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09120012CITY OF CUPERTIN D BUILDING PERMIT BUILDING ADDRESS: 19250 TILSON AVE OWNER'S NAME: WINDERMAN STAN/EVA SPERTELL :R'S PHONE: 4082538086 LICENSED CONTRACTOR'S DECLARATION License Class 2 Lic. # -_13� '7 ContractorPDate 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source relations per the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stricture is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save i• iify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONTRACTOR: COOPER BROTHERS, INC. PERMIT NO: 09120012 .:151 DEL FRANCO ST DATE ISSUED: 12/01/2009 SAN JOSE, CA 95131 PHONE NO: (408) 437-2442 ]WILDING PERMIT INFO: BLDG f— ELECT f— PLUMB MECH f— RESIDENTIAL f— COMMERCIAL JOB DESCRIPTION: REPLACE FURNACE ADD A/C •iq. Ft Floor Area: Valuation: $11800 kPN Number: 37540056.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 411 roofs shall be inspected prior to any roofing material being installed. If a roof is .nstalled without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance w,jth the Cupertino Municipal Code, Chapter 9.12 and the Health &SafetyCSections 25505, 25533, and 25534. ' ed agent - Date: CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a constriction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FUR21ACE/AC CUPEI�TINO PERMIT APPJLICATION FORM APN # _ 0U Date: — 1 —C) e7 Building Address: /s0, -. :, e- C 215 Owner's Name: Phone #: Contractor: Phone #: �t&v 4�,/f ZGC%$ Fax #: Contractor License #: Cupertino Business License #: 1�5 .2 6 _73 Contact: Phone #: Fax #: WT q3-7- 7 tri Building Permit Info: Elect ❑ Plumb ❑ Mech 01-� Residential V Commercial ❑ Job Description: For Resi ential Installations: Attic ❑ Isc floor [ 2°d 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): C 20 Strapped 0 On Platform LJBond ,-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, incl ide in plan set & the sheet index. xevised u1/0//vy CITY OF CUPEkTINO CITY OF CUPERTINO FUIMACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1 MRAPPVNT Residential for the install/relocate/ or replacement of ea appliance vent install & not ir cl in an appl permit. M FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Se- smic B 1 MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea for,ed-air/gravity type furnace/burnei, incl ducts/vents attached to such appliance up to and include l 00,OC 0 Btu/h M 1MFRN>100 Furnace Syst =- 100k BTU install or relocate ea forted-air/gravity type furnace/burnei, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1 EPERMITFEE Electric Perini t Fee E 1 MPERMITFEE Mechanical Pc rmit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO FURNACEAC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for e i gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. C omm/Resid P 1BREMAIRHAN Residential A/C units <= IOk CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Perm: t -M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF .UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 112 PERMIT # OWNER'S NAME: PHONE # r/v ` GENERAL CONTRACTOR: FAX # Ilu`l -fJ I am not using any subcontractors:- --- / 7 Si;;mature Date Please check avnlicable'subcontractors and comvlete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing V' 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