11110043 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7523 DONEGAL DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11110043
CONDITIONING
OWNER'S NAME: 1-IU ROSA Y TRUSTEE 1712 STONE AVE DATE ISSUED: 11/08/2011
R'S PHONE: 4083900346 SAN JOSE,CA 95125 PHONE NO:(408)2914717
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class —tO Lic.N T 'I l 7 U 1
n MECH r RESIDENTIAL r COMMERCIAL r
Contractor 444 LA/4-CC Date—/- 40((
I hereby affirm that I am licensed under the provision of C apter 9 JOB DESCRIPTION:REMVOE&REPLACE FURNACE AT SAME LOCATION
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the fallowing two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this
permit is issued. APN Number:36616060.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all nor- urce regul ions per the Cupertino Municipal Code,Section Issued by: Date:
9.18.
Signature Dale
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as dented by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&SafetyCode,S ctions 25505,25533,and 25534.
1 certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owner or ulh a ent: l y 00 C
Compensation laws of California. If,after making this certificate of exemption, Date: J
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING ACF.NCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
1 certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
."
nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
BI rting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
• CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36616060. 00
DATE ISSUED. . . . . . . : 11/08/2011
RECEIPT #. . . . . . . . . : BS000015262
REFERENCE ID # . . . : 11110043
SITE ADDRESS . . . . . : 7523 DONEGAL DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIU ROSA Y TRUSTEE
ADDRESS . . . . . . . . . . : 7523 DONEGAL DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RANDO AAA HVAC, INC
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 .00 41. 00 0. 00 41. 00 0. 00
1BCBSC VALUATION 3, 800 .00 1. 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 3, 800 .00 0.50 0. 00 0 .50 0 . 00
1MFR=<100 UNITS 1 .00 130. 00 0 . 00 130 .00 0. 00
1MPERMITFE FLAT RATE 1.00 44 . 00 0 .00 44 .00 0. 00
1TRAVDOC ' FLAT RATE 1 .00 44 . 00 0 . 00 44 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 260 .50 0.00 260 .50 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO, CA 95014-3255
® CUPERTINO (408)777-3228 • FAX(408)777-3333 •huildingecuoertino ora
❑PLUNIBING %(ECHANTCAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS '75Z3 o q L— 2 . AFN �Z 1 (.0 O (d
OWNERNAh1E p J E �
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STREET ADDRESS 3 FAX
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CONTACT NAME PH NE
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STREET ADORES s I /I C .y7ATE. �@O
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❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT aTCONTRALTOR ❑CONTRACTORAGENT ❑ ARCNTECT ❑ENGMEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME LICENSE NLWIBER U EE TYPE BUS.LLCM
IA Y tia $7 1 G2_0
COMPANY NAME E-MAIL FAX
�ur/v�cr� 41 F-29 -6 -7
STREET ADDRESS ` viZP , lJt `P�2 4jO —v7
7i
ARCHI TEC IENGINFER NAME LICENSE NUN®ER EUS.LIC M
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP
PHONE
USE OF S; Or Duple% ❑ Multi-Family PROTECTINWE.DLAND PROTECT IN
SiRUMME: ❑ Commercial URBAN BYTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OP WORK
LLJ S4 nv-q- orgp4jo.,j
TOTAL VALUATION:
9V✓ !�Y"� r� '��. fit- ��•?' .-tia
By my signature below,I certify to each of the follo I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pr is ect I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel ding o ctian. [authorize representatives ofCupertino t0 enter the above-identified property perry for inspection purposes.
Signature of Applicant'Ag, Date: ZL-1-i/
EMEMAL TION REQUIRED =. - �e.. �—--._� >�-- —'7
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MEFMUCApp_2011.doe revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
• ADDRESS: 7523 donegal dr. DATE: 11/08/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$3,800
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition /Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK remove and replace furnace at same location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $130.00
Meeh.Plan Check F0.0 hrs $0.00 Plumb, Plan Check Flec.Plan Chad,
Mech.Permit Fee: IMPERMIT Plumb. Pei nel Fee: Flea. Permlr Psi
Other Mech. Insp. 0.0 hrs $44.00 Orhe, Plunb lu p 011ie, Airco. torp. Ej
dfe,h.Insp. Fee: I'ftoub, to l" 1'ee: Flet,Imp. Fen:
NOTE: This estimate does not Include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the reNtdna information available and are only an estimate. Contact the Dept for addn7In a
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
S�ppl. PC.Fee
PME Plan Check: $0.00
Permit Per:
SuppL lush Fee
PME Unit Fee: $130.00
PME Permit Fee: $44.00
(,enlstruettun lox
Administrative Fee: /ADMIN $41.00
Work Without Permit? O Yes Q No $0.00
A,,lrnnced Planning Fres:
Travel Documentation Fee: ITRA VDOC $44.00
Lm Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $260.501 $0.001 TOTAL FEE: 1 $260.50
Revised: 10/01/2011
CALIFORNIASTATE i A FAMILY BUSINESS
LIC. NUMBER 76887fSINCE 1957
VISA/MC I DISCOVER 1712 Stone Avenue #1, San Jose, CA 95125
ACCEPTED Ph: 4081293-4717 Fax: 4081287-8534
•
SERVICE DATE: INVOICE N:
Oct 2811 INVOICE 0221440
TIME COMMITMENT SOLD BY:
DAVE RUMMELL
CUSTOMER INFORMATION: BILL TO INFORMATION:
ROSA UU
7523 DONEGAL DRIVE
CUPER11NO. CA 95014
HOME PHONE: WORK PHONE: HOME PHONE: WORK PHONE:
(408) 390-0346
CROSS STREET. WARRANTY: NIC BILL CASH CHECK CHARGE
PRIMROSE WAY
CONTACT/ATTENTION: CHECK OR CREDIT CARD p:
CALL DATE: I BY. P.O.#/ESCROW: ASSIGNEDTO: PAYMENT TERMS: AI R CUST p:
Oct 2111 GR C.0 D. NOCUSN
DESCRIPTION AMOUNT
INSTALLATION 3.800.00
REMOVE EXISTING FURNACE AND HAULAWAY
OODMAN UPFLOW 4 TON FURNACE MODEL#GMS81005C 100,000 B.T.U. (BLOWER MOTOR)
OIL BOX ONLY
SUPPLY PLENUM STRAIGHT CAN
FILTRATION SYSTEM -TRANE CLEAN EFFECTS
USE EXISTING FLUE
WALL SWITC WHARDWIRE
WHITE-RODGERS THERMOSTAT 5-2 DAY
GAS FLEX/SHUT OFF VALVE
2-CARBON MONOXIDE DETECTORS(1 -UPSTAIRS AND 1 - DOWNSTAIRS)
DUCT CLEANING
CITY PERMIT
20 YEAR WARRANTY ON THE CHAMBER
10 YEAR EXTENDED WARRANTY ON PARTS AND LABOR
TOTAL MATERIALS AND LABOR
Received by:
V/a% INTEREST PER MONTH OR 18% PER ANNUM
PLUS COST OF COLLECTION WILL BE ADDED IF ACCOUNT
BECOMES DELINQUENT
nRIr INAI
Building Department
City Of Cupertino
10300 Tone Avenue
l Cupertino, CA 95014-3255
U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: SZ o ( r L�-c PERMIT# z-f
OWNER'S NAME: 5A J PHONE# OB Zat3 ' oE'
GENERAL CONTRACTOR: AAA Fur-,,,ALC BUSINESS LICENSE#
ADDRESS: 17 rx A Dl, CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL UBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. C(
I am not using any subcontract.r,
Signature bate
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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date