06120058 CITY OF CUPERTINO '�'•°- �'
BUILDING DIVISION PERMIT CTnR NFORMA'CION"
BUILDING ADDRESS: ASTRO HEATING 4 AIR GOND f5't'IT NO.
06120058
10418 MIRA VISTA AV
OW NEWS NAME: PERMIT ISSUE DATE
KINNEY SUMAL 338 ROYAL AVE 12/13/2006
NE: SANITARY NO. CONTROL NO.
(408) 268-8877
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT T
PLUMB MECH
0 0 1o
pQ LICENSED CONTRACTOR'S DECLARATION Ib Description
with Se
i u U 1 Wrcby afEm OIL I am m
liecreed under Provisions of Chapter 9(comenOIp
cing
i ctian707)()of� sion3orthc Busineu endP feu'na J myliecnxr„ mmRmmemeerc awh FURNACE REPLACEMENTAssaf .
��iz L'cen Lk.N '
F Date Canv'ECL
A shall used
DECLARA ION
i p e 1 understood my plans WII W uuJ pe public rttnNs
yU
°off Liccwxd Pmfcnsional
OWNER-BUILDER DECLARATION
O 1 mrso a(Bm on 1 i. ucmpl cram Jte Contractor's ops,:A n c Law for to
:OC O following mason.(Section 7o1 L5, t,aim end w.det Professions Calc:Any city or county
5 m which mquiru a.moot to c rotor.
alter,ImProsu h fOrmit t en mpsig any awmum $2655
-iy Out het tsimsed'alsamq.iru thoaiskscant for Contrctoi',U,Cas Law(ned utemcnt
crap that me cingwonurtuanitotheof0wionsoftheheBirimess lJcenxrdinChapmr9 Sq. Ft. Floor Area Valuation
2 t– (commencing except
Sectio 10nd th Divis'on r th al eged exemil ption.
My vi Cnde)of
$
that o u ex.5 b themfom and the aper for the alleged taempnt to Any violation or
Sectors down
by hundred
for a permit subjects Ne applicant m a civil penalty of T Occupancy Type
.or mole Nan fico hundred dollen(55110}
❑1,u owmr of Ne propmty,a my employes with wage pe Neat tele campewtan.
will do the work end thesmceae is nut Wended oroRcred rorsak(SOe.1044.Businw - Raired Inspections
and Professor.Cade:The Cinracemea Lieenx Law does sat apply m en owner of - Required p
prapeny who wildsorimpnews Iherean,and who doessuehworkh uselfor through his
own employou,provided than such improvements art Wt intended ar oRcred furaak.If.
however.the Wilding or improvement is sold within one year of mmpicuon,one Owner.
builder will have the When of proving that Its,did not Wild or impose for purpose of
sale.)
❑1,as owner of the property,am uclu dwdy ciourecim,with 0ccmed conmmn.to
cautmet the Project(Sec.7066,Business and Professions Cotler)The Cmtraetafs U
cense Law does not apply to an owner of property who Wilds or improves dimmer,and
who conmets for such pojects win.comnmor(s)removed puri in the O nourac ars
LKCM1R Law.
❑ lamucmptundm See ,BAPCforthrmat
Owner Date
WORKERS COMPENSATION DECLARATION
I hemby air=under penalty of perjury We of the following decrnuons:
1 rave and will maintain a Cuufinte of Cauenl in xlf-inure far WaricesCompen-
sation,As provided for by Sttuon 3700 of the Labor Code,for dsc performance of the
wart for which this.coil is hnsmd.
❑I have and will maintain W.1i Compensation Inman¢,pe required by Sermon
3700.f the Mbar Code.for the do...of the work for which Of.permit r issued '
My Wend Policy nu rbc{,rt.�)^_— .v
VN4;
olicy No.: I/^\3'C (f�`xON FRO OKERS'INSURANCE
(ITrxNmreedsatWcanpktedifthepermitisfarohshun Bogan(5100)
nr less.)
1 sxnufy that in the performance of the wort for which this permit is fumed.I shell not
employ any person in any manmrso As in become subject m the Worker'Compensation
Laws of Calsromia,Date
Applicant
NOTICE TO APPLICANT.If,spur making this Certificate of Exmpuon.you should
become subject An Oc Workers Compensation provisions of the Latin,Code,you mot
.J z forthwith comply with each proviuou or this permit shall ho deemed mated.
zCONSTRUCTION LENDING AGENCY -
[--� 1Whebyalfim Out them'..couwctnn lending agenry for the pinfomance of
lY > the work for which this permit is instant(See 3031•Civ.C)
WA Undoes Name
6i
0.z lender's Add.
U Q 1 certify Oat 1 have rood this application and some that the&hove information is
LL F comm.1 agree to comply with all city and county ordinances and sus laws relating to
0U building constuction.and hereby authorim represemmives of this city to enter upno the
W alrosrmemidgre property for inspection which s.
(We)agn,to caw.hod.irmly and keep hamlets the City of Cupertino againn
► N in
jnce of th loveshe grunting eapmnsu which may in any way accrue againstsaid Coq
(„),'� A canx ANT NDER TAN of this.emit. 2
^
AP CANT UNDERSTANDS A"WILL COMPLY WITH ALL NON-POINT Issued by: Date G
S�.J�Y V AI Re-roofs
tgnatum of Applh keV toUSM RIALS DISCLOSURE Dak Type of Roof
Will the applicant of ruuue Wilding Occupant ream or handle havardou material
pe dcRned by the CupertinoMuni'pal Cao,Chapter 9.12,and the Health and Safety
Code.Section
No
ion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or tort Wilding Occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil W.M us air contaminants As Jcfhncd by tW Bay AMA Air Quality Management all new materials for inspection.
District?
❑Yes No
IhaveroatltheharaM umateriar reyuimments under Chapters.95oftheCalifor-
nrHulthkSafelyCo ,Secua.255115,25513am125536.1undenmantthuirthe Wilding
toes rhe ly w a temnl that it r m poh.ihility m noury th occupant of the
req k p m'ns te apancy Signature of Applicant Date
owner orautho ,<aagent m All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
i Cupertino CA 95014
h Telephone(408)777-3228
CITY OF Fax(408)777-3333
G$UPEkTINO
Building Department
JB ADDRESS: PERMIT #
o I V1 a� r2bn � �
OWNER'S NAME: PHONE # 1,A- — ol—I
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: w
Si a e ate
Please check applicable subcontractors and com Tete the f owing information:
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
• l �
Owner I ontr ctor Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35702015 . 00
DATE ISSUED. . . . . . . : 12/13/2006
RECEIPT 4 . . . . . . . . . : 37039
REFERENCE ID # . . . : 06120058
SITE ADDRESS . . . . . : 10418 MIRA VISTA AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER KINNEY SUMAL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : ASTRO HEATING
CONTRACTOR . . . . . . . : BROWN, BRADFORD T LIC # 20438
. COMPANY ASTRO HEATING & AIR COND INC
ADDRESS 338 , ROYAL AVE
CITY/STATE/ZIP . . . : SAN JOSE„ CA 95126
TELEPHONE . . . . . . . . : (408) 268-8877
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- --- --- - ---=--------- ---------- ---------- --- - ---- - - ---------- -- --------
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, 655 . 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
----------------- ------------ ------------------
CHECK 164 . 78 16213
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
•
CITY OF CUPERTINO b�l E6FURNACE/AC
OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date: I� C)
BuilliMdress: lJ S
Ow er's Name: Phone #:
n &uve�
C ntra giur: Phone: License#:
s e, 52Z�
Ph one: Cupertino Business License#:
r) bam
Building Pe t Info: L
Bldg ❑ Elect Plumb LJ Mech
Job Description:
ResidentiaINIX
Commercial
For Residential I st dations:
Attic EJ1" floor 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
eplacement same weight ❑ Additional weight(structural talcs) ❑
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Co t o roject: Type of Construction: Occupancy oup:
5 � ��
Strapped ❑ On Platform ❑ Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement Er
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 efm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Pemlit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING