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06090128 (2) 17441 ITY OF CUPERTINO FUILDiNG MVISION PERMIT hCONTRACTORtI,NFORMATION ILDING ADDRESS: CONDITIONED AIR PERMIT NO.06090128 ROLLINGDELL DR NER'S NAME: PERMST ISSUE DATE SANDWISCH MERLE 1701 LITTLE ORCHARD ST 09/18/2006 ONE: SANITARY NO. CONTROL NO. (408) 291-2220 k ARCHTECT/ENGINEER: BUILDING PERMIT INFO BLDG EIPCT PLUMB MECH .CZ 00 LICENSED CONTRACTOR'EDECLARATION lob Description i86 1 hereby N chy aBirei 1 am licensed under Provisions of f]tapmr Y(Commencing with Section 70M,of Division 3 of the Business and Professions Cade,and my license is REMOVE AND REPLACE FURNACE •p m iu full force and cf5CCL . sq? License Class C`_-Qr3 Lica 4`4 160 =a„p Dam O /O'er Contractor s ARCNRECTS DECLARA ION C i U I understand my plans shall he used u public meet@ oy Licensed Prufamonal OWNER-BUILDER DECLARATION i y 1 hereby affirm that I am exempt from use Conexcroes License Law for the following mason.(Section III.S D .Business and Profcw'ov Code:Any city or County 20 3:� .which¢quires a permit to Conswct,alter,improve,demolish,or repair any swemro $2400 _I6 prior of its issuance.also requires the applicant for such permit to file a signed suumcnt that he u liccnud pursuant to Nc provisions of Ne Commcwfi License Law(Chapter9 Sq.FL Floor Area Valuation �� (commencing with Section 7000)of Division 3 of the Businm and Professions Cause)or _ that be is eumpt therefrom and the basis for tha alleged eaempuon.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of mot mom than five hundred dollars(3.500} r Occupancy Type ❑1,af ower of the property,or my employees with wages as their sok Compensation. will do the work,and she awcmm;s nut in¢ndcd suffered for subs(See.Cosa,Busimas Re Ulied Is cert Nd Prefesims Cod.:The Contractors Lt..Law d.MI apply to an pWner of Q nP $ property who build,or improves Nemon,and who does such work himself or through his own employees.Provided than such imprommes,are not imeMed oroRemd forsale If. however.the building or improvement is sold within one year of completion,Ne owner. builder will have the taxation of proving that M did et build or improvx far purpose of sak1. / w 5 1.as ower of et property,.Business si and Professions with]!caused Coomeme, t. Construct tkproject(Sec.?044,wnrand Professions Code:)7W Conmarn. ofd cense law dors not apply a an owner or property who builds ra improve Neuron and whocontractsLace for sato projcm with a contractor(3)licensed pursant m de Convemrs O L'ecnu Law. / ❑Ison exempt under See ,B&PCfor Nis mown s/s9 Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby all.under penalty of perjury no of the following declarations: I ham and will maintain a Cerufiate of Covent to ulf-ivum for Worka's Contp . cation,as prnvicied for by Section 37M of the Labor Code,for Ne perfonnmce of the work,for which this perm;,is issued. ❑I have and will maintain Worksre Compensation Insurance,v required by Section 3700 of do labor Cods,for the performance Close were for which this permit u issued. ' My Workers Compensate.Insurance carrier and Policy mummer aro: Carrier: 9201. a CAeXM Policy N.01og64S-eM l PTION FROM WORKERS' COMPENSATION INSURANCE . CD'u senion need not 4 completed if the permit is Rome hundred dollars(SIM) less.) - L certify that in the performance of the work for which this Permit is issued.1 shall not (, employ any person in any manner so U to b Caxc subject to No Workers Compensation laws of California.Dau Applicant NOTICE TO APPLICANT:IL after making this Ccnincae of Exemption,you should become subject In the Worker's Compensation provisions of the labor Cods,you most .J a•Z forthwith comply with such provisions or this perm it shall be deemed invoked. Z 0` CONSTRUCTION LENDING AGENCY F 1 arrabY sirre that NPv is a covuumiolending agency lor the perfortnana of a the wish for which this permit is issued(Sec,1(19'1,Civ.C.) Lal A Lender's Name 0 Lenders Address U 0 1 early that I have mad this apldictuion am suis that the: infmosmion is Lt, correct.l agree to comply wit all city and county ordinances and stat laws.lasing to CU building construction,and hereby authoom mprosentaees of Nm is city to cnr up nn the ah.ve nenbunW property fur im,e m pUpuses. F0. (We)agree m saw,indemnify and kap humlas the City of Cupcnie against N Oibiliuu,judgmcnts,cost and,x,f.which may;.any way same againstasid City U Z in consequence of the gmnung of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date SOU EREGUL TONSs p fR' Re-roofs 9rfA pb� Ir Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building aeupantsroro or handle hvaAxus material as den.ed by the,Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cade.Section 255320)? ///�� ❑rex 01�No All roofs shall be inspected prior to any roofing material being installed. Imil Will the applicant or future Wilding occupant use equipment of devices which If a roof is installed without first obtaining an inspection,l agree to remove District?allous ser ccontaminantsas defined by the Bay Area Air Quality Management all new materials for inspection. ❑Ya tillfNu 1 have mad the harardars materials cgthmmcnu under Chaper 6.95 ofthe Caliror, on Health&Safety Code.Sectimu 259)5.25533 and 25534.1 undameml that if the building des amt attend,have a tenant,than u my reepmehifiky on.our,the=up.,of the requirements which moat W mel 'orw; ance ora Ccmficem of Occupancy. Signature Of Applicant Date l S'0C Oweergr atunomsdagent 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 WUPEkTINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # Cj-4 GENERAL CONTRACTOR: FAX # C� I am not using any subcontractors: f�� 9. Signature Date Please check applicable subcontractors and complete the following information: 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 T' v Owner/Contractor Signature Date CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: Zmyw COPY #Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35932006 . 00 DATE ISSUED. . . . . . . : 09/18/2006 RECEIPT # . . . . . . . . . : 36079 REFERENCE ID # . . . : 06090128 SITE ADDRESS . . . . . : 7441 ROLLINGDELL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SANDWISCH MERLE 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 *FEE 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, 400 . 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 CITY OF CUPERTINO FURNACE/AC OUPEkTINO PERMIT APPLICATION FORM APN# Date: 3�i- � • i$ o � Building Address: N41FZaW 1 r- Owne ' Name: Phone#: I ev l e saxid 40 8 &S oro Co tractor: Phone: License i 411 1R1 -a �ih ConI Phone: Cupertin 5i Business License#: Building Permit Info: —/ BldgEI Elect —/ Plumb ❑' Mech Jobescription: �evhA,le Residential ❑ Commercial ❑ For Residential Installations: AtticS` floor ❑ 2nd floor❑ Adhere to min set back requiretrI or Commercial Installations: Replacement same weight ❑ Additional weight(structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Pr •ect: O Type o Construction: Occup 'cy p�roup: Strapped U On Platform U Bonded Sq.Ft. Floor Area: New Location ElReplacement I Qty. if Applicable Fee ID Fee Description Fee Group BENERGY EnergyBUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch& Outlets j; ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMTTFEE 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 �I BUILDING i