06060087 CIT`.COFCUPERTINO
BUILDING DIVISION PERMIT -ONFORMATIO
BUILDING ADDRESS: SUPREME AIR SYSTEMS PERMIT NO.06060087
10999 RONALD WY
OWNER'S NAME: PERMIT ISSUE DATE
NEWHALL 80 GILMAN AVE 1 06/12/2006
NE: SANITARY NO. CONTROL NO.
(408) 376-0406
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
pQ LICENSED CONTRACTOR'S DECLARATION
asF 1 hereby affirm that I am licensed under provisions o(Chapur 9(commencing lob Description
�2`uf with Secdon 7")af Division Softhc Busmen and Prof.. rar1t�cn.cis
i's- infullromeandeffect O / REMOVE AND INSTALL NEW FURNACE/AC
z weensp Clggvss Lk.a
q Dam//li AConmacmr
:EW '�� ARCHIfECTSDECLARATION fVJr&% SUPREMEM AIR SYSTEMS RENEWED BL 6/12/06
I understand my plans shall be used as public records
ae U
•G Licensed Pnsfessional
OWNERBUILDER DECLARATION
in I
I I hereby aRrm Nat I am eonp,from the Conuactors Uccnm Law for the
O O following mason.(Secdon 11131.5,Business and ProfessionsCo&:Any city or county
E which requires a permit to construct.ams,improve,demolish.or repair say swcture
prior m in issuance.alw rtquu=the applicant for such permit to file a signed staenem
that he is licensed pumbam to the provisions of the Conuactar's Ucenac Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commmcing with Secdon71)(M)of Division 3 of the Businessand Professions Cott)or $'9870
.. that he is exempt thmmfrom and the basis for the alleged esempdan My vmladnn of
Section 7031.5 by arty applicant fora permit subjccu the applicant in a civil penalty of APN Number Occupancy Type
no,mom than five hundred dolt.(5500).
❑1,uownerof Nep pmy,amyemployeeswith=a utcumlccanpoasadon, D
will&mewark.and theawmure ls notmmndadororzema mraele(sec.7aa,Badne<• rte {]
and Professions Code The Conuecmry Licoue Law dao Out apply m an owner of Requi
im $� g ta10�nSp IryiRs
property who buildsarpmvu Nnon
o ,and whodoessuchwork tonsillar through his Spar ag
own employee,provided that such improsemenm are rut intended or offered for.sale.If.
howo ,We building or improvement u sold within one year ofcompletion,dmmvnor- ¢
builder will have,W burden of proving door he did not Wild or improve Zy�for purpose of JUL 9006
.nkJ. - J L tt
❑1.as owner of the property,am excludvoly comraning with liceraed conmanors te y
construct the project apply
n an Business and property
who Wi Code:)The Conbacmr's Lid p��as'Qs {[Ik e
carts Law docs not apply m an owner of propenY who W ills or impnves thereon.and. ([ll �J�t I'r\\��prljt
who comraw.for such pnjecta with a conuactar(s)licensed Pursuant m Ne Conmatemes 111111
License Law.
❑ tom exempt under sec. .8 8 P C for this reamn
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby all under penalty of perjury one of the following deciamtions:
I hart and w;R maintain 0 cordReate of Co..,to seK-in.are for woarera Campoo-
saion,as provided for by Section 37M of the Labor Code.for Ne performance of the
work for which this permit is ismed.
❑I have and will maintain Warier.Compensation Insunna,u,eyvined by section
3700 orthe Lubar Conan,for Ne performance ofthe work for which this permit is issued. '
My Warks`C•o�npenaalon tnuranec czmcr ium Pali,ri bor
Carrier.
CERTIFICATE_Y —1_ yst,Policy OFrE TION FROM WORKERS'
COMPENSATION INSURANCE ,
(Tia socialist need not W carpkcd tribe permit Is forces,hundred&pan($100)
or Ices.)
1 comfy the,in the performance of the work for which this permit is issued.I shall nes
employ any person in any manner but as in become subject to the Workers'Compcasomet
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject m the Workers Compensation pmvWons of the Labor Cade.you most
.J z forthwith comply with such pmvuiou or this pamt shall be deemed revoked.
'ZO CONSTRUCTION LENDING AGENCY
't•a� 1 herchy alRrm that them is a construction lending agency for the Performance of
!Yi
We wurk for which this permit is issued(See 3W7,Civ.C)
1 Q Underi Name
D z Lender Address
V C) I certify that 1 have mad this application and state that dre show information is
I, coned 1 agree in comply with all city and county oNinames and sum laws relating to
O V building construction,and herebyamborine rtpmsematives or this city Oriente,upon the
0. aMavonenudgin pno,pertya.lon for inspection purpwhicses.
(Ws,)agree to save,indemnify and keep harmless the City of Cupcnino against
f^+h Iiaconsequnce of thecosuandofpcnsu which may inany way attruc agaimtsaiOGrp
U z A consequence of the UNDERSTANDS
of this D WI
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
s�SouRRE�gEGu�y Re-roofs
ntureo pp//lion on—tor Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliem Or future Wilding accupantstme or Ioondle haaandous named
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Hoath and Safety
code,Section zss32(.)7
Ye u All roofs shall be inspected prior to any roofing material being installed.
41 �
Wilt the applicant 04".Wilding acupant use equipment ar device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdous air corm rmann as defined by the Bay Area Air Quality Management all new materials for inspection.
Diarict7
❑Yes IN.
I have read the haaardens materials requirements under Chi pmrb.95 of do Califar-
meHcalthkSidoVCade,Seen.25505,25533 and 255M.1 understand daifthc building
does rut curcnty ham a csum,Na,it is my resN.ihiii.y an notify,the,cup.(or the
mquirsmcn w ' mtpriorto issuance ora Canifmamoracapawy.ag, Signature of Applicant Date
Owns rautha ascot Dam All roof coverings to be Class "B"or better
Community Development
�.'. 10300 Torre Avenue
, [ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
gVUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/o9q
1Z. A-o 6 60 Edd �7
OWNER'SNAME: PIAN PHONE #
GENERAL CONTRACTOR: 5 erS FAX #
I am not using any subcontractors: toI2 p
t e ate
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
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35618009 . 00
DATE ISSUED. . . . . . . : 06/12/2006
RECEIPT # . . . . . . . . . : 34799
REFERENCE ID # • . : 06060087
SITE ADDRESS . . . . . : 10999 RONALD WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NEWHALL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : SUPREME AIR SYSTEMS
CONTRACTOR . . . . . . . : ALLEN SENNERT LIC # 21614
COMPANY SUPREME AIR SYSTEMS
ADDRESS . . . . . . . . . . : 80 GILMAN AVE, #1
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 376-0406
�EE 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
BSEISMICRE VALUATION 10 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 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 280 . 54 0 . 00 280 . 54 0 . 00
METHOD OF PAYMENT AMOUNT. NUMBER
----------------- ------------ ------------------
CHECK 280 . 54 2464
TOTAL RECEIPT 280 . 54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO
FURNACE/AC
*CUPCITY of
ERTINO PERMIT APPLICATION FORM
APN # fj n Date:
i
Building Address:
►og99 RoaQw I,t)n
Owner's Name: Phone #:
NE IIa�� yob -51 �- 0155
Contractor: License #:
SUPezme 2 S 4emr. 7gD(ao7
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description: �rY)atce Gin
MpJ EIC 6 nllr S 5 M AN INST4t t NEw 5 Sly
Residential Commercial ❑
For Residential Installations:
Attic C1I" floor 2"d 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- -usType of Constttion: Occupancy roup:
9 87D .
Strapped 6 On Platform El Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement 16
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of 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