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06060129 (2) CITY OF CUPERTINO �a,� BUILDING DIVISION PERMIT " OL1i�L.RL'1 }�It\A 041-tYl/Y1T1\ ,u' BUILDING ADDRESS: CONDITIONED AIR PERMIT NO-06060129 19959 LINDENBROOK LA OWNER'S NAME: PERMIT ISSUE DATE VICKY LEE 1701 LITTLE ORCHARD ST 06/15/2006 NE: SANITARY NO. CONTROL NO. (408) 291-2220 ARCHITECrfENCINEER: BUILDING PERMIT INFO BEPLOOO IMECH = app LICENSED CONTRACTOR'S DECLARATION Job Description C�a 1 humor affirm at l am limnxd under provisions of Chapter 9(commencing Sl with Section 7IX10)of Divides 3 of the Business turd Pulassiuns Code,and my llecnu is ate„ k 0 loonsI rr 44 1 6 @ R & R FURNACE �7 r[�� p� �q? LDok�na cissa COn4ato�llf ! anadl I'��Y7 �� ""-t- ARCHnECfuDECLARATION lql— 14'I*� O I understand my plans Nail he need u public mcmals 31! ka In Licensed Professional L �3 c `h5 OWNER-BUILDER DECLARATION •II Iii LOOU i X 1 hereby aErm that I am exempt from the Contractor's Licenm Law for the p e following msson.(Sadao 7131.5.Bu.and Pmfeasiam Cada:My city ar county $Pi which requirusa permit ro construct,albs Wish..demolish.ser mpair any structure 2 2 5 O -zY prior m its issuance.also mqulms the applicant fersuch permit to ftkasigned sutemenc rF� G that he u licensed puraamt to the proHaions of the Conuacmel Beans Law(ChMw9 Floor Area [ion Y 9 (commencing with Section 7wo)or Division 3 of the Business and professions Code). Q Nat he Is exempt therefrom and the basis for use,alleged exemption.Any vlalulan of Section 7031.5 by Lay applicants fo a permit subjects,the applicant to a civil peachy,of Occupancy TType not marc then Bw hundred dollars(SM. ❑1,a awns of the Property.as my employees with wages as theuank eompmeadon, will do use work and the suunum is not intended.offered for aak(Sec.7044•Bummers Required Inspections and Profnaion Cade The Contractors Lkenee s Law donot apply a an owner of q P property who build,or improves theme.and who does such work bim W r fir through hu own employees,provided that such Improvements art n imus arafremd(.sale If, however,the building or improvement Is said within om year or completion,the awner- bullder will have the human of proving foot M did net build or Improv fa purpose of sale.). ❑I,as owner of the property sun exclusively connecting with licensed mntnnoa w cerunuct the famines(Sec.7014.Business and Professions Cede:)The Contractor's Li- ccaue law data am apply at an owntr of property who Milos or improve thereon.me who comment for such projects with a eonuaaor(s)licensed pursuant to the Contractors Lkenee Law. ❑lunexempsundenSt, .BSPCforthureason Owner Dau WORKER'S COMPENSATION DECLARATION I hereby aNrm under penalty of perjury ane of that fallowing dechu deacon 1 acre and will maimum•Cenificae of Cusum to,ehf-Insure for WorkresCompn- aadm,as provided for by Section 37M of 0e Labor Cade•for the performance of the wart for which this permit is intend. ❑1 have and will maintain Worker's Compensation Insurance,u acquired by Sema, 37M of that labor Codc,for the performana of tion wok forwhkh this Permit is blued. ' My Workers Campansalon[assurance artier and Policy number em: Cartier. n(.000 18e Q 9.06 Policy No.:NAlt%&n et AM 4.1 CE— EXEMPr10N FROM WORKERS' COMPENSATION INSURANCE mrs section Tad tet Mcompleed Ifthe permit Is f.one hundred dollar($1011) or leu) 1 certify that in the performance of the work fee which this pemdl is cued,I Nall not employ any portion in any manaru as to become subject to the Warkes'Companudon Iowa of California.Deli Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subjm to de Workers Compensation provisions of the Lab.Code.yen mus .J z foMwith comply with such provislan or this permit Nail M doemm mroked. . 'Zy^ CONMUCfION LENDING AGENCY 'n 1 Mushy a Mm ms unions is a consuenm lending agency for see performance of (Yr> the work(tar which this permit k issued(See.3097,Civ.C) aLender'sName D z lenders Address U O 1 certify that 1 haw mad this applicalm and state fou de shove imormatiun is If.P cortca I agree in comply with all city and county amlna.te and sum Ian muting e O U building cons•union,and hereby euthorim mpreunutivca of this city to enter upon me 4kl .hove-meoiuned property for inspection purposes (We)agms to nos,indemnify and kap le rrelw the,Cty of Cupertino against V) liabilities.judgments.costs and cepensus which may in any'w'ay amus 4aimt tadCity t 1 vZ In consequence of the grading of this permit. APPLICANT UNDERSTANDS AND WILL qPMPLY WITH ALL NON-POINT Issued by: Date G^ ,5�-� 6- SOUR7EGULATIONS. .awr. Re-roofs Stlmax&4fAppIlc&nVCon0acuxr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or in=building acupantsore or handle brurdous material as defined by tie Cupertino Municipal Cole.Chapter 9.12.and the Health and Safety Cede.Section25732(e)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yos o Will the applicant fir fu building acupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hanumus air cmu bolus as defend by the Bay Am,Air Quality Management all new materials for inspection. District? Oyu bwlwu I have read the hasardau materials mquueoerns under Chapter 6.95 oft the Cali(ar nlalkaithd:SafeiyCme,Soc4=25505,27533a 25534.1uMe thxiftho Milthng doan nos,turamly haw•tenant.that It u my responsibility to notify the aecupant of me m nuwldchmushemepriar faCemfteateafOccupacy. Signature of Applicant Date e ranthavedag Date. All roof coverings to be Class"B"or better CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36923023 . 00 DATE ISSUED. . . . . . . : 06/15/2006 RECEIPT # . . . . . . . . . : 34872 REFERENCE ID # . . . 06060129 SITE ADDRESS . . . . . : 19959 LINDENBROOK LA SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VICKY LEE 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 BSEISMICRE VALUATION 2 , 250 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 164 . 78 0 . 00 164 . 78 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 164 . 78 VISA TOTAL RECEIPT 164 . 78 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 #UPEkTINO Building De artment JOB ADDRESS: PERMIT # lggsa Ltn6an\0,(WV- Ln OWNER'S NAME: lagL . I PHONE # G GENERAL CONTRACTOR: Y FAX # q q 1• S I am not using any subcontractors: ;K:: 61- 15-46 Signafure Dat Please check applicable subcontractors and complete the following information: RI SUBCONTRACTOR BUSINESS NAME BUSINESS LI NSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood 01 Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • GIS /OG Owner ontractor Signa a Date CITY OF CUPERTINO DU1 uao 19-9 ` FURNACE/AC PE TING PERMIT APPLICATION FORM APN # Building Address: lqq�ci Owner's Name- P one #: Contractor: Phone: License#: en �� ¢�,,� o-- C(-aaa� L[sfc,pz- Contact3 , ' n n P one: Cupertino Business License#: Building Permit Inf : Bldg ❑ Elect ❑ Plumb ❑ Mech Job Descrip ' :� Residential Commercial ❑ For Residential In llations: Attic E31' floor 2"d floor❑ Adhere to min set backke uirement❑ or Commercial Installatio s: Replacement same weightAdditional weight (structural calcs) ❑ Structural Calculations require or new installation ❑ New installation Planning Approval Required Cost of Project: Type of Construction: Occupancy oup: l3 Strapped LJ L On Platform Ll Bonded LJ Sq.Ft. Floor Area: New Location ❑ Replacement' Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch &Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING