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06010166 CITY OF CUPERTINO BUILDING DIVISIONPERMIT ,, C�NTRACTURd1NFURMATIQN,,,,y BUILDING ADDRESS: AAA FURNACE & AIR CONDITI R1TMO.06010166 21094 MARCY CT WN,HER'S NAME: PERMIT ISSUE DATE TSING JOHN Y AND MICHELLE L 1712 STONE AVE- 01/30/2006 E; SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECT/ENGINEER: BUILDING PERMR INFO BLDG ELECT PLUMB MECH 0 0 0 0 30o LICENSEDCONIRunder DECLARATION Job DesQ(I llplt piss ///�� B� a 1 thereby D)ai' that 1 w ReactedthBu under proviaiam of Chapter 9(commenting IfL114—p,trrlt �� with Section 70lkp ofDiviaion Sof tho BusirmsaaM Pmfculon Code.and my license is ❑❑❑ a, mmRmreeanda seg REPLACE FURNACE 80, 000 t b DauLicense Clan Cmnlrmtor 5 A CHf1EC15 DEC N ^3 g I undemarad my plans mall he used u public mcmh r�.� � 2006 31 5 XXXQ Licensed Professional u p OWNER-BUILDER DECLARATION i N I hereby affirmet I am exempt from the Contractor's License Law for the �pgBt it I 0 o following reason.(Section 703 1.5,Business and Profession Cade:Any city Or county 11� �)'{ 4 0 0 1$2 which requires a permit to construct,slur,improv.dmeallsh.Or repair any museum LI LLLJJJ IIIJJJ Sy prior M its issuvea.also requires the applicant for each permit to flit a signed auument < but heislicensed pursuant to the provisions afthe conmamraLiceno Law(Chapter 9 Sq.Ft. Floor Area Valuation ,x❑� (commencing wish Section 70D0)of Division 3 of the Business and professions Code)or 3.. Nat he Is exempt Entrant and tic bub for the sunned exemption.Any violation of Section 7031.5 by any applicant for a parealt subjectsthe applicant to a civil penalty of - erL`J Occupancy Type not mom that five hundred dollars(SSW). ❑I,u ower of she Property.Or my employes with sages u sheb ale comismum e. will 0 tended.offered per ( .7044,Business and Pro usul CadM Cade:The Conuutnork and the struchure 13 not t License mse does ooh appply to an owtur of 9 P Required Inspections property whobuildsorimprooes thereon.and whodoessuch work him dforthrough his ownemploycu,pmvided Nat such impmwmenu art nm Inw&d orofrered far We.if. however,the building or improvement is mid within one you of completion,the owner. bulkier will have she burden of proving that he did not build or Improve for purpose of - "In.). ❑1.as Owner of the property-am exclusively contracting with licensed mnrmmers to tonne[the pmjee(Sec.7044.Business and Profession Cade:)The Contractors U. cense law dna not apply to an Owner Of property who builds or improves thereon,and, who contracts for such injects with a cmtrmur(s)licensed punuml to the Contractors License Law. ❑I am exempt under Sea .B g:P C for this moon Owner Due WORKERS COMPENSATION DECLARATION 1 hemby spirit under porosity of perjury arc of the following declaration: I have and will malnuin aCemfesto of Cement toself-lasum ter WerkarsCompcn- enion,as provided for by Sm0on 37W of W tabus Code,for the performance of the wart for which this permit is issued. ❑I haw and will maintain Waters Compensation hamearce,as ru ohnal by Section 37W of the Labor Code.for Bm parformaneeef the waft fm which thio Permit I.IYYed. My Workers CompeuNon 1 sunny roma ant Policy number are Carrier. L !/ • Policy No ' CERTIFICA •OFE%EMPIUNFR�WORKERS' COMPENSATION INSURANCE (This melat nem notbecwnpleud if the permit b foram hundred dollau($4001 or bac) 1 certify that In the performurce of the work for which this Permit is issmd,I mall not employ any person in any manner an as to become subject to the Workers Compenation Laws of California.Data Applicant NOTICE TO APPLICANT.If.after making this CcelEGm of Exemption,you should become subject to the Workers Compensation provision of the labor Cede,you muss 0z fordwith comply with such provision or this permit mail be dcemN revoked. Z O5CONSTRUCTION LENDING AGENCY I bemby affirm that them is a construction lending agency forthe performance of gL�v� the work for which this permit b Issued(Sec.3097.Civ.C.) W Q Lender's Nms, , 7 Z IaMes Adder.. east O 1 cemfy that 1 have mad Nis application and sura Wt the about infa mmso is s Iy comet I agree to comply with all city and county Ordinance,and sum brat,rtlaiing m - C building construction,and hereby authorize upreeantiws of this city to enter upon tiro Gdt abovcmentioncd property for Inspection purposes. gy (Wc)agree to on,Indcmnhfy and keep harmless do City Of Cupertino against h Imbilides,judgments.costs and expenses which may In my wry mc=against Wd City fJ 7 In consequence of Ne tooling of this Permit. C• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUVE REGULATIONS Re-roofs a jnuum of ApplicanVCan=lot D of Roof HAZARDOUS MATERIALS DISCLOSURE Type vdl the applicantart future building occupanlalorc"handle hmalloua material u defined by tie Cuperim Municipal Code.Chapter 9.17,and the Health and Safely Code,Section 75537()? All roofs shall be inspected prior to any roofing material being installed. [:]Yu Wwill she applicant aretort Wndin,occupant use,equipment or hwber wrier If a roof is installed without first obtaining an inspection,I agree to remove ,hauom.,air contaminants as dented by tbe Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I haw read the hovel nweriaisrcquiremenu ander Chapter6.95Ofde Califor rob Health@Safety Cush,Savom75505.25533 and755N.i understand thaifthe building does not currently have•mount.Wt It is my responsibility to ratify the maupant of the requirements which must be met prior to Issuance of a L'enifiate of Occupancy. Signature Of Applicant Date off' ,a `� 4��•�",/d a All roof coverings to be Class"B"or better n rurauthorimd agent / �im CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32654027.00 DATE ISSUED. . . . . . . : 01/30/2006 RECEIPT #. . . . . . . . . : 32995 REFERENCE ID # . . . : 06010166 SITE ADDRESS . . . . . : 21094 MARCY CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TSING JOHN Y AND MICHELLE L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1658 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 IRE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ______ _____________ __________ __________ __________ __________ __________ BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00 BSEISMICRE VALUATION 2,400.00 0.50 0.00 0.50 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 164.78 0.00 164.78 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ _________---__---_ OTHER 164 .78 VISA TOTAL RECEIPT 164 .78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 0 r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `UPEkTINO Building De artment JOB ADDRESS: PERMIT��6/�/� dio9y - OWNER'S NAME: Jo PHONE # o?S`.?-So9,5— GENERAL CONTRACTOR: FAX # I am not using any subcontractors: –G EJ 5D d� 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 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO Lamm'-, FURNACE/AC 0601 • CU PCM PERMIT APPLICATION FORM APN# 3 0� � y da Date: Building Address: AU09V Owner's Name: Phone #: Contractor: License#: C fda 21 Contac : Cupertino Business License #: �d Building/Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Residential Commercial 't] For Residential Ins allations: Attic ❑ 0 floor IM 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 ❑ Bonded ❑ Sq.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 cfm MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING