06120033 f188
OF CUPERTINOa ~me: - »>-+f
UILDING DIVISION PERMIT GLINTRACTOR INFOaRMATION
G ADDRESS: AAA FURNACE & AIR CONDITI fffgU'06120033
S NAME: PERMIT ISSUE DATE .
1712 STONE
NE:
SANITARY NO. COKMOL NO.
(408) 293-4717
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oo LICENSED CONTRACTOR'S DECLARATION - Job Description
m❑ I lamby affirm that I am liconscd under provisions of Chapter 9(commencing
;Z, with Section 70(K))afDivision 3 ofthe Business and Profcssimes Code•and my license is
inmBfarteam REPLACE WALL HEATER
ZLicenac Clazs� 9 6 Lie.A
t.,o Dale i Conuasnr
ARCHITECTS DEC O r
i e< 1 understand my plans shall W used az Public rtcorha
ids
°QLicensed Professional
Oat I am comp,fes m DECLARATION
I hcmM1y alum Not 1 1. exempt from tM Contractor's License law for the
no following mason.(Seton 703 LS,Business and improve.
coons Calc:Any city m county
3_ which requites a permit to cottsWCL alw,improve.demolish.or repair any swmurt $1450
-Zi prior to its issuance.also requires the applicant for such permit to file a sigud statement
< that W is licensed punctual to tW previsions of the Contractor's Limmum Law(Chapter 9 Sq.Ft.Floor Area Valuation
I (commencing wish section 7000)of Division 3 or on,Business and Professions Cedc)or
at he u exempt taomfarto and the basis for the alleged assumption.Any violation of
Section 7031.5 by airy applicant for a permit subjects she applicant to a civil penalty of r Occupancy Type
not mom than five hundred dollars(5500).
❑I,azowner of Ne pmpeny,mmy wpiayces wish wagesuthe'v sok compensation,
and Profession
Cosh: sh Ow lasolNOndedar AW them
f WL apply. all weer or Required Inspections
propeand Professions Cade:The Contranofs cad who law tea rot apply m an owner of q P
mane ywhobisipro orireproverthereon,and who doessuch work himselfor through his
owns cat,.me Wilding or
improvalreachement
improvementsI.soldiinnot earofdaroRered for sale,.
build., Ne have
tike ar impmvemving that
he ditd one year of muspkuon,do,purpose
of
builder will have the burden of preying Nat he did nm build or improve for puryose of
sale.).
❑1,u owner of the property,am exclwively contrl with licensed contrazta s to
consumer the prejcm(Sec.7064,Business and Professions Cade:)Tae Conumme is LI-
eve law does not apply as an owner of property who Wilds or improvra thereon,and.
who contracts for such projects with a contractor(s)li¢nzd pursuant to she Contrumfs
License law.
❑1 am exempw.der See ,B&P C lar this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby anion under Penalty of perjury one of the following declarations:
I have and will maintain a Catitiu
ficase of Consent self-insum fm Workers Comport.
ashler,as provided for by Section 3700 of tM labor Cade•far to No....of the
woh for which on,permit is word.
❑1 have and will usaimain Wmkare Compensation insurance,as taquired by Section t
37W of the labor Code.for the performance of Uc work for which this permit is hatted.
My Workers•C[o�m,.auan lnsuun.coria end Policy number am: f/
Carica. s1 Tq'/[. ✓t1 >/ Policy No:f 4 7jS"G(L�_
C RE�n CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(tbu scrim need rat W completed if the permit is frees.hundred dollars(SIM)
or less.)
I cenify Ihet in the performance of the work for which this permit is'usad.I shall not
employ any person in any maturer an as to become subject to UC Workco'Compensadon
Laws of California.Date
Applicant
NOnCE TO APPLICANT:If,afmr making this Certificate of Exemption,you should
become subject to the Woll eh Compensation provisions of the labor Code.you must
.Jz forthwith comply with such provisions or this permit shall W accused revoked.
z O CONSTRUCTION LENDING AGENCY
I-•t I Wmby an.tha ft.is.cotutrvctime lending agency for the pmfomana of
6i the work for which this permit is issued(Sec.3097,Civ.C.)
W� Q Landeh Name
z Landers Address
U O 1 cenify that 1 have read this application and state than ft W.information is
lL coram.1 agree to comply with all city and county ordinances and state laws relating to
rJ U building comWction.and hertbyaathonae ep,euntafves of Nice city,.cmc,upnnthe
above mentioned p.,,Iy for inspcmlon purposes.
Fr-h y (We).,me res save,indemnify and hap harmless the City of Cupertino against
V1 lnailiues.judgments.cosu and expmnct which may in any way.eclat against said City
U,z in consequence,of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOU CE REGUyATIONS.
y/l, vya a G 7� UG
Sifnauhaor' 'NC tractor Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applipntar forum Wilding occupam tem as handle harallous roomful
az defined by tic Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
tat.0 an 25532(a)± 1— All roofs shall be inspected prior to any roofing material being installed.
Yes No
41 Will tic applican or future building.,.,use equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardous all cmtamim nu az defined by the Bay Area Ail Quality Management all new materials for inspection.
Disuiclt
❑Yes �No
I have mad the hmard,us maknals unromncros underChapmr 6.95 ofthe Cdifor-
niaHcol"Salary Code.Sccuons 25505.25533 and 25534.1 arderstand Uwifte Wilding
does rat cons"'Y have a tenant Nat it u my responsibility to tcufy uta eauPmr of the
tcqu' menu which mmt be met poor m issuance ofa Ccmfwam of open Signature Of Applicant Date
0d All roof coverings to be Class "B"or better
Owner tar aumorisd t re coverag Date
Community Development
10300 Tone Avenue
t Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4§UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/Opd' f- Db'/Z ao3 3
OWNER'S NAME: - PHONE # P 219�
GENERAL CONTRACTOR- FAX #
I am not using any subcontractors:
Signature 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
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37516034 .00
DATE ISSUED. . . . . . . : 12/11/2006
RECEIPT #. . . . . . . . . : 36997
REFERENCE ID # . . . : 06120033
SITE ADDRESS . . . . . : 18815 TILSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
OE 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 1,450.00 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
•
- � CITY OF CUPERTINO
FURNACE/AC
�UPERTINO PERMIT APPLICATION FORM
APN # � // � Date:
Building Address:
LSD�t/ oZ"/V rE
Owner's Name: Phone#:
/,��u rn � ti 73- F.? Y
Contractor: Phone: License#:
Do ," or< < ofd
Contact: Phone: Cupertino Business License#:
0P,9
Building Permit Info:
Bldg ❑ Elect 8' Plumb E? Mech
Job Description:
e- Gfc/ zx,
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor � 2"d floor❑
Adhere to min set back requirement❑
or Commercial Installations:
eplacement same weight ❑ Additional weight(structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
Strapped ❑ On Platform ❑ Bonded fff Sq. t. loor Area:
New Location ❑ Rep lacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy 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
BSEISMICOM Seismic Commercial BUILIDNG
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
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING