06060017 CITY OF CUPERTINO
.BUILDINv DTVI SION PERMIT R*Il ''ORM:ITIOIY
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BUILDING ADDRESS: ABC COOLING & HEATING PaRm"'ND'06060017
22145 ORCHARD CT
OWNER'S NAME: PERMIT MUE DATE
Ak RAY SCHEUERLEIN 31845 HAYMAN ST 06
E:
SANITARY NO, CONTROL NO.
(510) 471-8181
ARCHITECUENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
set
0 0 0 0
0, LICENSED CONTRACTOR'S DECLARATION Job Description
i U Fj1 Wreby affirm Nal 1 am fle ecd under provisions of chapter 9(commencing - P
with Section 7")of Di''on 3 ofdoe Busruas and Profam ons Code,and my license u
F m ran to=and nec( ZD j R & R FURNACE '10 0 K ADD ONF�A 6 TON & 60 AMP
,gj? in funis s Li9 O
-Ya Data sip IRCUIT. Rpq�
i C I undcrcomd my plans mails be.4 as public mantis 62ae
s y O ry+artt—
ut Li¢,sed Professional !IA
�
'03 OWNER-BUILDER DECLARATION �/
1 hereby alRrm Nat 1 am ucmpl from the ContractorsLiecnm Law far the (J- 700av
.
00 following wan.(Section]031.3.Business and Profession Code:Any city or county a� L D
$ which neyuims a permit to construct,alert impnow.dcmWish,or repair any arwwrt Q - )j •.
:Z6 prior to is issuance,also acquires thcappliewt far such permit o file a signed statement
xx that W is licensed pursuant to the provisions of the Canlrazlur's License law(Chapter 9 Sq.F[.Floor Area �'� I 105 3
2F$ (commencing with Section 7000)of Division 3 of the Bottom and Profusions Code)or
that k is exempt therefrom and Ne basis for the alleged Campton.My violation of
Section 7031.5 by esq applicant for a permit subjects the applicant to a civil unatty ofpN Llpt� er 0 0 Oeeu e e
re
nn.mothan Bae hundred dollars(5500). 3 AMO U 4 P Y�YP
01,mowwrofdeproperty.mmyemployeewithwarnutheirsalew Wmdon,
will do the work and the monsoon,unotintended oraRered formic(Sec.]Old,9u em
arta Professions Cade:The Contactors Lia, Law data ms apply m an owner of Required Inspections
Property who buildscrimposes thereon,and who doessuchwork himse f or through his --
man employees,provided that such impmaemws art not intended or offered for We.If.
however.the building or improvement is mid within one year of completion.the owner.
builder wig haw the Wrdw of proving that Ir did ms build or improve for purpose of
saki
❑1,as towner of Ne Property,am exclusively contacting with gcemW cwuannrs In
convect the project(Sec.]Wd,Business and Profusions Code:)The ConuacmYs Li.
cons,Law dais not apply In an owner of popeny who Wilds or improve Merton,and.
who contracts for such projects with a contractor(s)liceued paramount to the contractors
Licence Law.
❑I am"main under See ,B k PC for this wan
Owner Data
WORKERS COMPENSAnON DECLARATION
I hereby affirm under penalty of Perjury,one of de,follaranq dechoutimu
thaw anddc far
ore 37M ofCe Latermlde,farforWorkersCampers-
mtiw,"provided far by Section 3]00 of she Labor Cade,far Ne peRormance of de
wA for which Nu permit is issued.
1 haw and will maintain Workers Compemetion Insurance,as emanated by Section
D00 of Ne Lubar Code,for Ne peRarroance of the work for which this pmorit is Issued.
MYW ens Com`pe,�,don lnsunnCo artier and Policy number art:
time fd4 a, A k Policy Na.:C 7Ax36 03 !3/0
ERTIFICATE OF EXEMMON FROM WORKERS
COMPENSATION INSURANCE
(This section need MI W completed if the Morris is for.hundred doBaa(SIM)
or 1.)
I certify does in the Perforrearace of doc work for which this permil is laved.I mail nos
employ any person in any mmarm as In become subject to the Workers'Compensation
Laws of California.Dae
APPlicmt
NOME TO APPLICANT:If,after making this Certificate of Exemption,you should
become subjm to the Wcokers Compessatian provisions of the Labor Code.you mea
.,O ftoMwith Comply with such provisions or this permit shall W deemed revalued.
'Z i CONSTRUCTION LENDING AGENCY
(rr Thereby affirm does Vert un.consuvction leadin a for Ne
C> the work ran whim Mia t anry pmrarm„n¢ar
U3 Q Lender's Name
pennis u issued(Sec.J09'1,Civ.C.)
Landers Add.
U0 I Certify Nat 1 haw mad this application and auto dw the eWw i fonmadan Is
D. f COMM 1 agree a comply wish all city and cowry ordinances and state laws relating In
O V building convection,and hemby auhome mpmmmat,Ca of this city to enur upon tW
purrases
L[1
move-mentioned property far epcNon whichm-
CL (We)arae to save,indemnify and keep harmless the City of Cupertino againo
h Iiabilitiu,judgmcrs,cast and expcnsu which may in any way scree agaiw aid City
U z in comequene f Ne Conti of e
.. SOULICA NDE D WIL OM WI Al- NOY--POINT Issued by: Date
`�Z/a
Re-roofs
HAZARDOUS
S,gnesrt uof AppliaData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the o Cupertino
forum Wilding e,Chapter
sromorand the
hanNans material
u defined io Ne Cupertino Municipal Code,Chapter 9.12,and de H,a1N and Safety
Code,Semon 25532(")?
❑re VN6/ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant future Wilding occt sot ume u, If a roof is installed without first obtainingan inspection,I agree to remove
PP g c equipment or devise which P g
emir handout air contaminants ss defined by Nc Bay Arm Air Quality Management all new materials for inspection.
D WiCO
❑Ya gi,tf
I he-mad the harardan emoodds mboca ens under Chapter 6.95 of the Califar-
niafkalNkSarctyCodc.Secdom25%5.25533md2553.lumkraandthmifNe Wilding
does net cure tIY h]]]�]�]�]w a e a t Na II u y mspo 'M1ilitj m nodl'Y the occupant of doe
equlRmenLr W a W Rle(/rl of lam' CYpa�
Signature of Applicant Date
owner ar iumaraed resent r D,te All roof coverings to be Class "B"or better
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32617041 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . : 34669
REFERENCE ID # . . . : 06060017
SITE ADDRESS . . . . . : 22145 ORCHARD CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RAY SCHEUERLEIN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : GERALD UNRUH LIC # 24643
COMPANY . . . . . . . . . . : ABC COOLING & HEATING
ADDRESS . . . . . . . . . . : 31845 HAYMAN ST.
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510) 471-8181
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 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 176 . 74 0 . 00 176 . 74 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---- - ------------ ------------ ------------------
OTHER 176 . 74 VISA
TOTAL RECEIPT 176 . 74
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
�UPERTINO
Building De artment
JOBADDRESS: oZAly5 O� PERMIT#
OWNER'S NAME: PHONE # 51
GENERAL CONTRACTO • FAX#
I am not using any subcontractors:
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
L zo6
Owner/Contractor Signature Date
-� CITY OF CUPERTINO
I'«�'' FURNACE/AC
_...
CITY PERMIT APPLICATION FORM
APN # ?j 2 i —Il— 641, Date: G�y/r3 G
Building Address: O B
Za-�-
Owner's Name: Phone#:
Contractor: hone: License#:
5/0 `f7/ —tT/ rr-/ '2383
Contact: Phone: amv Cupertino Business License#:
9zC6 'yc3
Building Permit Info:
Bldg ❑ Elect T!fN Plumb-[2� Mech 197
Job escripti n: /�
�.4 Qex /OD _ Q��On A-`c / Ton + ,�6a4p
Residential Commercial ❑
Fores'dentialInstallations:
Attic I s` 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 ❑.
Cost of Project: Type of Construction: Occupancy group:
`IS3 z
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location Ig Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
i BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
1 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
I PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
1' BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING