06070002 (2) CITY OF CUPERTINO `"'
BUILDING DIVISION PERMIT ..I.:ONTRACTAi A'10RMA.TI N '
x rl „*svdyP .0 ifs
BUILDING ADDRESS: AAA FURNACE & AIR CONDITI� IGD'06070002
1038 CRANBERRY DR
OWNER'S NAME: PERMIT ISSUE DAM
10 WILLIAMS JO ANN 1712 STONE AYE 07/03/2006
NE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm loss am licensed under provisions of Claimer 9(commencing
with Sudan 70)11)afDivision 3 of use BuNea Profcasiom Code.said my Ike.it
m ren fa e a REPLACE FURNACE
I
j ya Z Licensee 1 L Lk.0
-:.tp Dau Canaacmr
7W RCHITEC'S DECLAR ION G
f 1 understand my p�ms.hall W need u public records
aid,
e C� Licensed Pnmfcssionel
b 3 OWNER-BUILDER DECLARATION
iI hcrehy,afro.that I am Mempt from the Convenors License law(ar the
3
COO following Motor.(Section 7031.3.Business and Pro(eaaium C.k:My city or county
which mquires a permit to construct,stmt impmw,dcmnllah.or repair any une.re $1800
_ZNy prior to its issuance,also requires the applicant forauch permit o file a signed statement
G that he is licensed pursuant to Me provisions of the Contractor's Lk'xmLAW(Chapter 9 Sq.Ft.Floor Area Valuation
IlFq (commencing with Section 7000)of Division 3 of six Business and Professions Cade)or
a 3 Nat he ts Martin therefrom and the basis for Use alleged erernption.Any violation of
Section 7071.5 by any applicant far a permit subjects the applicant to a civil penalty of r Occupancy Type
not tam Nan five hundred dolls.($MM.
❑I,vow"rofthepmperty,mmymploy=wiNw guuthe4mkcompensadon,
WIII dO NC Wark.Nd Ne lYanaR 11 no11nandCd afaBGmd(arlale(SCC.7DN.BYYM31 ecu s
Required Ins
and Professions Code:The Contractors License Law does mos apply m an owner of q p J"
prapeny,who buildsmimproves Neuron,and who doessuch work himselfo through his
own emplmyw,provided that such Improvements tie not intended oroRered for sue If.
however,and b ildingor improvement Is mid within ane year of mmpledon.the marks.
Insider will have the tookin of pmving dist he did tat Mid a improve for purpose of
sal0 1, 7/
m I- i owner of property,sur sines id convecting with licensed)The Committee
to
e.utmm Ne esproject(Sec.oat,mmer of rad Py wino ns CodeI The Conuaemra U- ."✓`
«nse Law does mot apply to
an owner or properly who sed p rs anproras Norton.red.
who mrmcu for such pmjttv with a ennuamorts)licensed pursuant in time Convenors
L4ense law. �) l
❑Tom exempt under Be, .B&PCfar Ni.reason
charter Dam
WORKERS COMPENSATION DECLARATION
1 hereby a Tranunder penalty of perjury ane of Ne following declauliom:
ave
I land will main Wn a Certificem of Consent in self-into.for Workers Catalan,
mi.,w provided for by Section 3700 of the Lab"Crede,fm the Perform.of the
wart for which this permit is ismad.
❑1 have and will maintain Wmkars Compensation Insurance,as acquired by Section
3700 of the labor Code.rat the performance of Ne work for which this permit is lasered.
My Waftes Comp. artier and Poluy number sae` -
Canin: y�Policy No.: �1 29C •ITS A OF2XEMPIONFROMWORKI R3'
COMPENSATION INSURANCE
Inns soden read mnbec.rpleted if nth Permit Is fee =hundred dm0am(SI0(1)
lir leu.)
1 certify that in the performance of the work for which this permlm Is Issued.l.hail Imre
employ any person in my summer w u to became mbjMt in Ne Workers'C imperamon
laws of CaRk.is.Dau
Applicant
NOTICE TO APPLICANT:If,.(ter making this Conlficrre of Exemption,you should
become subject in the Wotreh Compensation provisions of the labor Code,you mus
.,O forthwith comply with such provWom"this permit shall be dated revoked.
Zs^N.. CONSTRUCTION LENDING AGENCY
[-w I hereby M.that Nem is a conuroctinn lending agency for the scritunna"e of
Ne work f"which this permit m issued(Sec.3097.Civ.C.)
QLeader's Name
z Landers Address
U 0 I ete ify that 1 Mw read this application and sum than The above tot. .turn 4
D. corm.l agree In comply with all city and county oNina end and sum laws relating a
Q CJ building construction,and hereby auNorim representatives or Nis city to enter upon Lhc
Uabove-mcommcd Property for inspection purposes
y�^y 0y (We)agree to save,indemnify and keep hnmleu the City of Ctmenino against
cq liabilities,judgments.case sod eateries which may in any way seem against mid City
V Z in consequence of the grooming of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOU REGUTL��TIONS.
,/pRria_ ,/i�..a,..i �i)/7/l�
nuRe-roofs
Si �of, pPRonUContr ter1f
HAZARDOUS MATRAIALSDISCLOSURE Type of Roof
mi]the applicuo or future building mupmttram.handle haaNaus mater al
u de0mad by tie Cuperinm Municipal Cade.Chapter 9.13,and tie H"Ith and Safety
Code.Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya No
Will Ne applicant fuw a building azvpant use equipment ser devises whicM1 If a roof is installed without first obtaining an inspection,I agree to remove
emit barardons Mie commumanta u deOrmC by No Bay Arta Air Quality Management allnew materials for inspection.
District?
❑Yns u
I have read the msteriab mqulrenenu un@rChapter6.95oftheCaiirm-
n1s HealthkS.f.yCade,Swi..25505,25533uu1233a.lunWc dOeifNc building
does not currently hew a tenant that It Is my responsibility m molly f mceupaet of tho
Zen which must be met prior m issuance of a Cenirmate of Occupancy. Signature Of Applicant Date
Zen
ee see aaNarimd agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
i' Cupertino CA 95014
Telephone(408) 777-3228
Cl OF Fax(408) 777-3333
IOUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/b I g 06o 76a 0 2—
OWNER'S NAME: JoVvoj 6,, / :q w-r PHONE # 3/ 06 9
GENERAL CONTRACTOR: ahA.c /�j�A {evh FAX #
I am not using any subcontractors: ~"7'^ D �c
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
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36204051 . 00
DATE ISSUED. . . . . . . : 07/03/2006
RECEIPT # . . . . . . . . . : 35093
REFERENCE ID # . . . : 06070002
SITE ADDRESS . . . . . : 1038 CRANBERRY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WILLIAMS JO ANN
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
�EE 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, 800 . 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 ��tT1 D0 OZ
FURNACE/AC
CUPEkTiNO PERMIT APPLICATION FORM
APN# 3 Date
Building Address:
C' AN Elu
Owner'sName: Phone #:
tea- 3/ - /06
Cc tractor: License#:
vx 76 d,'7/
Contact: Cupertino Business License#:
Building Permit Info: /
BldgElY
Elect LY Plumb LMech JR
Job Description:
ac¢. • 'ui ce,
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor KF-2 nd 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 oup:
Strapped ❑ On Platform Et- Bonded S7 Sq.Ft. Floor Area:
New Location ❑ Replacement Er
Qty. if
Applicable 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
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC I Business License BUILDING