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®ULATIONS.
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