08050135)E
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CITY OF CUPERTINO:�*z
BUILDING DIVISION PERMITCONT"A3TORINFORMATION
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BUILDN D FSS:
�(g"fl SCOFIELD DR
AAA FURNACE & AIR
PERMIT NO.
08050135
NER'S NAME:
PERMIT SUE DATE
JARRETT FRANK L AND MARION A T
1712 STONE AVE
05/16/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
RE -PLACE SINGLE WALL FURNAC
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
p
1 hereby affirm that 1 am IiamM under provisions of Chapter 9 (commercial
with Section 70(M of Division 7 of site Business and Professiem Code. AM my license is
in fall force>n (tt a
LIcrnrC Clan— `J Lm.
.
Date Conu atter
AR Hr1EC1'S DEC R O
1 undersand my plans Mall he umM As public reaMs
Licensed Profcsom.1
OWNER -BUILDER DECLARATION
I hmby affirm that I am exempt from th Conuatar'a License Law for use
following mssoa. (Sttuon 7(ni.5. Business and Professions Cale: Any city or tote..
which acquires a permit to consauc4 alter. Wpum,e, demolish. or repair any slromme
pis« m its lssu Ara. Alia ¢quires theapplicant Im's ch permit In file. sigaW aatemenl
M A licensed Ne of ten Conlrscar's Lee= Law Chip= 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(commencing with Section 7000) of Division 3 orthe Business and Profuseness Code) «
that he is exempt therefore and the basis for th a1kgM emulator. My violation of
APN Number
Occupancy Type
PanC Y YP
Section 70313 by any applicant for a permit subjects the apPikmt In a civil penury of
nmdoes re fihundred dollars (6505).
«ere
❑ I,aawnrc of tle pmperty.«mY employees with mgmathe'vak campematon,
Required Inspections
will M thework Ana the carawder r«ak(Sts. tooN,masima
PM he Comminute,law dens trot Applyhiess m ro matter car
ns coca: The Gemstar'.
and when
MYWM andwha...ihw«k himself«though his
tut such imlrm emmm am not netted moRarM farme Wu U,
Ownsenywhobuilda«impromth itniu
awn employ.., progor
she building or improvement ts said within ors year completion, the owner.
i
Wilderhowmr.
r
haudea will n,ra the baNert or peeing that h airs fiat IwtiW «impram r« wma,<er
ale.).
El 1, As Owner of do property, are, exclusively contracting with licuued comet«, a
catsmn the project (Sec 700x, Bminm and Proressiem Code:) 71. Conmr.Ws U.
.
ce6m Law does not apply W an owner of Property who Wilds or Impram themed. and,
who eMmea for sweet projects with a eanuacubtfs) IIVJt2d penman to the Con amuses
Lit'. Law.
0 l un exempt under See , B B P C f« dus mason
Dam
WORKER'S COMPENSATION DECLARATION
I hereby &ffirm under pemiry, or perjury oro of the following dislanuom:
and will a Certificate of r« wartcfa Compnne
.. As far by are LaborCode.far
pmmahi far by Sttton neo or the lade«cone. kr the peAemana or rte
.boat, r
were for which this pmmit is issued.
'
❑ I have and will maintain Worke's Compensation Insurance, a ta7vired by Section
3700of the Lather Cods, for dm pedoerance of the wort f« which this permit u ivs«d.
'
My Work¢'. mpAmM.A 1. 'er AM Polley, number am:
`
Cartier: Policy No.:
C C F (EMMONFRO O
COMPENSATION INSURANCE
rTtusatim mea not k completed fifth permit is farm huffed do um;($1017)
or lea)
1 Qcuify that in the pwfomaace of the wort for which this permit is issued, 1 Mall trot
..play any perm. in my manner. As to become abjem to the WorserY Comperesadon
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate or Exemption, you Mould
baome subject An the Worsen'. Compcnsatien provisions of the Uah« Cone. you muss
forthwith comply with such provisions or this permit Mall be dmmM re Msec.
CONSTRUCTION LENDING AGENCY
I hemby.frrm this were is. construction IcMiag.genry far Ina perror an. of
the work far which tub permit u iumd (Sec. 7(197, Civ. C.)
Lender's Name
lender's Md.
I aniry that I hate read this application and su c that the me. information as
correct 1 agree In comply with All city and county ortlin•"^• AM sea laws missing a
Wilding convnrnima, ssW hereby Authorize represcntsum of this city as Onw upon tic
.averse property for impaction pury«es
(We) agree to are. Maturity and kap humku th City of Cupertino against
juanM
IiaconsequMeofthecam and of may in any war'.airs against aid City
in consequence of the granting of Nu permit
Our parall.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
�
Issued by: Date
SO CE REOULATI
Re -roofs
-
SIgIlimm terpp itan_ D
sillHAZARDUS
MATERIALS DISCLOSURE
Type of Roof
Will the applicant «future building occupat Ron, «handle namr tom material
u defined by t s Cupanlno Municipal Cade, CWPter 9.15. and the Health and Sakry
. [:Iyuss. 25531(.)7
❑Yes Ne
All roofs shall be inspected prior to any roofing material being installed.
5rn the. liant a fatten baaam emr
Ire g W nt use equipment or devica which
If a roof is installed without first obtainingan inspection, I agree to remove
Pe
aa-!' hlTus
ad .ir conumAs defined by ft Bay A. Air Quality M .... cmcnt
all new materials for inspection.
Dist❑Yes
/Jgy`'No
I hew read the h.aardws maurialsremOnaninuundcr Ch.pur6.95 of the Califes-
niaHolth&Safely Cak.ke m MM5,25533u 25534.lunderstsndlnssi(the building
does not currently fine a Amount. this it u my metastability to as ury the occupant of to
myyi¢mcnu which a= W mcl pier to ismms of A Cmr...0 of Declum
Signature of Applicant Date
All roof coverings to be Class 'W or better
Owner or atitr nnd agent' Dena
SNOW
aa
CITY OF
�UPEkTINO
E
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
CP SC GE
PERMIT #
C5,s�o SU ZAS
OWNER'S NAME: 41EC — e Q r i
PHONE # cLp 3 - /
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: • - S
Signa a D
Please check applicable subcontractors and complete the followin¢ information
Owner/ Contractor Signature Date
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
• 6 ITEMS OF 6
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CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN :'35910006.00
DATE ISSUED.......: 05/16/2008
RECEIPT #.........: BS000004797
REFERENCE ID # ...: 08050135
SITE ADDRESS .....: 20668 SCOFIELD DR
SUBDIVISION ....... '
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
224.85
---------------
224.85
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
OWNER ............:
JARRETT FRANK
L AND MARION A T
ADDRESS ..........:
20668 SCOFIELD
DR
CITY/STATE/ZIP
...:
CUPERTINO CA,
95014-2962
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
IBSEISMICR
----------
VALUATION 1,380.00
--------------------
0.50
0.00
----------
0.50
----------
0.00
lEPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1MPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
IMRRAA
UNITS
1.00
61.19
0.00
61.19
0.00
1PPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1TRAVDOC
FLAT RATE
1.00
40..79
0.00
40.79
0.00
TOTAL PERMIT
------'=-- ----------
224.85
----------
0.00
----------
224.85
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
224.85
---------------
224.85
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
CITY OF CUPERTINO
FURNACE/AC
OCaITYOF
UPERTINO PERMIT APPLICATION FORM
��D50/3
a
APN #
5 10 Mfx OD
Date:
D S -
Building Address: p
sce
Owner's Name:
Phone #:
c J- r -
Contractor:
Phone #:
C
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone
Y Z 6,
Fax #:
Building Permit Info:
Elect ❑ Plumb ElMech .R'
Residential Commercial ❑
Job Description:
e, Sip Jle- ICAC/ ��/q4c(z-
For Residential Installations:
Attic ❑ I I" floor 2"d floor ❑
Adhere to minimum setback 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 (Usage Class):
/3P,& 1;;�
Strapped On Platform LJ Bonded LJ New Location LJ Replacement
Valuation:
1 "Ma
Green Building: Must attach Green Building Check list to this application
�p1
CITY of
CUPEI�TINO
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Permit Type
Group
FURNACE
FURN/AC
1MCRAA
Commercial-Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1MCREPALT
Commercial for the repair of alt/add to
M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR
Commercial Install/Relocate ea
M
suspended heater,recessed wall.htr, or
floor mounted unit heater.
1PGASCOM
Commerical for ea gas piping System
P
1-4 outlets
1BPGAS
For each gas piping system of 5 or
P
more per outlet.
1MCAPPVNT
Commercial for the install/relocate/ or
M
replacement of ea appliance vent
installed & riot incl in an appliance
permit.
1BSEISMICO
Commercial Seismic
B
1MRRAA
Residential Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
IMRSUSHTR
Residential Install/Relocate ea
M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT
Residential for the install/relocate/ or
M
replacement of ea appliance vent
install & not incl in an appl permit.
0
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CI OF
CUPEI,TINO
CITY OF CUPERTINO
FURNACE/AC
FEESCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
FURNACE
FURN/AC
1PGASRES
Residential for ea gas piping system of
1-4 Outlets
P
1BPGAS
For each gas piping system of 5 or
more per outlet.
P
1BSEISMICR
Residential Seismic
B
1MECPLNCK
Mechanical Plan Check
M
1MFR=<100 7
Furnace Syst <=100k BTU install or
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
M
1MFRN>I00
Furnace Syst > 100k BTU install or
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
M
FEPERMITFEE
Electric Permit Fee
E
/
1MPERMTTFEE
Mechanical Permit Fee
M
1PPERMTTFEE
Plumbing Permit
P
1TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
0
CITY OF CUPERTINO
FURNACE/AC
CUPEr TINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
AIR
CONDITIONING
FURN/AC
1BCAIRHAN
Commercial A/C Units <= IOk CFM
B
IMCRAA
Commercial Mech Repair/alt/add
M
1BSEISMIC0
Seismic Commercial
B
1PGASCOM
Commerical for ea gas piping System
1-4 outlets
P
1PGASRES
Residential for ea gas piping system
of 1-4 Outlets
P
1BPGAS
For each gas piping system of 5 or
more per outlet. Comm/Resid
P
1BREMAIRHAN
Residential A/C units <= IOk CFM
B
INHUL A
Residential Mech Repair/alt/add
M
IBSEISMICR
Seismic Residential
B
1EPERM TFEE
Electric Permit
E
1MPERMITFEE
Mechanical Permit
M
I PPERMITFEE
Plumbing Permit
P
1TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
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0