08010036 CITY OF CUPERTINO :wc
BUILDING'DIVISIOK PERMIT _CCINTRAGTORgNF0RMAT70N:_
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PERMR NO.
Bu1LDtj+cjra�TT'LA JOLLA CT AAA FURNACE & AIR 08010036
OWNER'S NAME: PERMIT ISSUE DATE
PEDROTTI DONALD G AND MIRIAM 11 1712 STONE AVE 01/07/2008
,E: SANRARY NO. CONTROL NO.
ARCHT1ZCT1ENGINEER: BUILDING PERMIT INFO
REPLACE FURNACE 80, 000 BLDG ELECT PLO MEOCH
oo LICENSED CONTRACTORS DECLARATION l Job Description
1 Wmby affirm Nal I am llmmed under Provisiau of Chapter 9(momm miing p
with Section 7M(lj of Division 3.1'the Business and Profession Cade.md my Inc.is
R in full(Dine a IT t.
Lieen.Clas
�t-qqW Dole Converser
.A CHMSC1'S DECO N
i�` I undemmnd my plain shall W uud u public r"ools
IdU
Licensed Pro(cssional
OWN3 Me I am exempt ro m DECLARATION
Contractor's
Z I hereby affirm(S.' Nn I a1..Bump,s an the Caavanofa Licenu taw for the
-p o following mason. er it t 1str Business and improve.
der li Code:Any dry s moony
f m which as nesissuance,
a also
....Cres th L alter.W prom,h Permit
t erre pair any suunum
-i< pilar.ilcndpunaorequithcpmyision al for Lbe onimmilmfilcasUw(Chtemem
s (commencinawdpunuonnathcpmvisionan aftheB amass Liccnscasw(C ede)ur Sq.Ft. Floor Area Valuation
that Its
Sectiouseand th basisfrafthcoged exemnd ption.
Any
Cede)Ser
Nat W b eumpt thmef.m and the buil for the alleged eumption.Any vlol.tian of
Section 7031.3 by arry applinnt fon permit subjccu the applicant to a civil Penalty of APN Number Occupancy Type
oat mart dun five hundred dollars($30%.
0i.uownerof0upmpmy,mmywployeuwhowag"uthe'oolemmpe don,
will dothewons and theawnurebnoantundnse Law Met an,apply
Wan.Buda.." Required Inspections
and property
wh ora Cade:The Canuecmrs Limine Law does tet apply 1f an owner of q p
own eery who buildsorimprovesch i themon,and who deansuchwork oraffe err throughhie
awn employees,Wilding
thin Such improvements in not inundN mpledsed for uk.lf.
however,the Wilding or Improvement bold within am year err mpro a rw the purpose
of
builder will love the burden of proving Net W did not Wild m improve(a puryou of
❑1,u owner of the propert,am excludmly .n mains with limned commuters to .
cousrmet the project(Sec.]Ban.BuSWSa and Pmfesdous Code:)The Convanula U. '
cause Law don not apply as an owner of property who Wilds or improv"thereto.and,
who contracts for such projects with a com enctor(s)Ilcmud pursuant ea the commences
License Law.
❑l..exempt under Sae ,B&P C for thio rexson
Owner Data
WORKER'S COMPENSATIONDECI.ARATION -
thereby.Biru under penally o(pe7ury oneof du following declarations
hamandwillmainuina Ccrtibnmof Conanttoelf.iasumforwark sCompm-
on,as provided fm by Section 3700 of the labor Cade,for the perfo mance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insmana,as nn Mmd by Section
3700 M.lab.Code,for the performance of the work for which this Permit is issued.
My Wartime,Ca.Peusation Iusmanm estier and Policy number sus:
Cartier. �O ♦.✓ Policy Nal/.T.i"X
�A&'0'FBXEMPnON FRO WORKhI lIS'� -
COMPENSATION INSURANCE
(This Section need oat W completed if IW permit Is foto.hundred dollars(SIM)
leu.)
1 certify that in the performance of the work for which this permit is issued.l shall tort
employ anypenon In any manner..to become subject he the Warkere Ca.Peussien
Laws of Califomia.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Labor Code,you mus
.JO forthwith comply with such provisions or this permiuhall W deemed revoked.
zv" CONSBUCTION LENDING AGENCY
F-r I hereby affirm Nn Outs iwcmuvuctinn lending ayym for the perfomaammaf
a 7 the work(of which this permit is issued!(Sue.3097,Civ.C)
W Lender's Name
z Lendees Address
U 0 1 certify that I have mad this application and sou that thc above information is
LL. correct.I ague to comply with all city and county ordinances and state laws misting m
U building consruction.and hemby authorim representatives of this city to enter upon tits
,tea sWm-mcmiMed pno,ay for inspection mrpnus.
(We)agree to nuc,indemnify and Kest,bumlasa the City of Cupcninu again,
E.y liabilities,judgmenu•costsandesp.whichmayinanyway.ecrueagainstsaidCity r�
of ft graming of
U Z PrC ts purnit.
APLNfUNERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOU ERE GULATIO
Re-roofs
ignuum of Appli HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will the applinm or fretum Wilding occupant score"Mmile hmand m.material
az dermad by the Cupertino Municipal Code.Chapter 9.12,and the Health and Eafcry
Cads.Smaom M532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu e
Will the applicant a ft Wading Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
a huiardma air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yrs �No
1 he. ad the hvardms materials mquimnunu um i rCWpur6.95of the Calif"-
nUHnlN&Safely Cade,Section MM.25533 w125534.1 undenund duo ifthc Wilding
dins not curmndy have a tenant thin it b my rtam"ihilitY u mdfY the accupmt N the
mqu'mmenu which must W Mi pdarm basmac ofa certificate of Occupancy' Signature of Applicant Date
Ownenr.mari ed as=rat Date All roof coverings to be Class "B"or better
1 0 0
CITY OF CUPERTINO
01410FURNACE/AC
CUPkiNO PERMIT APPLICATION FORM
APN#25-�pDate:
loy � , 00
Building Address:
3 3
Owner's ame: Phone#:
Con ractor: Phone
Fax #:
Contractor License#: Cupertino Business License#:
(Fd ro
Contact: Phone #:
Fax #:
Buildinj Permit Info:
Elect Plumb [ Mech
Residential Comm tial ❑.
Job Description:
For Residential Installations:
Attic ❑ ls` floor 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
Strapped On Platform El Bonded 71 New LocationEl Replacement
Valuation:
X00, a�
• Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
` FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,inel
installation of controls regulated by this
code.
1 MCREPALT Commercial for 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.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
IBPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install & not incl in an appl permit.
� CITY OF CUPERTINO
LU. FURNACE/AC
•CUPi�REkT�NO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
I 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner;incl ducts/vents
attached to such appliance over
100,000 Btu/h
' 1 EPERMITFEE Electric Permit Fee E
/ 1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
CITY OF CUPERTINO
FURNACE/AC
ciao
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
IBCAiRHAN Commercial A/C Units <= I Ok CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMIC0 Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
IBREMAIRHAN Residential A/C units <= 10k CFM B
1MRRAA Residential Mech Repair/alt/add M
IBSEISMICR Seismic Residential B
IEPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
IPPERMITFEE Plumbing Permit P
1TRAVD0C Travel Documentation B
1BUSLIC Business License B
CITY OF CUPERTINO
® 6 ITEMS OF 22 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621045 . 00
DATE ISSUED. . . . . . . : 01/07/2008
RECEIPT #. . . . . . . . . : BS000003633
REFERENCE ID # . . . : 08010036
SITE ADDRESS . . . . . : 11233 LA JOLLA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PEDROTTI DONALD G AND MIRIAM P
ADDRESS . . . . . . . . . . : 11233 LA JOLLA CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4738
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, 400. 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
IMRRAA UNITS 1. 00 61 .19 0 . 00 61 .19 0. 00
1PPERMITFE 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 VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING . 508 FINAL MECHANICAL
•
Community Development
Cupertino10300 Torre
Avenue
CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
i �UPERTINO
Building Department
JOB ADDRESS:
S: L r PERMIT #04 A-6)
OWNER'S NAME: 0134,2PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: A � 42/-o 7 -e--)�
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 r VLte J"
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date