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08010034CITY OF CUPERTINOt 3"LRt•s ?,x 'ti..� a-..�� a?"x tfiGONTRAGTOIt=I URMATIO BUILDINC DIVISION PERMIT BUILDIT5f9r'kNNY DR AAA FURNACE & AIR- PERMITNO 080.10034 OWNER'S NAME: PERMITISUEDATE WIGGINS E V AND SYLVIA TRUSTEE 1712 STONE AVE 01/07/2008 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: REPLACE FURNACE 80,000 BTU BUILDING PERMIT INFO BILDO ELECT PLUME MECH O LICENSED CONTRACTOR'S DECLARATION Job Description Chapter 9 (commencing 1 Mich, affirm Nat 1 am liansw under provisions of m with Section7l111U) of Divislan 3 ofine Business and Professions Code, ave my liceaseu - m full force and qq L.%o . License 4w Lie.I Da¢ Conuamar ' 9 6 ARCHilELTS DECD A N I I .M.not ad my plans shall W umd as public moms Licensed Pmressian.l OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Conlractuh License Law far the following mason. (Section RA 1.5, Bmaresa and Profeulons Cmu: Any City or..aty which require a permit to construct alter. improw, dcmoluh, or m mir my structure prior to its issuance, also requires the applicant for such Permit to file a signed su¢nmm he is licensed m me or me Contractors Liame Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions (commencing with section 7Wo) of Division 3 of the Business and Profusions Cook) or Oat he is exempt therefrom and the basis for the alleged exemption. Any vwlauon of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant an a civil penury of non mom than five huwmd dollars (SRX)). i. u owner o(dx propmY• a mY wPloyce wise wages as mens ante eompensadon, Required inspections willw me work. andlW swmuo is ant inmwcd or aRerw for We(Stt. ]044. Busimas s License Law dot apply an awr at Add Profcaslam Cad. The Canuamore sem rc q P property who builds or improvu,herean, and whadoessuch workhimselfmthmaghhu own employee, provided mat such improvements Are notinlended oro@sed gmsale If. ' however, me building or improvement is mid within one year triumphed... the dwner- builder will have the burden of proving mat he did an, Wild at improve for puryose of r.ic ❑ 1, as owner of the property am exclusively connecting wish licensed contracmrs m construct the pmjen (Sec. 7044. Business and Prafexdons Cade:) The Conlrmmh U. cense law does hot apply m in owner or property who Wilds or improves thereon. sed, who cmucacia fen.uch projects with a mnvacmrts) licensed puna., m the Cantonal. License law. 0 lamexemmmoterseC .Bile PCfmthumam. Owner Date -" WORKERS COMPENSATION OECURATION I Wmby affirm under para ty of perjury me, of 1W following decivadmc haw and will maintain aCaniOaue of Consent m selr-msure for workers Compen- an, As provided for by Section 3700 of the labor Code, far the perf ice. of the work for which this permit is issued. 1 have and will maintain Workers Compensation Insurenm, As required by Section 3700 of the Labor Code, for the Performance of the work for which this permit u iaued. My Workers Cnm As on Inman artier and Policy number Canicr. Policy No.: #7J'.•sy,�6 CE PTION MOM WO KERB S COMPENSATION INSURANCE (ITU scctim need sen W completed If 1W permit Is Toone hundred --,($100) or less.) 1 lenity that in me perfmmance of the we& for which thi. permit is issued, l shall hen employ any Nixon in any mmMr an as to became subject in the Workef3 Cmrlpe.adM Laws or California. Date Applicant NOTICE TO APPLICANT: If, after making this Cenificau of Exemption, you shwW became subject to the Worker's Compensnion provisions or the tabor Code. you most ' forthwith comply with such provisions or this permit shall W deemed revoked. j CONS. I,A.. cfi.. 1NOAOENCY 1 thereby arcthi Nat mem is eonswNnn lending agency for tW perfmmartae of s ' the work for which anis Penni, is issued (Sec. 3091, Civ. C.) ' lenders Name t<ndcrs Address j I certify mat i haw read this applumion end sum dot thc above infmmatiun u _ ' correct. I agree to comply with all city and county eminences and sate laws miming to building consuumion, and hereby authonre mpmenmatives of this city to enter upon the aMre.m.mwned propeny for iaspccu.e ar,naca. (W c) agree to save, indemnify and kcap hanniess the City of Cupertino against j habiIdvWjudgmcnu, cosh and expenses which may in any way accrue againstsedd City in consaxof the gronfing alrmit. APPLIICCANTCUNDERSTANDS AtND WILL COMPLY WITH ALL NON.POINr Issued by: Date SO&REGULATIONS. Re -roofs Type of Roof A -_ 9 $I n amVa( plie VLDaM HAZARDOUS MATERIALS DISCLOSURE Will Nc applicant or future Wilding emupent store or handle hvardoa manorial As defined by de Cupertino Municipal Code, Chapter 9.13, and dm Health and Safety Coast. section 25532(a)7 All roofs shall be inspected to any roofing material being installed. C] Y. Na prior If a roof is installed without first obtaining an inspection, I agree to remove Will hes"dican,0, umm Wilding occupant.seewipme.tadevioewhich 1 hal moux air commormts As defined by the Bay Area Air Quality Management all new materials for inspection. ,,Icl7 ❑Yen Nu I hew mad the loamy emamrials requirements under Charter 6.95 afthe Calif.. iiaHcahh k Safety Cade, Suctions 25505,35533 and 25534.1 uodcmund thatif the Wilding dna not curmmiy haw a senam, that it is my mapon ihility to non l'y me accustoms of me mqui ntx winch m.AtWmet prior onismamaorACertificate W(011op7y. Signature of Applicant Date ag g �g° �� �� All roof coverings to be Class "B" or better ncr or au pori cd agem I Dam CITY OF CUPERTINO • 6 ITEMS OF 22 PERMIT RECEIPT OPERATOR: patg COPY # : 1 • 0 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35912027.00 DATE ISSUED.......: 01/07/2008 RECEIPT #.........: BS000003633 REFERENCE ID # ...: 08010034 SITE ADDRESS .....: 10147 BONNY DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... VOICE ID DESCRIPTION -------- ---------------------------- 113 SLAB 303 ROUGH MECHANICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL 506 GAS TEST 508 FINAL MECHANICAL OWNER ............: WIGGINS E V AND SYLVIA TRUSTEE ADDRESS ..........: 10147 BONNY DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2903 RECEIVED FROM ....: JIIM RANDO CONTRACTOR .......: RANDO, JIM LIC # 8050 COMPANY ..........: AAA FURNACE & AIR CONDITIONING ADDRESS ..........: 1712 STONE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)293-4717 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 IPPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- - 224.85 - 0.00 ---- 224.85 ---------- 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 113 SLAB 303 ROUGH MECHANICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL 506 GAS TEST 508 FINAL MECHANICAL CITY OF •CUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM aol oozy APN # 15 .2C> • 0(7 Date: Building Address: Owner's Name: Phone #: Contractor: f IPhone #: e - C Fax #: Contractor License #: Cupertino Business License #: S"99 Contact: Phone . d 9,7 - 51 7/) (-<,k Fax #: Building Permit Info: Elect Plumb Mech Job Description: �Le Residential Commercial LJ 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 Re uired ❑ Cost of Project: Type of Construction (Usage Class): lsa" Strapped H On Platform 0 Bonded New Location Replacement Valuation: ,J fn Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO �° � FURNACE/AC CUPEkTiNO FEE SCHEDULE FURNACE: Qty. if Annlirnhle Fee TT) Fee Descrintion Fee Group Permit Type 40 • • MCRAA Furnace M FURN/AC MCREPALT Commercial Mech Repair/alt/add M MCSUSHTR Commercial Suspend Wall/floor Heater M PGASCOM New Gas Piping System 1-4 Outlets Commercial P BSEISMICO Seismic Commercial B MRRAA Residential Mech Repair/alt/add M MRSUSHTR Residential Suspend Wall/floor Heater M BSEISMICRE Seismic Residential B MFLRFURN Install/relocate Floor Furnace M MECPLNCK Mechanical Plan Check M MFR=<100 Furnace Syst <100k BTU M MFRN>100 Furnace Syst> 100k BTU M 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 Residential P BPGAS Gas Piping System 5+ Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business License B • • CITY O •CUPERTINO AIR CONDITIONER: Qty. if Applicable Fee ID CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Fee Descrintion Fee Groun Permit Tvne • BCAIRHAN Commercial A/C Units <= l Ok CFM B FURN/AC MCRAA Commercial Mech Repair/alt/add M SEISMICOM Seismic Commercial B BREMAIRHAN Residential A/C units <= IOk 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 1-4 Outlets P PGASRES New Gas Piping System Residential 1-4 Outlets P BPGAS Gas Piping System 5+ Per Outlet P TRAVDOC Travel Documentation B BUSLIC 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: 1,01s12 vE PERMIT # PO 00 `T OWNER'S NAME: PHONE # p - GENERAL CONTRACTOR: FAX # I am not using any subcontractors:Z/a- , _. D Signatur - Please check applicable subcontractors and complete 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 Heating C f— Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date