06050168 (2) CITY OF CUPERTINO r ".nwves,a^ + *w-'
BUILDING DIVISION PERMIT �CONTRAG�TQR TPIP`ORMt�.','�f�
BUILDINGADDRESS: RESNIDENTIAL HEATING AND A C�'ah.iVO-06050168
21900 LOMITA AVE
OWNER'S NAME: PERMITISSUEDATE
DEBBIE CASANOVA 65 CRISTICH LN
NE: SANITARY NO. CONTROL NO.
4083774073
ARCHITECTIENOINEER: BUILDING PERMIT INFO
BLDG O PLUMB MECH O
io0 LICENSED CONTRACTORS DECLARATION Job Description
1�t 1 hcmby affirm WI I w I�mmcd under Provisions of Chapter 9(commuting P
wlm Section 70110)afDiviaon 3 of the Business and Profosaom C mylicersets
In fall farce and effect. t/S�✓ t-1 INSTALLING WHOLE HOUSE EXHAUST FAN & ADDING
.tq� L1cneCavas LI`'g .VENTILATION AND ELECTRICAL SWITCH
ill
'
Dow TS DEbr
�3y ARCHITECTS DECLARATION / y'ti
1 I mWerstand my plans shall be used u public Martin ,
5 U
Wp
Licensed ProRssianal
OWNER-BUILDER DECLARATION
a I herehy.AITIM(Sec mm t I. exempt From the Canlns CO Ucenm Law for me
5 p o following moon.(Schon 7 mIS. t.a1W. and apron,da il Code:MY city m county
9 which roqulms•pvmlo r aonsuthe oar, t forSude ch Permit
fie aligned
any UWMCni
3 mme
z rr prior s its l ivuanc0.W se,to u the Applicant far ConsescuLiance Law(Chtemcm
p � thuhetslkeoscdpurmantmfaprovisioruofNeContncurreUcemelaw(Chapter9 Sq.Ft. Floor Area
Valuat' 04260
¢�$ (commencing with Section 700%of Division 3 of me Business arm Profession Code)of
e — that he Is exempt themfmm and the buts for me alleged memption.Any violation of ppN N b
Section 7031.5 by any applicant far•permit subjects me applicant m a civil penalty of 3 5 77 5��8e�0 0 Occupancy Type
nal man than five huramSW).
d"Iner(S
❑t,u owner otthe property,tar my employees W W wgG u theb ale campewtio,
will do thework,and the svunum is not immneedw anaed Runic,(Sec.7044.Business Required InsP.potions
And Profadom Code:The Contactors License LAW does net apply W ono Mauer of
Property who alldsorimprov tlwcon.and woodonauchwork himselfor through his
a memploya n,provided that such imprmanenu are uel inm led moRered fmsale.It.
however,the buildingor improvement Is mid within oue ymar of compiation.the mwer-
builder will haw the hordes of proving test a did nm how a improve for purpose of ,
ala.).
❑h As Owner of to property,am exclusively conumting with[lensed comruron an
caulmet the project(Sec.7044.Business and Profession Cade)The Coovanoes U•
cue Law docs not apply a an owner at property who builds or improv thereon.ad.
won eonuacu far tueb Peojecls WlNaconuactar(s)Iiaued purawnlmthe Conumtora
Licca LAW. %❑lamempture ,B&PCfivemumaven �INamUD
Owner
'
Due
WORKERS COMPENSATION DECLARATION +, I
I bemby a0bm under penalty W Perjury one of me following dcclaru5'31lOw •( — 2005
I have and will maintain•Certificate of Coucm n self-imus for Workers Camper- s�-f
sstio,r provided(pe mi Benson 3700 of me Labe Code,for site peaormauue Of me rw l
work far which mu permit is issued. �� .� � \\\I"1`}fj Q[tjw'„'+r/�/
❑I low and will mantan Workers Compensation Imearnme,u required by Sectio C!
3700 Of the Labs Cade,for me performance ofea work for Which the pausit It . .
My Workers Compamation Inmrmee carrier and Policy number am:
Carrier: y`.$,ne S1-:P, Policy Na.: znn1.�T�+.a1 —C71
C... ATE MON FROM WORKERS' o
COMPENSATION INSURANCE r
(Thissenlm med not be compbted if am pormlt tsfa oue hundraddefara(Side
or leu.)
1 aafy that in the pa rnmearce of to work for which this pamlt is issued.l shall Wo
employ any person in any manners As W become subject to the Wonken'Compemaion
law of CallorniL Date
Applicul
NOTICE TO APPLICANT:If.afar making this Cenincam of Exemption,you shouW
become subject an that Workeri Canpeuation lonwisinu of ma labs Code,yen raw
.J O forthwith comply with such provision or this permit Mall W dermad rtvmkad.
Z= CONSTRUCTION LENDING AGENCY
the her Which rte Nermmro iWod(Seeti3097.Civ agency fm the perfurmanee of
C> Umahfar which tills permittsissued(See.3W7.Civ.C.1
W Q Lenders Name
�s O
Lenders Md.
Trona 1«Nty that I taw read this application W sate mm the above mfac ndan is
it,F correct.I agree to comply with all city and county adnamma and state law muting Of
OU building convection,and bcmby amarim representatives of this city to enter upon the
r W above-mentiuned property for inspection purposes
M (We)agree to caw,indemnify and kap harmless me City of Cupertino againat
wF.t rn IiWilltim.Judgmcnta,coW and espascs which may In any wayaante against sand City
U in amsommm of the granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EGULATIONS. t;—)l Re-roofs
Signs=of AppllmuXoNseler Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Noe building occupant same or handle hmardoua material
As defined by the Cupertino Municipal Code,Chapter 9.13.cad the Health and Safely
Cade.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yos
Will the applicant or forum Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit huamnus air cone ninams as defrncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yos �Nu
I haw reactive hsntmnumaaviahmquircmctm underChpu:r6.95 ofthe Califor-
nbHcath&SafctYCo .ScNau75505,25533u M534.1unkraandthalfmc ddlding
does out cammily have a tenant that it b my responsibility to odfy the oaupant or me
mqulmmenu which most be met priormtssuamc ofa CAmlicautof Occupancy. Signature of Applicant Date
5?/t
Ownerm utha 7zd agent Date All roof coverings to be Class"B”or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: =- 1 v o PERMIT#
6"'dC
OWNER'S NAME: bS PHONE # -I - 4o-7
GENERAL CONTRACTOR: 4 AV1 t1 L o...1-1 mA FAX # .
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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
•
Owner/Contractor Signature Date
Residential Heating & A/C, Incl
Lic. # 705554
65 ClIstichC Lane ��%,2
•
Campbell, CA 95008
Office: (408) 377-4073 Fax: (408) 377-9854
PROPOSAL .
Ms. Debbie Casanova May 9, 2006 C; >L
21900 Lomita Ave.
Cupertino, Co. 95014
We propose hereby to. furnish material and labor-complete
in accordance with specifications below, for the sum
of $3,260.00 due upon completion.
Authorizing Signatures 11 t/�_
The following items to be installed:
1 Airscape 1.0(1000/600 CFM)Two Speed Whole House Exhaust Fan
1 Remote Control
1 Carpentry Subcontract-Replace Drilled Eave Blocks with Full Screen Vents
for necessary attic ventillation per manufacturer recommendations. Total
ventillation required=two square feet
1 Sheetrock cut and framing
1.Tie into Existing Electrical
Alternates Permit - City Pees plus $120'.00
ll (((JJJ
Notes Any painting repairs needed around save venting installation
not included. Owner pre-approved save venting with building
structural engineer. Should City Require documentation of
approval of screen installation owner to obtain required inforamtion.
Acceptance of Proposal-The above prices, specifications and 'conditions
are satisfactory and are hereby accepted. You are authorized to do the
work as specified.
Date signature
Contractors are required by law to be licensed and regulated by the Contractors State License Board,
which has jurisdiction to.Investigate complaints against contractors If a complaint regarding a patent
act or omission Is filed within four years of the date of the alleged violation.A complaint regarding a
latent act or omission pertaining to structural defects must be filed within 10 years of the date of the
alleged violation.Any,questions concerning the contractor may be referred to the Registrar,Contractors
State License Board,Post Office Box 26000,Sacramento,California 86826.
�CEr'trE�
MAY 1 9 2006 '
CITY OF CUPERTINO
em 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35715108 . 00
DATE ISSUED. . . . . . . : 05/18/2006
RECEIPT # . . . . . . . . . : 34457
REFERENCE ID # . . . : 06050168
SITE ADDRESS . . . . . : 21900 LOMITA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEBBIE CASANOVA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RESIDENTIAL HEATING
CONTRACTOR . . . . . . . : CATHY HAIRE LIC # 21161
COMPANY . . . . . . . . . . : RESIDENTIAL HEATING AND A/C IN
ADDRESS . . . . . . . . . . : 65 CRISTICH IN
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : 4083774073
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 : 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 3 , 260 . 00 0 . 50 0 . 00 0 . 50 0 . 00
MPERMITFEE 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
---------- ---------- ---------- ----------
TOTAL PERMIT: 113 . 30 0 . 00 113 . 30 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
•
CITY OF CUPERTINO
a
FURNACE/AC
OUPEI,TINO PERMIT APPLICATION FORM
APN# 551 -
115I OQ Date: 1C 1
Buildin Address: v
a 1goo LOy-\`1+A �� e
Owner's.Name: Phone#:,
S a n oVck . "-1-1- l� I
Contractor: Phone: Licen
(G 3��1-clo�3 ,oss
Contact:- Ph e: 1 I Cu ertipp Business License#:
10� L
Building Permit Info: / .
Bldg ❑ Elect R Plumb ❑ Mech
Job Description:
\ \SIM0 ,1
Residential Commercial ❑ rvt ccs B-w i
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
Adhere to min set back requirement❑
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation
New installation Planning Approval Required ❑
Cost of Project:,'--,,.
roject: '--,, . O Type o�CQns ction: 0ccupapcy grqup:
Strapped ❑ On Platform LJ Replacement
LJSq.Ft. Floor Area:
New Location ❑ R lacement El
Qty. if
Applicable 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
BSEISMICOM Seismic Commercial BUILONG
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