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06080113CITY OF CUPERTINO 3 OfoMwith z Q Fcoact. U ILL h ',Z v --t ga *P .aa�«9± :r. x.t �`�`' '°`'` `' ''' ' ' T. CONST U TOR II�C? 2NIATI01�1 BUILDIN67DIVISION PERMIT s BUILDING ADDRESS: AAA FURNACE & AIR CONDITI RM(1006080113 18771 NEWSOM AVE OWNER'S NAME: PERMIT ISSUE DATE MIKE BUELL 1712 STONE AYE nR/i6/2onr SANITARY NO. CONTROL NO. (408)293-4717 ARCHITECDENGWEER: BUILDING PERMIT INFO BLDGPLIC IECH� l� l� LICENSED CONTRACTOR'S DECLARATION Jab Description P 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7010) of Division 3 of the Business and Professions Cocc. and my license IS mrall raree.wa ,s REPLACE FURNACE 60,000 BTU AND ADD A/C 3 TON License Clara y e / O Lk. N Date - Camuusor_ J 1tirA 200 AMP UPGRADE ARCHITECT'S DECu�51I I undersand my plana shall he used a Public reeorda Licensed Professional OWNER -BUILDER DECLARATION 1 hereby onion that I am exempt from the Consumes License Law for the following mance. (Section 7031.5, Business and Professors Code: Any city or county which requires a permit to emmucL sus+. improve, demolish, or repair any strumure prior m its issuance, also mquiRa the applicant for Such permit m Isle a signed stmenctil cammcmes Limar< Law (Chapter 9 Sq. Ft. Floor Area Valuati*%B 850 the he Is licensed paraant m the provisions of the (commencing with Scedon 7000) of Divislon 3 of the Bufloesa and Pmfrssion Code)or Nu he B exempt therefrom uW the basis for the alleged monologist, My violation of N Number Occupancy Type Section 7071.5 by any applicant for a permit subjects the applicant, m a tial penalty or not mor than firs hundred dollars (5300). 3'929036. 0 0 0 1, u owner of the property, or my employees with wages u their suleeompewtion, Required Inspections 9, will do the work. and the =turn is not intended or offered forok(Sec. 7044. Business from Professions Code: The Canirumr'a Cicero Law don rot apply lf an owner is pmpenywho builds oimpmwtremae.and who dassuchwded oro lfo Waugh h0 own employers. Provided mus welt emprovemmts ane mol Tended oolfered fnak.IL however.building orimpmwmann4hat within arcyenofimrovefo•meowrcr- ' builder WU have the louder Of pouring that he did m, bulk) rc improve (art purpose of in ak.I• /l 0 1. u owner of the property am exclusively contracting onto licensed conuumr e construct the pmjem (See. 7014. Business and Proture. Code:) The Coauacmes U- came (ave tan not m owns of property who betide or improves W mon, and whocontractsLacss for such pmkea with a mnuumgU licensed partum, m me Consacmta c License law. ❑lam accept under San. .BkPCfor mu memo Owner Dam WORKERS COMPENSATION DECLARATION 1 hereby all= under penny of perjury one of to fallowing declasaio� I ham and will maintain a Carotene of Consent to self -Insert for Woatees CamPen- . anion• m Provided for by Section 3700 of W Labor Code. for the perfrstorm of W work for which this permit is Issued. 0 I haw and will maintain Workers Compensation Wurnce, m required by Section 37M of me Labor Code, for me performance of the work for which this peend, is Issued. ' My Workee mpwati/9�p In.. carrier and POI'7 num err �� i! f Cartier PoIicY NI.:B CERTIFlGTE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crlds smoke need not N completed if the pemril Is forms hundreddollar ($101) or less.) 1 certify that in the performance of the work for which this permit b hound, l shall not employ any Peron in my mmorm u m become subject m the Worlo ri Compensation Laws of Califom{a. Date Applicant NOTICE To APPLICANT: If, after making this Certificate of Exemption, you should booms subject m the Workers Compensation provisions W the labor Code yen muse comply with such provision or this permit sludl be domed revoked. CONSTRUCTION LENDING AGENCY I herehy affirm WI there a ... muucdnn lending agency for We performauc of the work for which this permit a issued (Sec. 3097, Civ, C.) Lendces Name Lenders Address I cenify that I haw rod this application and sum mat the above information Is I agmc m comply with all city and county oMnamv and sue Ice mlaung e Wilding convection, and hereby authorise rprexemaives of this city no enter upon the above-mcntiuned property for inspection purposes (We) agree m taw. indemnify and Kemp harmless W City of Cupertino against liahllntim,judgments. cats and expenses which may In any coy accrue agairte aid City In consequence of the growing of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date t1 b SO RCE REGULATIONS. Re -roofs Type of Roof SittrachicalIVApplicaniX.Olihichir Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future balding occupant one or handle haradouf material u defined by the Cupertino Municipal Cade. Chapter 9.13. and the Health and Safety Code. Section 255374)?All roofs shall be inspected prior to any roofing material being installed. ❑Yrs No If a roof is installed without first obtaining an inspection, I agree to remove Will me anflool r future building occupant use cgalpment or devices which emit harsNnm air contaminants a defined by the Bay Ama Air Quality Management all new materials for inspection. District? 0 Yn I haw mal WIncome..:crieoctmimmems undcrChmtc,A95ofW Cnirow riaHalthd: Safely CadeSmiots25S05.35533 and U534.IuMcrsaM tmnfW Wilding does not currently how a tenant. Thal it u my raponibility to nafy the eceuPanl of W regut memsswhichmot W=1priormiauancoaraCenutiesteorOccepancy. Signature of Applicant Date All roof coverings to be Class "B" or better Own ler th n.megcia nate !m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37529036.00 DATE ISSUED.......: 08/16/2006 RECEIPT #.........: 35647 REFERENCE ID # ...: 06080113 SITE ADDRESS .....: 18771 NEWSOM AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: MIKE BUELL ADDRESS ..........: CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 2 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 •FEE ID UNIT QUANTITY BENERGY PERMIT FEE 1.00 BREMAIRHAN NO.UNITS 1.00 BREMFURN NO UNIT 1.00 BELEC200 METERS 1.00 BREMRECEPT NO. OUTLETS 1.00 PPERMITFEE FLAT RATE 1.00 BSEISMICRE VALUATION 9,000.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : METHOD OF PAYMENT AMOUNT ----------------- ------------ OTHER 206.07 AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 34.86 ---------- 0.00 ---------- 34.86 ---------- 0.00 10.26 0.00 10.26 0.00 14.31 0.00 14.31 0.00 29.43 0.00 29.43 0.00 1.20 0.00 1.20 0.00 38.37 0.00 38.37 0.00 0.90 0.00 0.90 0.00 38.37 0.00 38.37 0.00 38.37 0.00 38.37 0.00 ---------- 206.07 ---------- 0.00 ---------- 206.07 ---------- 0.00 NUMBER ------------------ VISA TOTAL RECEIPT 206.07 VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 304 ROUGH ELECTRICAL 507 FINAL PLUMBING 0 VOICE ID DESCRIPTION -------- ------------------- -------- ------------------- 303 ROUGH MECHANICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL i CITY OF 4fUPEkTINO • Community Development 10300 Torre Avenue. Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: ")i 510 PERMIT # O S01//3 OWNER'S NAME: OLI PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors:DF /6 D� Signature Date Please check applicable subcontractors and complete the following information: 21 • 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 Owner/Contractor Signature Date aw OUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM 011ft 113 APN # -03 �o Date: Building Address: dv /%SDA C UE BREMFURN Owner's Name: Phone #: u2P 3 BREMACOVER A/C Unit> 10,000 cfm Co tractor: Phone: 74 f'�- l- License #: dol/ 1M G MECHANICAL C ntact: Phone: Cupertino Business License #: z4,6,4 I BSEISMICRE Buildi g Permit Info: BUILDING Bldg ❑ Elect Plumb ❑ Mech Job Description: u4.0 are N c c Elec Permit Issuance Residential Commercial For Re idential Installations: f E3 ❑ Mech Permit Issuance 2nd floor Attic I' floor PPERMITFEE Adhere to min set back requirement ❑ PLUMBING BPERMFEE Bldg Permit Fees or Commercial Installations: Replacement same weight ❑ Additional weight (structural Elctural calcs) BPLANCHK Structural Calculations required for new installation BUILDING New installation Planning Approval Required Gas Piping System Fee Cost of Project: Type of Construction: Occupancy group: Business License BUILDING Strapped LJ On Platform LJ Bonded 13 Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if FAA m Fee Descrintion 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 I BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG 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 BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING aei•2G2_00