06060208 CITY OFCUPERTINO
BUILDING DIVISION PERMIT
gONTRAC'
:TQRa NFORMATION ��
a.h +cs,'+.`
BUILDING ADDRESS: , ANDERSON RADIANT HEATING PERMIT NOD6060208
22436 RANCHO DEEP CLIFF DR
ERS NAME: PERMIT ISSUE DATE
FINN RITA A TRUSTEE 116 DILL
PHONE:
SANITARY NO. CONTROL NO.
(408) 378-3868
ARCHITECT(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
upQ LICENSED CONTRACOWS DECLARATION lob Description
i u C 1 Mrcby affirm 0u 1 am licensed under provisions of Chapter 9(commencing P
R!
Wit Section 90(10)of Division 3 Oldie Business and Profession Code.and my licence is
,�N inmRmmeandeffcctr y LKa �I 7�8 REPLACE EXISTING BOILER
' W Ltecnx 1 s '7/
in
DECLARATION ilea
7 Dau �- Conuxour P 'p{ tr' \�\
6 U I uMcrstanJ my Plars,hall he used u public records �'J t' It p7
gay Licensed Professional �` Y� {L`LSi+t'✓
5 OWNER-BUILDER DECLARATION
ii E I hcmhy affirm tot I em exempt from tint Contractor's License Law for the JI 11 1)_ 2006
M o following mann.(Section 71131.3,Business and Professions Code:Any city or county L I)
$ which rcquims a Permit m conamct,a@n improve,dcmnlish,Or repair any suucturt 88800
prior on its isuaxe.alzu rtquirnce applicant forsueh permiltofile asigned statement Naa{fy� a,
E that Ice is licensed pursuant to one provisions of do ComenclmY License law(Chapter 9 Sq.Ft. Floor Area FI (L �kp
a; (eommeruingwit See'ion7W0)nf Divuion3ofte Businesaand Pmfmsions CWc)ur [jt trj�J��kt71
that he u e,empt therefrom and the basis for the alleged exemption My violation of
Section 7031.3 by any applicant for a permit subjects the applicant in a civil penalty of -5-ATN4*"or0 U Occupancy Type
not more tan five hundred dollars($SM.
01,moweroftheprogeny,ormyemploycvwitw rsutheirantemmpevedon,
and docewons Codes he Contun.ltunded,Lawn fa hot apply us an Builxas Required Inspections
and enywhProffescbis Cnor:The improves
.o.and he IoW does nnl apply b an Owner is q P
progenywhobuilds i improveschicon.andwho arcssuchwork himselfedthrough his
own a however,
the W iprovided Net such impmsemw t art net oundea impled ea fvsale.IL
however,the buildingorimprowmhot'sold whinone year o I., pordepwvr-
builder will have the burden of proving cu he did wt brdW ar improve fur purpose of
0 1,as owner of the property am ucluiwly contracting wish licensed contractors to
cmmmct the project(Sec.7044.Business and Profusion Code:)The Cootractols U.
cove law docs not apply in an owner of property who builds or impmwrs cemon.and
who contracts for such projects with a comae er(s)licensed pursuant in the Contractor's
License law.
0 l am exempt under See ,B&P C for this rtuon
Date
WORKER'S COMPENSATION DECLARATION
I hereby afrrm under penalty of perjury one of the following dMarations:
0 1 hive aM will maintain a Cenirinu of Covent u self.iasum far Worker'sCmnpcm
salon,as provided for by Secdon 37M of the Labor Code.for the peRormana of she
work for which this permit is issued.
1 have and will maintain Workce&Compensation Ivcti
uranec,u mquimd by Section
op
duelL�a��bor Cade,for dm performance claim work for which this permit is issued.
MyWm
r and Policy
Canier.H�((J1'0.�C atr/UN cemc Policy No.:nu 1a`�RDoo-,z .
CEIMFTCATE OF EXEMPTION FROM!WORKERS'
COMPENSATION INSURANCE
(ruxcti.n aced..'M completed lite p.it 4 foronc hu.dmdelollan(SIM)
or less)
I cenify,that in dm performau:c of tc work for which this Permit is issued.I shall not
employ any person in any manner an as m become subject In tc Workers'Compenation
Law s of Califomia.Dau
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject in the Worker's Compevati.n provision of the labor Code,you most
.J O foMwish comply with such provision or cu permit"I lx m
deeed ranked.
Z h CONSTRUCTION LENDING AGENCY
1-+ Ibuchy alarmdid dnrtuacovtroctinn lending agency for tor, darmarusof
CYi > she work for which this permit is issued(Seth.3097,Civ.C.)
aUnderf Name
Z lender's Address
V Q I certify dal I have mad this application said sate cu the show informadun is
f+.H correct.I agree to comply with all city and county ordinances and sum laws mla'ing to
0U building conesuclion.and hereby a.thorim aprexnutiva of this city to enter upon use
r 6i shove-mcmiomed gmeno.cny for espauon purposes
(We)agree to sec,indemnify and keep harmless tine City of Cupertino again,
.F".iZ incoitiu,juag ofh.cosyand expenseswhich may in anyway eccmc agains4 said City
V zs Permit.
APPLLIIC NTcUNDERSTANDS Ashe granding of IND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE BMWs..
Jl amo � , � 60 26 66 Re-roofs
Sitnazurt of pplrtaHAAZARDOUS MA ALS DISCLOSURE Dau Type of Roof
Will de applicant or future building occupant stow or handle harndous material
as defined by the Cupertino,Municipal Code.Chapter 9.12,and ftRea s,and Safety
Section 256320)I All roofs shall be inspected prior to any roofing material being installed.
D Yea V.
Will the applican,or future building occupant use cyhipmout in devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haraNnus air conumivLna�u��dermad by the Bay Arta Air Quality Management all new materials for inspection.
DisuiaO 61D�d
Yes
I have mal do hsraramrsmaurisls rtquimmcns umkr CTapu,6.9s ads Califon
ria Healed:SafefyCode,Sectiav2a5U5.2333J and 23574.1 unJcrsund thaziflM Wilding
does no,currently haw a tenant der it u my respchadolity m notify she occupant of the
mtiuimrecn whichmuabcmclpn�htis.an«.faccMicas,of Signature of Applicant Date
n� ( !Owner of authorized agent All roof coverings to be Class "B"or better
are
CITY OF CUPERTINO
Zt. 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35602053.00
DATE ISSUED. . . . . . . : 06/26/2006
RECEIPT #. . . . . . . . . : 35009
REFERENCE ID # . . . : 06060208
SITE ADDRESS . . . . . : 22436 RANCHO DEEP CLIFF DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FINN RITA A TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM :. . . : GLENDON WAGNER
CONTRACTOR . . . . . . . : GLEN WAGNER LIC #23141
COMPANY . . . . . . . . . . : ANDERSON RADIANT HEATING
ADDRESS . . . . . . . . . . : 116 DILLON AVE.
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
• TELEPHONE . . . . . . . . : (408) 378-3868
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BSEISMICRE VALUATION 8,800.00 0.90 0.00 0.90 '0.00
BBOILER2 NO OF BOILER 1.00 26.19 0.00 26.19 _ 0. 00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
ELECTRIC SQUARE FEET 1.00 0.08 0.00 0.08 0. 00
MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 243.77 0.00 243.77 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ _____-_---_------_
OTHER 243.77 MASTERCARD
TOTAL RECEIPT 243.77
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
•
CITY OF CUPERTINO
Ou o�O a 05
bTYOF PERMIT APPLICATION FORM
•CUPEkTINO
APN# 3—�> _ Oa _ O53 Date: ` 0
Building Address• ^•7 Mailing Address (if different from building address):
GZy 3 /24,&t) AID
Owner's Name: Phone #:
Zia-
LicenContractor: se #:kap y7G�/ 7/`J
J
Contact: /P� / , Phone: 1168 59.2 G3y Cupertino Business License#:
q ne✓' Fax: q0k 5 —0k1 a?3Or
Building Permit Info: 1 /
Bldg ❑ Elect Cr Plumb C�r Mech CIX
Job Description: ` �Er11 �!5'(trL�
Residential C� NFi� bWLEg— r (/NC61 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: p 'CIO Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: El
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
/ BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elee 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
(� CITY OF CUPERTINO "
CITY'OF PERMIT APPLICATION FORM '
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
M
HOOD Installation of Hood MECHANICAL
MISC Misc Apparatus ELECTRICAL
RAPP Rem Non-Res A liance ELECTRICAL
OLE Pole/Platform Fixture ELECTRICAL
OWER Power Device/A aratus ELECTRICAL
ECEPT Rc tl, Switch & Outlets ELECTRICAL
LOCA Relocation of Hood MECHANICAL
EPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
Cha CITY OF CUPERTINO
cTM°r PERMIT APPLICATION FORM
CUPEI'TINO
IIVU—a—ptity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
3of3