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06090090 CITY OF CUPERTINO BbamncmvlsloNPERMIT ;COl1TRtlCRINPP M"T BUILDING ADDRESS: AAA FURNACE & AIR CONDITI YWO-06090090 10925 NORTHVIEW S OWNER'S NAME: PERMrrISGUEDATE GRAIG ROURKE 1712 STONE AVE09/13/2006 NE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECT/ENGINEER: BO BUILDING PERMIT INFO EO PLO MEOCH 00 LICENSED CONTRACTOR'S DECLARATION Job Description i 1 hemby affirm that 1 Am licensed under provisions of Chance 9(commencing wide Section 7001 of Division 3 of dse Business and Prormmons Code.ami my license is imroll ramenad REPLACE FURNACE ttg__ Lmenmelns 1 I D Le.g i F Dam _Comracmr yQ RCNITELTS DECI.AI i 2 1 understand my plans shall he used m public records �NL iyr �C3 Licensed Pnsfeasionel m Oat lam exempt DECLARATION I hereby affirm dent 1 am eacmpt from dee Cssionstd's i Any c Law rte my o o following moan.(Section](1 omm B.Car. and Professions Code:Any city m county 3 which it m•pumas re eonsuuct alcor.imdeve,demolish,ft A or,pair any atmctum $3475 -i< priermid isauancc.atw mquirm the applicant for sechpermite Ek asigned stammcnr e that he is licensed par>,.,in the provisions ofAnConstitutes U..Law(Climte,9 Sq.Ft.Floor Area /6 Valuation 25 (commando{with Smdon]000)of Division 3 of use Business And Piefentians Code)or — Nat o Is exempt deemfros and the basis for dee alleged aempdam Any vialation of Section 7031.5 by y applicant for a permit subjects Jon m applicant a civil penalty or LT anC aney Type not mom than five hundred dollars(M). ❑I,As owncr of die property,or my employees with warm in their sale compensation, will do the wank.and Mongan.u not mended maRcmd for sale(Sic.7W.Baanasa Required Inspections and Pr nfemlam Cole The ContmcasYs Llane,Law dose e not apply m an owner of 9 P property who builds ar impraws thereon,end who dam sue h work himsel f d through his own employees,provided thalsuch improvements are not Intended arolp red formle.If, however,the building orimpmvement Is mid within ism year of completion,the owaer. builder will have the burden of proving that he did act Wild or Improve for purpose of sok.). ❑1,as owmr of the property,am exclusively naming with Iicemed mossexan An construct the pmfCa(SCC 7014.Business ant Profession;Cade:)The Commodes U. an., LAw d.oat apply m m awnCf of pmpeny wbo Wilda of imp,K.tltemart.cod, who consmcm for such picked with actmenu mr(s)Imenadpossmat An Jon CanuacmM1 License La . ❑I em mempt underSec. .B&P C far Nu msaote ' OwnerDam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury do of it.rollawfnr dmla amts: I have and will maintain a Certificate of Consent m self-Imum for Workers Curti n- sation,As provided for by Section 3700 of the Labor Code,for Ne performance of IIIc work far which Nis permit is issued. ❑1 haw and will mainmin Workers Compensation Insurance,As required by Section 3700 of the Liber Cod.,fer the performance oftlte wok for which this Paestum lsstw.d. ' My Workers Compensation issuance carrier and Policy number am: �s( carrier. TY'/J Yui L...i d Policy No.: TI 5&6PTION Fmog W C COMPENSATION INSURANCE (lTmseetion need notocompleml if the permit is ideas hundred dollen($100) or in .) I certify Not in the performance of the work for which this permit is issued.I shall not employ any person in any manner an as to become subject in the Workers'Compemadon Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Campeau of Exemption,you shauld become subject As the Worker's Compmandion provisions of the Labs Cade,you mus O fardewith comply with such provisions m MA permi "I be deem d revised. zv CONSTRUCTION LENDING AGENCY _ [-, I hembyalfmn tha them iso construction lending agency for the perfarmarta of ai > Ne work fur which this permit d issued(Sec,3197,Civ.C.) a0 Lenders Name z Lenders Address f,Q 1 cosily that I have mad this application and sum Nat dee move iamataiun is U, F correct 1 agme to comply with all city and county ordinances and sum laws roleting to t7 U building construction.and hereby amhorim mprescndtivm of this city to enter upnn the W ahuvc-mcntmedprucny far inspection pdpoxs. (We)Agree to save,indemnify and lump harmless Ne City of Cupertino agains vF„y liatrilma,judgmcnd,cnsd and expcnas which may In my way mcrm against mid City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Sop RCE REGULATIONS. it 12 /3'8G Re-roofs olianUCo lar Dale xAz oS MATERIALS DISCLOSURE Type of Roof WIII the applicant or future alC building Examplese.Chant r9,1 orhandlet hvmdoan material As dented by the Cupertino Municipal Code.Chapter 9.I2.and tits Health mJ Safety Code.Section 25532(q] All roofs shall be inspected prior to any roofing material being installed. ❑Yea WIII the applicant or futum building occupant use equipment or devices which If a roof is installed without First obtaining an inspection,I agree to remove emit hanmdnm ale contaminated As defined by Ne Bay Arca Air Quality Managcmmt all new materials for inspection. Dimiet1 0 Yes I have coati the hmdm a material rowimemnd under Chapter 6.95 of the Caliror. .in Hamth&Safety Cad.,Sectiaos 25505,25533 am125534.1 understand Jon if the Wilding does act currently have a teran4 tha It u my responsibility m notify dee=now,or the roquindwhhmmlboMEprior in issuance ofaocrtifcamafDean panry' Signature of Applicant Date Da All roof coverings to be Class"B"or better owurmthorikilagent CITY OF CUPERTINO m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31636002 . 00 DATE ISSUED. . . . . . . : 09/13/2006 RECEIPT # . . . . . . . . . : 36025 REFERENCE ID # 06090090 SITE ADDRESS . . . . . : 10925 NORTHVIEW SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GRAIG ROURKE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , 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 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 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE 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 . 28 0 . 00 164 . 28 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 248 . 30 VISA ------------ TOTAL RECEIPT 248 . 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 SUPERTINO Building Department JOB ADDRESS: PERMIT # 0 6 O Dd a 0OrC-P � OWNER'S NAME: . ( PHONE # Zf3 GENERAL CONTRACTOR: a FAX # I am not using any subcontractors: Signa6re Date Please check applicable subcontractors and complete the following information: 60 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 CITY OF CUPERTINO ovcnoO oI o 4 -- F URNACE/AC • CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: O T U t� ell Owner's Name: Phone#: 6 lea 0 (o' Contractor: License #: n � Contact: _ Cupertino Business License#: S Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: Residential ❑ Commercial ❑ For Residential Installations: Attic ❑ 151 floor ❑ 2nd 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 ❑ Cos of Project: Type of Construction: Occupan g ,,j Strapped On Platform ❑ Bonded 0 Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group tl BENERGY Energy BUILDING / BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 000 clip MECHANICAL BREMRECEPT Rec tl, Switch &Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMrrFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEEPlumbing Permit Issue PLUMBING BPERMFEE BldgPermit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING