08010031 (2) BUILDING DIVISION- PERMIT ✓�� s4V''T� Y��,'�`a=^`""� �� q�p^ '
BUILD D RESS: PERMIT NO.
�.�g SCOTLAND DR - 'A PERFECT CLIMATE 08010031
OWNER'S NAME: PERMIT ISSUE DATE
DE, MARCOS MOIRA " 8375 BRENTWOOD BLVD STE B 01/07/2008
E: SANITARY NO. CONTROL N0.
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
REPLACE FURNACE 8OK BTU BLDG ELECT PLUMBMECH
0 0 0 0
uesEDON�AtpovCoofChapI hemby aRres mTnder provision hate9(commnmmng Job Description
with Sectim,700D)afOivision 3 afthe Bestows,and Professimu Cade.and my license is
.ow in full force and eRmt aA /S
,,aaZ Licensc lase `'�1 Lk.g
:F o Dam r III Conenato
qq A CHTECTSDECLARATION
i W 1 undersand my plans shall he used as public retards
a
H Licensed Pnonssional _
3 OWNER-BUILDER DECLARATION
f I hereby affirm Nat 1 am exempt from No Contractors License Law for she
00 following rumor.(Section 7031.5,Business end Profted..Cade:Any city or..in,
IRE! which"u nes a permit to construct.ether,improve,demolish.or repair my s arcaure
-zy prior to its issuancc.alm requires the applicant for such Permit to file a signedawommt
:Z< that he1.licensed pu..Itothe pmvisionsofth,Canlrmter'Li...Law Chapter 9 Sq. Ft. Floor Area Valuation
eH (commencing wish Section 7000)or Division 3 orthe Businemand Prafessinm Code)m
that he is exempt aherc6om and the basis for Me alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil Penalty of APN Number Occupancy Type
oat mom than ftva hundred dollars(550(). P Y YP
do
en wMkafthe fleauty,nomyemntended withwagesRshebsule W,Bmmer
will daProfesion ande:The ttum unn.Licdad aroRcmdformlepplya an Bueness Required Inspections
and property
Cade:The eanOacmis and
Law uch rot apply lf rt owner is q P
property who bis itch car improves thereon,and who area rah work himself car through M1 f. -
howsam ver,th ses,building
provided that rahimprovementsare not earoedmpletied possum.B,
however,the building orimprowment remit within one year or mprovefor the o res of
builder will haw the burden of proving Nat he did not Wild a improve for proposes of
mkJ.
❑1.as owner of the property,am exclusively contracting with licensed covuusars in
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cave Law dem art apply in an owner of property who builds or improver themm,and, "
who contra for such projects with a conusictur(s)licensed pursuant m ate Comnicu fs
License Law.
❑IamexemptunderSec. ,B&PCforthisreamn
Owner Dam
WORKERS COMPENSATION DECLARATION -'
I hereby".under penalty of perjury..of the following declarati..
have and will maintain Iifi
aCmcehe of Cammattoself-imute for Warker,Camper,
an,ss providrd for by Section 3700 of the Lab"Code,for Ne peeannanm of rhe
work for which this Permit is Extend.
have and will maintain Werkefs Compensation Isssurence,as mquimd by session
]00 of the tabus Code.far Ne performance of Ne work for which this permituissned. '
My Work�o°1m�'pevation lvumncr artium Iity//g�strry5b-vver are: � .^.',v
Cartier.L�.tidr/re,rsC u. Policy No.:t,dl�(7J O V/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sects s need net hecanplemd lithe permit is fmone hundred do0ua(5100)
or less)
I certify Net in the performance of de,work for which this Permit u issued.l shall oat
employ any parson in my monster so m to became subject he the Workers''Campettwion
Laws of Califaroix.Data
Applicant
NOTICE TO APPLICANT:If.after making this Comficam of Exemption,you sbouw
become subject m the Wotier'a Compensation provisions of the labor Cade,you mom
,J O forthwith comply with such provuinv or this Permit shall he deemed revoked. „
z a" CONSTRUCTION LENDING AGENCY
[-+14 I herchy alOrm Nat Nem is a covtroctimn kr ding agemT for the perfurmanm of
a > she work fur which this permit is issued(Sec.3077,Ci,C.)
W Q Lender's Name
z Lenders Address
U Q 1 certify Nat I have read this application and=Mc Nat Ne shove information is
f^ correct.I agrm in comply with all city and county ordinances and sate laws miming to
(� building construction,and hereby aushmirz mpresctr tivv of this city to enter alms the
shovo-mcmioned Prolcrty,for inticctionlusPoscs.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments,cera and expenses which may in my way accrue against said City
V z APPLICANTAND thisof Me grousing of Permit.
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplinData Re-roofs
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will Ne applicant m(umm building acupanumro car handle Health w s Safety m defined by the Cupertino Municipal Code.Chapter 9.12 and the Health and Sa(tty
Code,Section 35513(a)?
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Handing a upant am gaipnhent car devices wh b "If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air eonaouremss ss dcOs al by the Bay Ama Air Quality Managmtmt all new materials for inspection.
❑Yes
1 have matt the Enormous materials mquiremuus umlcr Chapter 6.95 of the Califor-
niaHealth&SafetyCom.Scctimu 25505.35533 and 25534.1 undersand that iftlte building
d of curmmly hmc a Imam than it u my msNmihility m notify the=ce c of the
nu whim um be et eonaissu Ce niBcmearaeuparcT. _ Signature of Applicant Date
-7-00
Owner oraathori,.e ,gent Dam All roof coverings to be Class "B"or better
okol 0031
CITY OF CUPERTINO
sm FURNACE/AC
®CUPEkTiNO . PERMIT APPLICATION FORM
APN # �(PO�A Wo
1 Q () Date:
Building Address: I /
jl 3 � Q tJ co fL awC �r (9
Owner's Name: Phone#:
aT0S 7 92 (o
Contractor: Phone#:
� �- � � Q �e Yoe— d26/— 9SYs—
2✓7 e G Fax #: YO(F-
Contractor License#: Cupertino Business License#:
72 3 /.5- F C— 2J Z i/ yv
Contact: L 1 / Phone#: yod2- d'6/-5 ej-
401 5�� S4,% 75C�f /re
(� Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Job Description: eo K I37—V
i
�-2/� �4 c 2 /�✓ �vl 4 c GG
Residential/ Commercial
For Residential Installations:
Attic ❑ I" floor 2nd floor ❑
Adhere to minimum setback requirement ❑
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 (Usage Class):
Strapped On Platform Bonded New LocationEl Replacement
Valuation: n
Green Building: Must attach Green Building Check list to this application
A
CITY OF CUPERTINO
FURNACE/AC
CUPER,TiNO FEE SCHEDULE
FURNACE:
Qty. if
Applicable Fee ID Fee Description Fee Group Permit Type
MCRAA Furnace M FURN/AC
MCREPALT Commercial Mech Repair/alt/add M
MCSUSHTR Commercial Suspend Wall/floor M
Heater
PGASCOM New Gas Piping System 1-4 Outlets P
Commercial
BSEISMICO Seismic Commercial B
MRRAA Residential Mech Repair/alt/add M
MRSUSHTR Residential Suspend Wall/floor M
Heater
BSEISMICRE Seismic Residential B •
MFLRFURN Install/relocate Floor Furnace M
MECPLNCK Mechanical Plan Check M
MFR=<100 Furnace Syst<100k BTU M
>100 Furnace S st> l OOk BTU M
MFRN Y
MRAIRHAN Comm/Res < 100k BTU M
/ EPERMITFEE Electric Permit Fee E
MPERMITFEE Mechanical Permit Fee M
BREMRECEPT Electric Receptacles E
PGASRES New Gas Piping System 1-4 Outlets P
Residential
BPGAS Gas Piping System 5+ Per Outlet P
TRAVDOC Travel Documentation B
BUSLIC Business License B
aio
CITY OF CUPERTINO
FURNACE/AC
•CUPERTINO FEE SCHEDULE
AIR CONDITIONER:
Qty, if
A licable Fee ID Fee Description Fee Grou Permit Type
BCAIRHAN Commercial A/C Units<= 1 Ok CFM B FURN/AC
MCRAA Commercial Mech Repair/alt/add M
SEISMICOM Seismic Commercial B
BREMAIRHAN Residential A/C units <= l Ok CFM B
MRRAA Residential Mech Repair/alt/add M
BSEISMICRE Seismic Residential B
EPERMITFEE Electric Permit E
MPERMITFEE Mechanical Permit M
PPERMITFEE Plumbing Permit p
BREMRECEPT Electric Receptacles E
PGASCOM New Gas Piping System Commercial P
1-4 Outlets
PGASRES New Gas Piping System Residential P
1-4 Outlets
BPGAS Gas Piping System 5+ per Outlet P
TRAVDOC Travel Documentation B
BUSLIC Business License B
CITY OF CUPERTINO
® 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot: .
APN . . . . . . . . : 36228015 . 00
DATE ISSUED. . . . . . . : 01/07/2008
RECEIPT #. . . . . . . . . : BS000003624
REFERENCE ID # . . . : 08010031
SITE ADDRESS . . . . . : 1136 SCOTLAND DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER DE MARCOS MOIRA
ADDRESS 1136 SCOTLAND DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : SMITH, BYRON E LIC # 21144
COMPANY A PERFECT CLIMATE
ADDRESS 8375 BRENTWOOD BLVD STE B
CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513
TELEPHONE (408) 861 9545
® FEE ID UNIT QUANTITY - AMOUNT... - PD-TO-DT THIS REC NEW BAL
--------- ------------ ---------- ----------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 657 . 00 0. 50 0. 00 0.50 0. 00
1EPERMITFE FLAT 'RATE 1. 00 40.79 0. 00 40.79 0. 00
1MPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1MRRAA UNITS 1. 00 61.19 0. 00 61 .19 0. 00
1TRAVDOC FLAT RATE 1 . 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 184 . 06 0 . 00 184 . 06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 368 .22 MC
---------------
TOTAL RECEIPT 368.22
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
10300 Tota Avenue
Cupertino CA 95014
Telephone(408)777-3228
OPER INO Fex(408)777-3333
Building De artment
JOB ADDRESS: 1136 Sc o-f 1ct T-),,, PERMIT#
owe �
OWNER'S NAME: . 114 q r r' q r?// G i cos PHONE# Yod' Z 7 Y z G
GENERAL CONTRACTOR: A 2e dc. FAX#
I am not using any subcontractors: 61(/� � �n—� * /— 7- foo J'
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 e� ��f /r:� 4✓e. Z //w
Insulation
Landscaping
Lathing /
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving .
Plastering
Plumbing
C Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
- /— 7- 2oOd'
Owner/Contracto i Lure Date