05110063 CITY OF CUPERTINO ..NT
BUILDING DIVISION PERMIT ,('� Rt1G�TRI1�1'QRMATIgIV:,
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BUILDING ADDRESS: AAA FURNACE & AIR CONDITI ff&005110063
20236 NORTHBROOK SO
OWNER'S NAME: PERMIT ISSUE DATE
SHARON COLE 1712 STONE AVE 11 /14/9,005
NE SANITARY NO, CONTROL NO.
(408) 293-4717
ARCHIECT/ENGINEER: BL00 BUILDING PERMIT INFO
' EISCT PLUMB MECH
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30 ij LICENSED CONTRAMFVS DECLARATION Job Description
1 hereby+flim that 1 me licensed under Provisions of CMPW 9(commmainl P
with Section 70nal,of Division 3 of do BuallwssW feaskmCode.ad my license is
+�er inmBfaraaadeJe ��f �� RELACE FURNACE
jx Lkemc Clue li.du'ftl
Dam - Conumaar
ARCHITECTS DECLARATION
Q I understand my plans shall be used As public recnma
J (�
sib Licensed Professional NOV ,vv 200,5
`m3 OWNER-BUILDER DE Ce COMrsON
o•i5 I hereby.(S that 11. exempt Imre the C alms o Licence taw for me
O followamm,m nsaoa.(Scodon 7031.5.Business and Improve.
Atm ll Cade:Any city or county
3$� which rtquues•permit to corselet.alnL Wpow,dcmd40.er repvir any suunure $3000
-:� Oderbis inuurLe,calm rtyuims tin applinnl faraah permitto file aalLmdsummcet
< dwheislkensedputmanllodspmvidmsafineCommeme,LicenseLaw(Clupter9 Sq.Ft. Floor Area U Valuation
2 a (commendag MLh Sndon70DO)dDivision3afds Budnmmditfcni mCadc)w
l= Nal he is exempt therefrom and the basis for do alleged assumption.Any violation of
Section 703M by any applicant for a permit nbkcs the applicant to a civil Penalty of er Occupancy Type
Out more than live hundred dollars(SSW). '
❑I:u owner of site pmperty,m my mployem with m9n u dnbmlo cmpenasdon,
wiU&Lbcwo&m4lbaanmum4rot Nundedor.ff.Wroraala(See.70w,Bud•w•a Required Inspections
Am Professions Cad.Tin Caallader'S License law dom ret apply m an Moss m q p
property who Wilda As improves Un .red whudoeaauch work hiseselfmtiuoulh his
Own employees,provided that such improvements are not Intended moResed for We.U.
hovever,Ne Wilding or improvemem Is mid within ore year of mmplmian,the owner-
Wilder will haw Us burden of proving that he did ret WIM or Improve for purpose of
isle.).
❑1,an owner of dm property stn exclusively contracting with!lamed contractors m
construct the pmlcn(See.7044.Business and Profesalom Cole:)The Comusa is Li-
maw law does am apply se an owner of property' im Wild,or improves thereon,and,
whoeonuuu far such projects with aeonvutortal Recused purauam to use Contratmofs
Lkeem Law.
❑lunacmpturdasa, ,B&PCfmmisreuoa
OwmrDan
7C111WORKERS COMPENSATION DECLARATION
1 hereby alarm under penalty,of perjury ren of the following deciam lom:
I Mw and"I malnW o aCertifkan of Cometh In nlf-Iourre fm W-ftes ComPa'
.
on,u provided for by Section flan m me labor Code.for the pedormarw of the
rk for which rola Permit is Intend
1 haw and will maintain Worke/a Compematian Imuran:,u required by Section
W ofme lather Code,for me performance ofNe work far which mus parse,4lused.
y Workees Compensation lsurance carrier and Policy numrtier. f'1 , a4. r/;:t,l Policy No.:��•S
-C 77FICAPION FROM WORKERS'
COMPENSATION INSURANCE
(7hdmerion read notbecompkud Uthe pemb is feranehundrtddodan($100)
Or kaa)
I ceN[that In the performance of me work An,which mla patmit H inued,I Nall Am
employ any person In my maonerm u m become subject to tin Workers'Compasaion
Laws of Califamla,Dale
Applicant
NGICE TO APPLICANT:IL afar making this Cenillcan of Exemption,you should
become subject to the Worlmes Compmwdon previsions of the Labor Code,you raw
.J O forthwith comply with such provisions a this permit Nall W doomed mmked.
Z v~y., CONSMUCION LENDING AGENCY
E~ l hereby affirm mat more H a cowman lending agency for that paalumanmm
ai 7 the work for which this permit is issued(Sec.3097,CW.C.)
W�Q lander',Name
z Leader's Address
U Q '1 ceNfy that I have,read this application and slate mat the&hew infowation 4
0,!w rooea I alma at comply with all city and county omlmmm and rete laws mlNnl In
Q SV` Wilding eonsanna.n.and hemby nemadm npreunwiwa ofthis city to enter upon the
W slave-madoned property for inspection purposes
Ly,,(5. (We)agree to nuc,indemnify and kap banks,the City m Cupertino.001mich
`s„i f�j IHmlldes.fWpnens.emu and espea,whmay in any coy tame agdml,dd City
U Z in consequence of the{ranting of this permiL
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REGULATIONS.
I �l Re-roofs
Sinorm alAppitaHAZARDOUS MA ASS DISCLOSURE Type of Roof
Will Ise applicant or lot=Wilding occupant Rote whandk huswom material
u deamd by do Cupertino Municipal Cade.Chapter 9.17,and the Halm and Safely
ode.Ses an 75537(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑YonNv
Will my applicant or Ism building ocoupmt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanmom air anumimo s As defined by the Bay Ama Air Quality Manalemenl all new materials for inspection.
DisWct7
❑Yon
I have mal de hasarm msteriaisnaltmmrns undm ChpW6.95ofdreCdifor-
nulicalmlSalcryCadc,Satiw 17505.75533 md75534.1 undl'nurd malfmp Wilding
Ince tat armady Mw a tenant mat it As my aespommillly to notify the occupant of me
requite ruts which must he mclptiorm issuance ofa Cerdrnanof Occupuny. Signature Of Applicant Date
3 'f W'J All roof coverings to be Class"B"or better,
0•✓ncrur aulh rinds ort Dan'
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
�
CITY OF Fax(408)777-3333 UPEI�TINO
Building Department
JOB ADDRESS: / S PERMIT#oS/) 0049 10
OWNER'S NAME: ,S PHONE # 3 - 3 ,2 2 O
GENERAL CONTRACTOR FAX #
I am riot using any subcontractors: /r� -��f —
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
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
M.. CITY OF CUPERTINO
m% FURNACE/AC
COF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
6 h'O�Q iC OP c�
Owner's Name: Phone #:
Te o - ls
Contractor: License#:
Contact: Cupertino Business License #:
Building Perm' Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description-
Residential ❑ Commercial ❑
For Residential Installations:
Attic ❑ I" floor ❑ 2nd floor❑
AM 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:
f 000,
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
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31639023.00
DATE ISSUED. . . . . . . : 11/14/2005
RECEIPT #. . . . . . . . . : 31930
REFERENCE ID # . . . : 05110063
SITE ADDRESS . . . . . : 20236 NORTHBROOK SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHARON COLE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0504
RECEIVED FROM . . . . : BARBARA MANGAN
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
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
______ _____________ __________ __________ __________ __________ __________
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 3, 000.00 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 2441
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