aCeru firm of Covent to self-insure for Waiter's Compen-,
ntian,m provided for by Section 37M of time Labor Code,for ON pedo..of the
work for which this permit is untied.
ve and will nummam Workers Corepensmlon Insurance.ns reyvimd by Section
37000 Labor Code.for Ne performance of Ute worts for which this permit is issued.
My Workers Compeammust Insurance carrier and Policy number are:
Cartier. •)5§gjg( iM F�rtiBoliry No.: f
Y�'�CERTIFlCAM OF EXEMPTION FROM ORKERS'
COMPENSATION INSURANCE
(this section recd ret be Compkutl lithe permit is fmone hundrd dollars(SIM) r
or lest)
1 cc ifv that in the perrormanec of the work fm which this permit u issued.I shall moa
employ any person in any manner so as to become subject he the Workers'Compenudon
Laws of California Date
Applicant, -
NOTICE TO APPLICANT:If.aMr making this Certificate of Exemption,you should
become subject in the Workers Compensation provisions of the,Labor Cad%you mum
.J Z foMwith comply with such provisions m ends permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
t-' I hereby alRon that Ncre is a comtrucrinn lending agency for Ne pedormanto of
a do,work for which this permit is issued(See.3097,Civ.C.)
ILA
Lender's Name
z lender's Address
U Q 1 cevfy that I have read this application and sow that the above information is
f" comet.1 agree to comply with all city and county ordinances and sthm laws miming w
0U building consruction,and hercbyamharim represomanvesor his city to enterupon mite
0. alcove-mentimed propeny for inspection purposes.
(We)agree to save,indemnify and keep homeless the City of Cupertino against
r fq liabilities,Judgmcnts.costs and expcnsq which may in any way acemc againstseid City
U Z ren consequence of Ne germing of Nis permit
APPLICANT UNDERSTANDS AND WIL OMPLY WITH ALL NOWPOINf Issued by: Date
SOUGULATIONS.
.14 Le Re-roofs
Si to ApplicaMC orator Date
HAZARDOUAIS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant store or handle hazardous material
a defined by the Cupenino Municipal Code.Chapter 9.12,and she Health and Safety
Code,OuIca on 255321x)? All roofs shall be inspected prior to any roofing material being installed.
No
Will Nc applicant or f to ilding occupant use eyuipmens ar dossier which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conumimmas as dcfmod by the Bay Amo Air Quality Management all new materials for inspection.
District?
Oyes _11<1 .
I have read the hazardomm\aterials requi ena nu under Chapter6.95 of Ne Califor.
nix Health da Safety Codc.Scetiom 25505.25533 and25534.I undeound Nmifthe building
dxa rot curremly have a wnant Nat is k my rnsponsihilitY w trotifY Ile oecupant of de
regal rats hkbmm%bCmeLpaiorIomaaanKcafa e:ateorOccupancy. Signature of Applicant Date
ow ar,a reed ran, Dow All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34250020 . 00
DATE ISSUED. . . . . . . : 05/11/2006
RECEIPT # . . . . . . . . . : 34357
REFERENCE ID # . . . : 06050097 .
SITE ADDRESS . . . . . : 22995 STANDING OAK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GOHRING KURT K AND ERIKA A
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----- ----- ----------
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 7 , 000 . 00 0 . 70 0 . 00 0 . 70 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 176 .44 0 . 00 176 .44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- ---------- ------------------
OTHER 338 . 37 VISA
TOTAL RECEIPT 338 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
f - Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: PERMIT #
&aqqs CX D6-
OWNER'S
c5 6OWNER'S NAME: C c) �r PHONE # I
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informa ' n:
SUBCONTRACTOR BUSINESS NAME BU NESS LICENSE #
Cabinets &Millwork
Cement Finishing /
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing i
Masonry
Ornamental S et Metal
Painting/ Waflpaper
Paving
Plastering
Plumbing
oofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
OAer-/Con66ttor Signature Date
CITY OF CUPERTINO
Iry FURNACE/AC
CUPEI�TINO PERMIT APPLICATION FORM
APN # Da
ya ' ,bD " 000 te: 5 • II o6
Building Address:
CJA2•n 6m o2K CA. r cA qSo y
Owner's Name: Phone#:
YYl`C C`1o1� � d5 31 4I9
Contractor: License #:
Conti, V%O ,r s Li4516� C=
Contact: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect qR— Plumb C5' , Mech I�K
Job Description:
OCL Ch Ove C }
Residential C3_ Commercial ❑
For Residential I stallations:
Attic ❑ 151 flooi2nd floor❑
Adhere to min set back re uirementpj�
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy cup:
6• Ro0 . � , r
Strapped ❑ On Platform LT Bonded 0 Sq.Ft. Floor Area:
New Location ❑ Re lacementa3—
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN 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
�0*9 MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING