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07050176 CITY OF CUPERTINO BUILDING bIVISION PERMITNTRAGTC,iR INEORM� TON•;. BUILDJN p KESS: PERMIT NO. MM E ESTATES DR 'T;DD 111 lanPMPP4J_?+L3— 07050176 OWNER'S NAME: '� p — p �2 �2-rQ�f plt'.Y1p d PERMIT ISSUE DATE BURNS ROBERT C AND SHERRY O 05/18/2007 NE'D SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH po LICENSED CONTRACTOR'S DECLARATION Job Description F I hereby M) that I am licensed under provisions of Chapter 9(commencing :u U w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE t a a in full force and effect. � z License Class Lic.# NEED CONTRACTOR INFO F w Date Contractor ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records )yV U.y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the in O following reason.(Section 703 L5,Business and Professions Code:Any city or county < which requires a permit to construct.alter,improve,demolish•or repair any structure } prior to its issuance,also requires the applicant forsuch permit to rile a signed statement Ft.Floor Area Valuation =G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q t (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2400 Q L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars($500). 3690703-':. ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does pot apply to an owner of Q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under ec. B&P C for this reason Owner V� Dare WO R'S C NSATION DECLARATION I hereby affirm nder penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code•for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any man:2�cso as to omc bj the Workers'Compensation Laws of Califo ' Applicant NOTICE TO APPLICANT ,after making this Certificate of Exemption,you should become subject to the Wor is Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z "" CONSTRUCTION LENDING AGENCY [�►�. 1 hereby affirm that there is a construction lending agency for the performance of GY. the work for which this permit is issued(Sec.3097,Civ.C.) (la Q Lender's Name Lender's Address U 0 1 certify that 1 have read this application and state that the above information is C>:+ ►-' correct.I agree to comply with all city and county ordinances and state laws relating to rJ J building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save•indemnify and keep harmless the City of Cupertino against f/) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC ULATIONS/.� ' 1/f- j�7C/iS '�'/r 4 Re-roofs �--� Signature of App' /Contractor Dare Type of Roof MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new maerials for inspection. District? ❑Yes P.1Itt- 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whichmust be met ' to issuance of a Certificate of Occu ancy. Signature t)f Applicant Date All roof coverings to be Class"B"or better Owner or autho' d agcnf Dare CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 36907033 . 00 DATE ISSUED. . . . . . . : 05/18/2007 RECEIPT #. . . . . . . . . BS000001378 REFERENCE ID # . . . : 07050176 SITE ADDRESS . . . . . : 10156 E ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BURNS ROBERT C AND SHERRY O TR ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3304 RECEIVED FROM . . . . : SHERRY BURNS CONTRACTOR . . . . . . . : TBE - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBE - TO BE DETERMINED ADDRESS . . . . . . . . .. . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34 . 86 0 .00 34 .86 0. 00 BREMFURN NO UNIT 1.00 14 .31 0 .00 14 .31 0. 00 BSEISMICRE VALUATION 2,400.00 0.50 0 .00 0 .50 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 PPERMITFEE 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 REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 164 . 78 VISA --------------- TOTAL RECEIPT 164 . 78 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 FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM D7oso 7b APN# Date: 07 -0)-33 i �7 Building Address. _ /tel Z�: t—:57Z2,-X� fir. Owner's Name: P one #: C;ontrac.,tor: Phone: License ;;rol Ca act: Phone: Cupertino Business License#: o ��e 635 Building Permit Info: -��/c�c� Bldg ❑ Elect 0" .J P[umb [Y' Mech ❑-' Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor -R 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: .eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: 2yoo Type of C Ilion: Occupancy grp: Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/'Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/'—Units<= 10, 000 efin MECHANICAL BREMRECEPT Rc cptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE EIx Permit Issuance ELECTRICAL MPERMITFEE Moch Permit Issuance MECHANICAL PPERMITFEE Phunbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Pl,,m Check Fee BUILDING BPGAS Gs Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 7UPEKTINO Buildi.-,tig Department JOB ADDRESS: PERMIT # 0-7050116 OWNER'S NAME: ghot7` PHONE # e'-j`, 55-— GENERAL CONTRACTOR: ,YI-2 ii' FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and cornT lete 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 Tile Owner/Contractor Signature Date