The URL can be used to link to this page

09060104 CITY OF CUPERTINO ZL '��N` BUILDING DIVISION PERMIT � � PERMIT NO. BUILDING ADDRESS: PERMIT ISSUE DATE OWNER'S NAME: SA CONTROL NO. • BUILDING PERMIT INFO ARCHI TECI7ENGINEER: BLDG ELECT PLUMB MECH FURNAC:3 CHANGEOUT ADD AC a p G LICENSED CONTRACTOR'S DECLARATION WITH D JCTS Job Description mI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70()0)of Division 3 of the Business and Professions Code.and my license is n y in full force and effect Z I-(cenac Class Lie.M E-12 Dam pContractor ARCHITECTS DECLARATION I�< I understand my plans shall be used as public records DyU L o y Licensed Professional WOWNER-BUILDER DECLARATION n I hereby affirm that 1 am exempt from the Contractor's License Law for the M O following reason.(Section 7031.5,Business and Professions Code:Any city or county 4-.9 which requires a permit to construct,alter,improve,demolish,or repair any structure I';- prior to its issuance,also requires the applicant Cor such permit to file a signed statement Valuation G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $q.Ft.Floor Area yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑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 Contractor's License Law does not apply to an owner of property who builds or improves demon,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.). ❑1,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 themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .don,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. al-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 am: Cartier-rL��C-�l / 17 Polity No.: A01er2J;7I-` CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section treed not be completed if the permit is for one hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dare Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions to this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [~-t rte. 1 hereby aflirn that there is a construction lending agency for the performance of a,> the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name r04 Z Lenders Address V C) I certify that 1 have read this application and state that the above information is LL►� correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding conswction,and hereby authoria representatives of this city to enter upon the U above-mcntiorred property for inspection purposes. CL (We)agree to saw,indemnify and keep harmless the City of Cupertino against Hto liabilities,judgments,toss and expenses which may in any way scenic against said City V Z in consequence of the granting of is permit. Date 11+ I DEC Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store 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. ❑Yea � Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which I hazardous air contaminants as defined by the Bay Area Air Quality Management all new r taterials for inspection. trier? ❑Yes pfru I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505, 533 d25534.I understand tat if the building does not Da CITY OF C'UPERTINO PERMIT RECEIPT OPERATOR: SylviaM 8 ITEMS OF 8 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36211045. 00 09 DATE ISSUED. • • • • • ' : 050000007990 RECEIPT #• • " " : Og060104 REFERENCE ID # • • • SITE ADDRESS 8005 RAINBOW DR SUBDIVISION • • • . . CUFERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ADDRESS 8005 RAINBOW DR CITY/STATE/ZIP CUPERTINO, CA 95014-4946 RECEIVED FROM . . . . : PELLE HEATING & AIR CONTRACTOR ST]3VE PELLE LIC # 27593 COMPANY PE:�LE HEATING & AC INC ADDRESS 3728 C CHARGER PARK DR CITY/STATE/ZIP SAJ JOSE, CA 95136 TELEPHONE (408) 978-7060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ------1.00 0. 00 - 1.00 12, 049.00 1.00 0 . 00 1BCBSC VALUATION 0. 00 91.79 0.00 1BREMVENSY NO UNITS 1.00 91 79 0 . 00 1 .30 0 . 00 12, 049.00 1.30 0. 00 1BSEISMICR VALUATION 1 .00 40.79 0. 00 40 .79 1EPERMITFE FLAT RATE 0 . 00 40 .79 0. 00 1MPER,MITFE FLAT RATE 1.00 1222.79.38 0. 00 122 .38 0.00 1MRRAA UNITS 2 .00 2 79 40 1 .00 0 .00 . 0 . 00 40 .79 1PPERMITFE FLAT RATE 0. 00 40 .79 0. 00 1.00 40 .79 ---------- 1TRAVDOC FLAT RATE --- 0. 00---------- 0. 00 379.63 0. 00 379.63 TOTAL PERMIT : AMOUNT REFERENCE NUMBER METHOD OF PAYMENT -- --------- ----------------- CHECK 379.63 3722 TOTAL RECEIPT 379.63 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --- ------------------ ------------------ -- ------- 507 FINAL PLUMBING 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OFCUPERTINO FURNACE/AC alTy CUPEKTINO PERMIT APPLICATION FORM �0 0% APN # Date: � L+� o� Building Address: Owner's Name: Fax#: LtU". `tTl -L11 40 Contractor License#: Cupertino Business License #: Contact: Phone#: \J GZ, Fax#: qo g Building Permit Info: Elect Rl- Plumb 0/ Mech Residential JqCommercial ❑ Job Description: C_,C, �� fi cz-,4& U,3 t+-4A G UC-irS For Residential Installations: Attic F-11St floor)(( 2"d floor ❑ Adhere to minimum setback requirement lir For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of C instruction (Usage Class): of Strapped ❑ On Platform ❑ Bond,;d ❑ New Location ❑ Replacement Project Size: Express ❑ Standard ❑ Large [] Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09 CITY OF C'UPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee %FU : Type Group FURNACE /AC 1 MCRAA Commercial-Rc pair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,ab,,orption unit,or ea heating,cooling,absorption or evaporative coaling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial fo c the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Ir stall/Relocate ea M suspended hea:er,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICO Commercial ",eismic B 1MRRAA Residential R,-pair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative doling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounte i unit heater. CITY OF CUPERTINO ml FURNACE/AC CUPE1{TINO FEE SCHEDULE Quantity Fee ID Fee Descripti c)n Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= lOk CFM B 1 MCRAA Commercial M,-ch Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical fo•ea gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B 1 MRRAA Residential Me::h Repair/alt/add M j 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B J 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B 13r-E IJsl-�f Community Development ?> 10300 Torre Avenue m _ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Buildh7 De artment JOB ADDRESS: jj PERMIT # OWNER'S NAME: I am not using any subcontractors: 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 Tile Owner/Contractor Signature Date