06090216 CITY OF CUPERTINO sP
PERMIT 4raa,«tia'*.ar
BUILDINGDIVISION - kC�TsOo2>�R`I�>N5^"5'F*OR' MA�T�IO`N
BUILDING ADDRESS: FURNACE & AIR CONDITI 1�f11 0006090216
10317 SCENIC BLVD
OWNER'S NAME: PERMIT L4UE DATE
ilk SOF GOENAWAN 1712 STONE AVE ____09L22/2006
NE:
SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECf/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
lop LICENSED CONTRACTOR'S DECLARATION
N
wF 1 hffirm
crtby aal l am licensed under provisions o(Chapier 9(commencing Job Description
�Zwith Section 7") (Division 3 of the Business and Professions Code,and my license is
in full fartc and c t ,- ADD A/C
ElZ Liccnu Clas L'c,g
Vi t• Daw Commewr
iO4'
RCHITECTS DECLA 1 N
50< I uncantand my plans shall he used as public rccordu
U
C� LicemcJ PsufcsUonal
OWNER-BUILDERomorp, DECLARATION
c c I bmean .(Tien Nat I em exempt from the rmium; is I!AnyC Law for Nc
p0 following means. erittt 703 0,Busimss and Profcssiuns Cm lc:Any city orcounty $4300
d•
m which requires a permit re cnnswn.abca improve,h pcMiiI L or repair any udement p 4 3 O O
-mithither itsiensedpnnuntto the thovisios of for Commrmiuo Tilc aeLaw(uwmcnt
that ce lieenudpursuenutthctrovisitmufNcCaneumr'LLi.nx aw(Chat¢r9 Sq.Ft.Floor Area / Valuation
(commencing wish Section 700))of Division 3 of the Business and Professions Code)or
Nat M is exempt therefrom and the buss for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects Ne applicant in a civil Penalty of
Trot more Nan Rte hundred dollars(5500) eT O Occupancy Type
Tro
Lothe woul.Ne pro pcsy,ormyemntende orNwagnudte'u sole70". usautn,
will dothework and ft The numunotintendedorawit (trek(Sec.]Ma,name,v
and rtfwssmM Code:The vesthe es.creme law acre not apply lf rt awmr of Required Inspections
property who builds or�d tat such
thereon,and who diessuch work himselforthrough his
own employees,p.vicad pr such improwmmts em,notear iffdoraRered haruse owner.
hander Nebuildingorimprowmennissold withinore year of completion,du:owmr
builder will have Ne burden of proving that he did not Wild or improve for purpose of
talc.).
❑h as owner of Ne property,am exclusively conuacting with licensed comments,to
consumer the Indica(Sec.]Odd.Buua
Business and Rmeesidm Cade:)The ConewLi-
c.. rLi-
c..law don ore apply wan ovmer of phmprry he builds or improms themon,and.
who canuacis for such projects with.eom.o s)B.nsed pursw the e Cdnuanors
License law.
❑ 1 am exempt under,Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hemby aRmt under penalty of perjury tm of Jw following dwlwadom:
Also,and will maintain a CeniEow of Comemto selDimum far Wmkcfa Cmnpen-
u ion,u provided for by Sectitn 3100 of Ne[abm Code,far the pchfdnnm.of Ne
Worse far which Nu permit is issued.
have and will maintain Worker's CompmodMit Imuran.,as myuimd by Section
00"the labor Coca,far 0.'do...of the wok,for which Nu permit u issued. '
y Worker's Compnsnce
eation Insuracaeia ty num
and Policy art:
Co.
Na: WO .ERLia•.owl
C RTI COMPS EXEMPTION RAN ORKERS'
COMPENSATION INSURANCE
(mu smite rued mtbe completed if the Permit is far..hundred dollen ISM)
or less.)
I.nih shat in the perfa mance of the work for which this Permit is fated.I shall not
employ any person in any mansierm u to become subject to to Worker'Compensation
laws of Cslifamia.Due
Applicant
NOTICE TO APPLICANT:If,after making this Cenincaw of Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Code,you muss
0z forthwith comply with such provisions in this permit shall W deemed revoked.
ZM CONSTRUCTION LENDING AGENCY
F l thereby affirm that Nen is construction lending agency rot the Performance of
(Yi Nc work for which this permit is issued(Sec.3097,Civ.C.)
af+7 Leader's Name .
7 z Lenders Add=
U0 I certify Nat 1 have read this application and suite Nu Ne throw information is
ly torten.I agree to comply with all city and county ordinances and suite laws relating in
OU building construction,and hereby authorise representatives of this city to enter upon the
�0. above mentioned ProPcstrLy for i expenses
which may
(We)agree to saw,indemnify and keep harmless the City or Cupenino against
rZ in
of the groaning
or this permit. may inmyway eccmc against said City
t„),'Z A APPLICANT
of UNDERSTANDS
A permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
"'
GL 10N5.
J2'8 •
— Re-roofs
SignuincofApph_
1tiNARD015 MATERIALS DISCLOSURE Dow Type of Roof -
Will the applicantor future building occupant orhandlehaaamommamrial
as dcrined by the Cupertino Municipal Code.Chapter 9.12,and the HcaIN and Safety
CoJc,S0on o 25532(1)? All roofs shall be inspected prior to any roofing material being installed.
Y
Win the appl;cam car arumo building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hi.Mous it conumimmis as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑YesNu
I have mail the hvam mawriala requireixm underchapter&95ofthe Califor-
niaHwldt&SafcsyCodc,Scanner 25505,25533 and 255W.l undcrsund Nuir the handing
n rerrentl
dot currently have a wean Out it u my responsibility w notify the occupant of the
requitemems which mare be=1 poorm issuance of a cerdrieaw or oecurrancy. Signature of Applicant Date
ow rmr m ;.eJase DateAll roof coverings to be Class "B"or better
CITY OF CUPERTINO
!m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35702008 . 00
DATE ISSUED. . . . . . . : 09/22/2006
RECEIPT # . . . . . . . . . : 36167
REFERENCE ID # . . . : 06090216
SITE ADDRESS . . . . . : 10317 SCENIC BLVD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SOF GOENAWAN
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
---------- ------------- -- -- ------ ------- - - - - -- - - - - - -- - --------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 4 , 300 . 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 161 . 93 0 . 00 161 . 93 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
s Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
6UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
/01 /9 Sc i C /.� va/
OWNER'S NAME: S oE,v PHONE #
GENERAL CONTRACTOR: — FAX #
I am not using any subcontractors: a-> D 9- Z L 06
Signa e 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
Owner/Contractor Signature Date
CITY OF CUPERTINO 066�M L
]FURNACE/AC
• CUPEkTINO PERMIT APPLICATION FORM
APN# 35� Date:-b2 z4 �- z Z -e.?
Building Address:
D 3 7 iC
Owner's Name: Phone #:
D ENAw.oN df - 7� S=p f
Contractor: License #:
A i& 6
Contact: Cupertino Business License #:
G 7-W r 4 oSo
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech [ "
Job Description:
Residential ❑ Commercial ❑
For Residential Ing tions:
Attic ❑ 1" 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: Type of Construction: Occupanc group:
aa.,za VN
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
A licable Fee ID Fee Description Fee Group
I BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfrn MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
1 EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
_ - gj
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING