03120021 CITY OF CUPERTINO ��^- '' Attq ,g -
BUILdINGDIVISION PERMIT CONTRA.C.TOR`INF,.ORMAT,.I,O�N,
BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO TMb "003120021
" 0101 UNITED PL
:R'S NAME: PERMIT ISSUE DATE
dLEN KWAN 1712 STONE AVE 12 /04/2003
PHONE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELO PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION' O
£uF l hereby arum mal 1 am licensed ender prnvixinns nI Chapter v(enmemmdng - - Job Description
mW with Section7gg)ofDivision3ofthcBusinessandProfessionsCmIerindmylicense is p� pq
in full force and 7 7/ FURNACE AND A/C FINAL ■ w
s�z License Cly s_ _Lic.N s iM��O
Vit- Dam
run. Or
pp RCHITECT$DECLARATI N
f C U I understand my plans shall he used as public mea de
FEB 1 0 2004
'oto Licensed Professional .
g OWNER-BUILDER DECLARATION
'ys e y 1 hereby affirm that I am exempt from the Contractor's License Law for the BU1LD1NG
C
0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,ager,improve,demolish,or repair any struature
prior to its issuance,also requires the applicant for such permit to rile a signed statement
g o
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation
Ari (commencing with Section 7")of Division 3 of the Business and Professions Code)or
Nn he Is exempt thcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3��a3ep}I�er00 Occupancy
not more than five hundred dollars($500). _ p Y Type
❑1,as owner or the property,or my employees with wages as their sole compensmlon,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
prepeny who builds or improver thereon,and who does such work himself or Brough his
own employees,provided that such improvements me not intended or offered for sale.If,
however.me building or improvement is sold within one year of completion.the owner,
builder will have me burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of to properly.am exclusively contracting with licensed contractors to
conawcl the project(Sec.7044,Business and Professions Code)The Contractors Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. ,B A,P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one or the following decimations: .
❑1 have and will maintain a Certificate of Consent to sei6insum for Worker's Compete
station,as provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the tabor Cole,for Inc performance of the Work forwhich this permit is issued.
My Worker Compensation Insurance carrier and Policy nuumberr�amr , �sQ
Cartier. C'`A6T � polity No.:_(y�.�'�.5��
l CERTIFIC'A'TE` EX EM
NSATION INS FROM WORKERS'
COMPENSATION INSURANCE
(This section need nuthecompaud Bribe permit is(crone hundred dollars(SI W)
or less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any marmoso u to become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Comfreme of Exemption,you should
become subject to the Workers Compensation provisions cruise labor Code,you mum
JZ forthwith comply With such provisions or this permit shall he deemed revoked.
Z CONSTRUCTION LENDING AGENCY
C+ I hereby offirm mal there is a constriction lending agency for the performance or
x the work for which this permit is issued(Sec.3097,Civ,CJ
QLender's Name
= z lender.Address
U C 1 certify Bas I have read this application and vale that the above information is
" F. comet,l agree to comply with all city and county ordinaras and state laws relating to
0U building construction,and hereby autboria repreaendtives 0(0115 City to enter upon the
,roe ahmnm,judgdpropeny fond expenses
purposes.
(We)agree to aave,indemnify and keep hornless the City of Cupertino against
IFyZ incinsequnce costs and eSpenaprmiwhich may lnany way accrue against said City
V z inconsequence of the gmnling of this permit '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 �ca Date
SOU E REGULATIONS.
A � Z O 0� Re-roofs �(
Signature of ApplicanUCmilnc r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the epplicanl or future building occupant store or handle hazardous malarial
defined by the Corinthian Municipal Code,Chapter 1,11,and the Heilth and Safety
.saaea 25532(a)1❑Yes All roofs shall be inspected prior to any roofing material being installed.
' �}'flu
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
adult haeardnus air contaminants as derincd by the Bay Area Air Quality Management all new materials for inspection. -
District?
❑Yes
Ihavereadthehavande x materials requirements under Chapter 6.95oftheCalifnr-
nia Hcmth 6 Sdcty Codc,Sadona25505,25533 and 7534.1 undersmnd 01atif IM building
dams mol currently hove a tenant,that it is my responsibility in nod ly the Occupant of the
rcyviremcnts which mustM duct pdorm issuance nfa Ccnificam
Ho, Signature Of Applicant 'Date
�.�
Os/ner nr apmedved agent Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM l/
APN# a- Date:
� - �3 - o / y -� yo3
Building Address:
Owner's Name: Phone#.
W1_1_ eAl le&,1,9A/ G 4 - 9/d'9
Contractor: iG/�AF�r+....� . N/C Phone: License#:
Sao .tiv�0e ' c 76eop7/
Contact: Phone: Cupertino Business License#:
h
e A xa- do All, 7 8 SO
Building Permit Info:
BldgEl Elect Plumb El Mech
J� Description:
t -Fnv14 f4� a0000 d ori t� c 3G Q o l! / JW /
Residential Commercial ❑
For Residential Installations:
Attic El151 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 instllation ❑
New installation PlanningApproval Require I d ❑
Cost of Project: Type of Construction: Occupancy group:
� D
Strapped LJ On Platform ElBonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec d, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE --Fl—umbing Permit Issue PLUMBING
BPERMFEE Bld.g Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
/v
` CITY OF CUPERTINO
Itv 2 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32653014.00
DATE ISSUED. . . . . . . : 12/04/2003
RECEIPT #. . . . . . . . . : 23961
REFERENCE ID # . . . : 03120021
SITE ADDRESS . . . . . : 10101 UNITED PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HELEN KWAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5723
RECEIVED FROM . . . . : AAA FURNACE
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 9.50 0.00 9.50 0..00
BENERGY PERMIT FEE 1.00 23.10 0.00 23.10 0-.00
BSEISMICRE VALUATION 4,750.00 0.50 0.00 0.50 0.00
MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
__________ __________ __________ ----------
TOTAL PERMIT 104.14 0.00 104.14 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -____----_________
CHECK 176.51 4933
TOTAL RECEIPT 176.51
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•