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06030180CITY OF CUPERTINO R BUILDING DIVISION PERMIT �hCONTRACTQR INFORMATION<. BUILDING ADDRESS: O 22406 RANCHO VENTURA ST R'S NAME: PERMIT ISSUE DATE WEBSTER DAVID A 1712 STONE; AVE 03/31/2006 PHONE: SANITARY NO. CONTROL N0. (408)293-4717 ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECN M o l� 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Job D O with Section 7")of Division 3 ofNc Business and Pmressions Code. and my liccnm is Lroll farce and c fig . full f REPLACE 60, 000 BTU F ��® L Cloy s Lie. tl Contractor- h j2 ARCHITECTS DECLAR ON I understand my shall W used as mcords �� /� APR iy a/aUU plans public e_ LY 6 Licensed Pmfewioml OatNE. DECLARATION exempt from License law for lbe 1 thereby a0im that 11. exempt from Ne Conlon Cos following ream.. (Scion 7o Business and cssiom Calc: Any city or county 2000 str which myusa • Temno m construct. almc it see. dcermitt or repair twaurt forst ed prior m its issuance, also nt to she Nc applicant for such permit w eo a signed statement the liconsedpursuantmNcprevisionsofNcCanuinessandPrescLaw (Chaper9 Sq. Ft. Floor Area alua[ion (commencingPrefra comma n Section n Division n 3 of NC vi Cale) or exempth a and the egad! c umPt ' Nat he is exempt Nae(rom and de bash (or the alleged! caempuon. My violatim of too he y um er Occupancy Type Section 7031.5 by any applicant far a permit subjects the applicant to a civil penally of not more Nan five hundred dollars (S500). ❑ I. as corer of the property, or my employees with wage ax their able compcnssom, Required Inspections will do the work, end Jeswcmre isnot intended or afferent for age (Sec. 7044, Business and Pmfeasioru Code: The Comacmfs License law dila mat apply m an owof ener q P property who builds or improves thereon. and who docs such wok himself or through his awn employ=. provided Natsuch improvements see not intended mattered forsala It. however. the building or improvement is sold within oro year of completion, the owner builder will have the burden of proving Nat he did not Wild or improve, for purpoae of sale.). EI 1, as owner of the property. am exclusively contracting with licensed contrvctors to construct the pmjet (Sec. 7044, Business and Professions Code:) The Centracten's Li - come law docs not apply to an owner or property who Wilds or improve d¢mon, and. " who convects for such projects with a conuacmr(s) licensed purswm m the Contractor's License. law. ❑ I am exempt under Sec. B &P C for this mason r Data WORKER'S COMPENSATION DECLARATION I hercbj affect under peualty of perjury me of the following declarations: ❑ 1 have and will maintain a Certificate of Comenuoself-insure for Worker'sCanpen. swan, as provided fm by Section 3700 of the Latter Cade, far the performable of the work for which this permit is issued. s ❑ 1 have and will maintain Workers Compensation frommus. m required by Section 3700of the labor Code for the performance of the wants for which this permit is issued. My Worker's carrier and Policy number are: ACompensationhasunnec Cartier: Policy No.:'7WORKERSCt�GOFerKEMP ION FROM'i COMPENSATION INSURANCE (rhis seaicat reed not becomplemd if the permit is foram hundred dollars (SIM) or It..) I airy that in she performance of the work for which this Permit is issued. l shall not employ any person in any manner an an, m become subject o the Workers' Compensation Laws of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Cenilicam of Exemption, you should become subject to the Worker's Compensation provisions of tW Labor Code, you must forthwith comply with such previsions or this Permit shall W deemed nrvokeJ. CONSTRUCTION LENDING AGENCY 1 bereby aflirm that Nese is a construction lending agency, far the perfor mn¢ of Ne weak for which this permit is issued (Sec. 3097, Ci, C.) Lender's Name Leader's Address I certify Nn 1 have red this application and state that the above information ix correct. I agree to comply with all city and county entrances and state laws relating to Wilding construction, and hereby authorim representatives of Nis city to enter upon tha oned for inspection purposes. above-mejudgm projudgments. (We) agree to save, indemnify and keep harmmm Ne City of Cupenimo against greeny, grantand costs easai may in anY vv'aY accrue against said City s4to�l incoiscalue m consequence of the gaming of Nis D Knott. of this APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU EREGULATIONS. — Re -roofs ignmure of Applicanl/Conwcmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne, applicant or future building occupantstom or handle hasardous material defined by the Cupertino Municipal Code,. Chapter 9.12, and the Heahh and Safety e. Oban 25532(a)? , Ya All roofs shall be inspected prior to any roofing material being installed. will thea ream or fbture Wildin «c, rl PP If a roof is installed without first obtainingan inspection, I agree to remove P tu a Pt equipment or which emit harannus air contaminant as defined by Nc Bay Area Air Quality Manegcmcm all new materials for inspection. Dixuin? QYcs /[$\'No I have mad the two duSusultalcrialsreAuirement under Chapvs G95aflhc C�lifor- .i.R.IN6Safe,tyCode.Sttfi.25505.25533und25534.1undmawd Nmiflbe Wilding dons not currently hast a tenant, that it is my responsibility m notify Ne, occupant of the reett�.,�J9'�cru which newt W mcupriar m issuance art Ccdfeam of Occparry. Signature of Applicant Dale ��``)`""5� — iJ; All roof coverings to be Class "B" or better a�erora ner or uNomcJ agent pare cl>Y of �UPEkTINO r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # -7614-0 ✓UGLr 6Q OWNER'S NAME: o ><r.,�,/t PHONE # GENERAL CONTRACTOR: o U>Ke FAX # I am not using any subcontractors: ,,4,,� f� y, , 4) Signature ate Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating A Do�00A !1/7C 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 I* 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35703019.00 DATE ISSUED.......: 03/31/2006 RECEIPT #......... 33808 REFERENCE ID # ...: 06030180 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... 22406 RANCHO VENTURA ST CUPERTINO OPERATOR: amyw COPY # : 2 OWNER WEBSTER DAVID A ADDRESS ..........: CITY/STATE/ZIP ...: NASHVILLE TN, 37202-2131 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 BSEISMICRE VALUATION 2,000.00 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 ------------ OTHER 164.78 ------------------ VISA 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 • L CITY OF CUPERTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM ObU30100 APN #3�1 0� DI� J Date: Building Address: BREMFURN n C c W0 MECHANICAL Owner's Name: -b SN Phone #: —=W l/ 0/ - Contractor: License #: BREMRECEPT Rec tl, Switch & Outlets Contact: Cupertino Business License #: Seismic Fee Res BUILDING Building Permit Info: Elec Permit Issuance Bldg ❑ Elect e Plumb Mech Job Description: MECHANICAL -Fv a Plumbing Permit Issue Residential d:. Commercial ❑ BPERMFEE Bldg Permit Fees BUILDING For Residential Inst llations: ❑ Plan Check Fee Attic 1" floor 2"d floor ❑ BUSLIC dhere to min set back requirement ❑ BUILDING 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: �.C.0 U 2— Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement 2 - Qty. if Applicable Fee iD FPP TiPCPnn}tnr U-- ! BENERGY Energy 1 VV l Iuu BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin 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