06090029 CITY OF CUPERTINO � a, xa . '?e t` ' ' �'� ''�""
r�,r�Ig,g� n��7.N. _v. .,7ly�k0 } �1
9UILaINC DIVISION PGRMIT },i,/y�?a, 4��1\�1wt.C4�.LY1� 10,AF
BUILDING ADDRESS: AAP. FURNACE & AIR CONDITI ]IMU006090029
22106 DEAN C
OWNER'S NAME: PERM17ISSUEDATE
JEAN HE 1712 STONE AYE 09/06/2006
NE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECT/ENGINEER: BUILDING PERMITINPO
BLDG EO PLO MEOCH
%z LICENSED CONTRACTOR'S DECLARATION Job DeSCfIpI100
U Fp�j I horuby affirm Nu 1 am lishssed under previsions of Cleaptsr 9(coneemos n{
i�S with Senlon 700t)ofDivpian 3oftha Buairw•.and Professions Code.end my license is
SSS2 infullraw.A `g 1 2 ADD A/C 48 , OOOBTU
i$2 Licenea CT Lk.N
1 Dem CbmtxeW
ACHITECTS DECLARATION
i I understand my plans shall he used u public((cards
ha
Licensed Professional
s y Oat I am exempt
from
DECLARATION
:O C I hereby Maso.rrivesec Nos 11. .Bumps from t r Conti us or'sCoo IJcene Law for the
0 4 following uisson.permit
t RD citta and are,de ons Crede:Any city st rounry
S$Pi which its Luo a permit m minutes
Iconstruct,aloe improve,for such
demolish.m repair ed structure $5546
j, peat he i its Lung=,pursuant alea mquim movisio s o far Comp ami'micenom aw(Chmmenl
5r�< Ihathnturch withSection
mmuprovisision3heConuanessanPrefccw(CMpkr9 Sq.Ft.Floor Area Valuation
3�$ 'hammmt resemptt Sec from and the
Division r ahem alleged
Business eM on.Any vi Code)or
�.. Nat M ts exempt therefrom and Ube heti far the allc{ed exemption.Any violation of
Section 7031.3 by any•ppllant for a permit eahjew the applicant In a civil penalty of A16N MAWer u J Occupancy Type
not mom than five hundred dollars($50)).
❑1,as owner of the property,or my employee with Magna as their able compensation,
will do the work and He smsmumts not awarded oroRered fur ask(Sec.76th,Busi•,.. Required Inspections
and Professions Code:The Genoa me,License Law dm an[apply m an as e nswno! q P
property who builds or i mpromts Hereon,and who does such work himeel f or diuough his
awn employees,provided that each improvements we not intended oroRend(mends.If.
however,He Wilding or improvement Issold within one year ofcompletion.the owner.
builder will have the burden of proving that he did ret Wild or improve for purpose of
saic /
❑1,as owner of the interparty.am exclurevely contracting with licensed conbaemrn m �O
cormorant the project(Sec.7044.Business and Profadons Code)The Commenor'i U. /
cc=law dura not apply m an owner of property who Wilds orimproves meteors,and, e,
who contacts for such projects with aantrazmr(q licensed pursuant m to Contricmt's /
License Law. /
❑Tom eaempt under Sea .B A PC fm this—a - C
Game, Dam
WORKERS COMPENSATION DECLARATION
1 I hereby aRna under peWlty of perjury ane of the following declarations:
I ham and will maintain a CcNBoam of Covent to ulf•insum forWorker'sCompere
73700
on,as provided for by Section 3700 of the labor Code.for the performance of me
k for which Hu permit is issued.
1 have and will maintain WorkeYs Compensation Insurance,u required by Semlon
of the Lahm Code,far the performance of the wok for which this permit is lamedWorker's Compevadon In urate eser" andPolicy number tic:ier. l N Policy NO.:
TIFI ATE FO EXEMPRONFRO ORKERM1fW S'
COMPENSATION INSURANCE
(ITIS section need nothecmnpkmd time permit is far one hunaeddoilm(SIM)
or less.)
I certify that in the performance of the work for which His permit is issued,I Hall not
employ any person in any remunerate an to become subject to the Workers'Compensation
Laws of California Data
Applicant
NOTICE TO APPLICANT.If,ager making this Certificate of Exemption•you should
become subject to the Woheh Compensation provisions of me Labor Coda,you mot
.,z forthwith comply with such prowivats or this permit shall be demand mored.
'Z„I 0 CONSTRUCTION LENDING AGENCY
[r Ihemhyafrm Hat there iaaconsuuctlnn lending agency or the reclamation of
a 7 me wish for which tide perch u issued(See.3097,Civ.C.)
W� im Lendcls Name
iD- z Lender's Address
U Q 1 eerily that I ban read this application and stem that me above information is
lL F comet.I agree to comply with all city and county oNiesban and sum laws relating,to
0 building construction,and hereby audited mrcpmenutivv of His city to enter upon the
a ahovc-mentioned property for instance purposes.
(Wc)agree to smut,indemnify and keep harmless the City of Cupertino against
wcM liabilities.judgments.costs and expe.which may 1.Myway accrueq.I.,atoCity G /
U in consequence ofthe gaming of this permit. (�
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCE RE ULATIGNS.
/ g-,�- 4Id,
06 Re-roofs
amu cenCmr
HAOUS
MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanLeore or handle Incautious material
as defined by the Cupen rat Municipal Code,Chapter 9.11.and the Health and Safety
cbdc,Section 25532(a)7
❑Yv All roofs shall be inspected prior to any roofing material being installed.
ie
willwilltate applicant or
tmum Wilding acupam taw equipmem or denim which If a roof is installed without first obtaining an inspection,I agree to remove
It Inundate,air contaminants as donned by the Bay Amo Air Quality Management all new materials for inspection.
u tT
[:]Yes u
Iban madthe havaNn smamrials mquiremens under Chapmr6.95 ofthe Califor.
Ireni.FEca["S.f,tyC.&.S==25505.25333�25334.1��
ifine Wilding
cs tort currently haw a meant.that it is my responsibility to redly He occupant ofthe
haments which munMmet prior so issuance ors Ccrdfmtmedo,cupanry. Signature of Applicant Date
/� ra D 9 is oG
b%Cl,fh"ari.t! gat Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
! f' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEI�TINO
Building Department
JOB ADDRESS: PERMrr #
d/4'
OWNER'S NAME: PHONE # G�P • ?6 S- /o ptp'
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:(Q di 49-DG rd�
rA-
Sighature Date
Please check applicable subcontractors and complete the following information
61 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
s _
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35709033.. 00
DATE ISSUED. . . . . . . : 09/06/2006
RECEIPT # . . . . . . . . . : 35922
REFERENCE ID # . . . : 06090029
SITE ADDRESS . . . . . : 22106 DEAN CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JEAN HE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM 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
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------ ---- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 .26 0 . 00 10 . 26 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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
---------- ---------- ---------- ----------
TOTAL PERMIT 161 . 43 0 . 00 161 .43 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 161 . 43 VISA
TOTAL RECEIPT 161 .43
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
CITY OF CUPERTINO aMocc
FURNACE/AC
PERT
OF
.CUINO PERMIT APPLICATION FORM
APN# �6-1 Date:
Building Address: (J�
ofd /06 X00
Owner's Name: Phone #:
� c Looe-
Contractor: License#:
ZeAkilyA /iAC A/C. 96geop,91
Contact Cupertino Business License#:
D
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
WQo _U
Residential ❑ Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
Adhere to min set back 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: Occupancy group:
Strapped On Platform 11 Bonded ElSq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfrn MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
l PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING