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06020022 CITY OF CUPERTINO ' --"*a 'k ''`tr BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: yt lwr:`4`id _.e.� <FYAI�- .Yd,a.'il4la X. ' BUILDING ADDRESS: AAA FURNACE & AIR CONDITI ff 'lt!' OO6020022 10833 WILKINSON AV OWNER'S NAME: PERMIT ISSUE DATE BOB SMITH REALTORS 1712 STONE AVE" 02/03/2006 NE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION u❑ 1 hereby affirm Net I am licensed under pmvi ions of Cromer 9(commencing Job Description �iW with Section 7(M)oloivison 3 ofdm Business and Professions Code,and my license is naR infull forteondABe REPLACE FURNACE 100, 000 �� j$? Lkenu Class f Lin.N F p Da¢ Conlruur r 'J' ARCHITECTS DECLAR 0 £ u 1 understand my plans shall w used as public records le Licensed Professional MAY q- 2006 g OWNER-BUILDER DECLARATION 9<F I hereby affirm that I em exempt from the Contmmoh License Law for IW O O following reason.(Section 703 IS,Business and Professions Cole:Any city or county 5$ which requires aermm pit construct.eller,improve,demolish,are repair any structure 3 0 0 -iy prior In its issuance also mquires de applicant for such permit to file a signed statement < Out he is licensed pursuant oNcprovision ofthe Contractors LuremeLaw(Chapmr9 Sq. Ft. Floor Area -pas x�$ (commencing with Section 70M)of Division 3 of the Business and Pmferaiuu Cow)or - that he is exempt thcmfrom and OF beau for the alleged corruption.Any violaiian of Section 7031,5 by any applicant fora Permit subjects the applicant to a civil penalty of nor mom man fire hundred dollars(gem). r Occupancy Type 0 1,u owner of the progeny.or my employees with wag.as their ule compensation, will do de work,and the structure,is not intended or offered forage(Sec.7044,Business and Professions Code:The Cmustaxra License law does not appy to an owner of Required Inspections pmpenywhobuildsorimprorcschicon,end who doesstiltwork himselfare for We his own employe.,provided Oat suchimis told it ma net ear dedofc mOedon,ffered for Owner. builder Nebuildingor improvement ishathwithinox)ear of completion.me owe of builder will have the burden of proving that he did not Wild or improve for puryose of xlcJ. 0 1,as a,of 6e pmppny,am.clmively contracting wish licensed contractors to construct dw project(Sec.7044,Business and Professions Code:)The Contractor's Li- . come law dors not apply in an owner of property-who Wilds or improvea thereon.and who contracts for such projects with a comrxmr(s)licensed pursuant in the Contrhamr's Lkmue Law. 0 I am exempt under Sec. ,B&P C for Nis rutin Dam WORKER'S COMPENSATION DECLARATION 1 hereby Num under peulty of perjury one of the following datmations: 1 hsrc and will maintain aCenifinm of Cansem uxl4imuu for Wortrfs Compcn- xtian,u provided for by Section 3700 of the Labour Code,for m the performance of Nth 2 work for which Of,permit is issued. 1 have and will maintain Worker Compensation Iruurancess required qcu uired by Scon of the labor Codc,for Inc performance of the work for which this permit is i.ued. My"rker9 COCKboo i In race eartim and Polity number art: Cartier. Policy Na.:�-�/ 5.�� C RI Fl XEM MON FROMRKERWO S' COMPENSATION INSURANCE (Tuxetion reed notwexamplard if Ili Permit is forone hundred doBan(SIM) or less.) 1 caufy that in she performance 0f the work for which this Permit u issued.I shall not employ any person in any mannas as u become subject o the Workmt Compensation Laws of California.Dna Applicant NOTICE TO APPLICANT:If,after making this Ccnificam of Exemption,you should become subject in the Worka's ComPmsauon provisions of the Iairr Code you mut .J O forthwith comply with such Provisions or this Permit shall W darned masked. z� CONSTRUCTION LENDING AGENCY [+ 1 hereby Nirm that cert is a consuuctinn lending agency for the perfurmmsx of G' the work for which this permit is issued(Sce.3097,Civ.C.) 1 Q Undoes Name z Lender's Address U C) I ansify Nat I base read bis application and sum that use,al ti formasiun u I¢. F coma.1 agree to comply with dl city and county whimp ces and suite laws miming to 0U building construction,and hereby atthadx representatives ofthis city to enter upon the F Ga Wvcmenuoned property for insPecuon purposes (Ws.)agree to save,indemnify and keep harmless the City of Cupertino against req liabiliu.,judgmers.eess and expanses which may in anyway accrue against said City U Z in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SODate 2- Oil 4U/R� E/C, RE�GULA_IIIOONS. y azure 4rApplmanUCanuu�mrr' y `'YID��- r" Re-roofs HAZARDOUS MATERIALS DISCLOSURE Typeof Roof Will the applicant or future building occuFantsecre or handle hmardous material as derined by the CuPenino Municipal Code.Chapter 9.12.and the Health and Safety adnLCodc,Secumr 25532(a)? ❑Y. �Na All roofs shall be inspected prior to any roofing material being installed. IM F Will the applicans or/fntum building Occupant Use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hisOmki air comininans as defined by the Bay Area Air Quality Management all new materials for inspection. District? Oyer u I h,vcmad she have nusmncrialsrcquimmcnuundcrChepmr6.95o(OcCalifor- nulYalc&SafctyCodc.Savons25505.2533u Z534.IundoWd deaffNe Wilding does not currently have a soman,that it is my r.ponsibiliry to nosily the occupant of de, requirements which must W met prior on issuance of a Ccru0cam 0;7:3,t36, Signature of Applicant Date W,ar,tNored`�eT�" D,te All roof coverings to be Class "B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35613020.00 DATE ISSUED. . . . . . . : 02/03/2006 RECEIPT #. . . . . . . . . : 33073 REFERENCE ID # . . . : 06020022 SITE ADDRESS . . . . . : 10833 WILKINSON AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BOB SMITH REALTORS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4733 RECEIVED FROM . . . . : JIM RANDO AAA HVAC 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 __________ _____________ __________ __________ __________ __________ __________ 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 2,300.00 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 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 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 #UPEI�TINO Buildin De artment JOB ADDRESS: PERMIT# OWNER'S NAME: err ` rec! }Zlr PHONE GENERAL CONTRACTOR: � � FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass/ Glazing Heating c — 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 FURNACE/AC . ye CUPEkTINO PERMIT APPLICATION FORM APN # 3 6a- 13— O Date: D1 - p�z -oma Building Address: 6Di ,73 Owner's Name: Phone #: /3.9/ /La- X36- Soot Contractor: License #: ao -arnc ,t�C; / Contact: Cupertino Business License #: /awZce Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Descri tion: m U Residential fSl Commercial F-1 For Residential Ins Ilations: Attic ❑ 151 floor 2nd 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: Occupancy group:' Strapped ❑ On Platform ❑ Bonded El Sq.Ft.�Floor Area: New Location ❑ Replacement Qty. if A licable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL 1 REMRECEPT 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 Bld a Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING