06080046 (2) CITY OF CUPERTINO _? + .�aa*t
BNLQINC DI'�R61ON PERMIT 6 Cd)N�TRACT(iR INFORMATION
Al dSlt=..g,t.... a'+,!I{•A:R hl< f,..,a 9�'&v'b „i6»"f
BUILDING ADDRESS: PERMIT NO.
ANDERSON RADIANT HEATING 06080046
10920 KF.,qTFR DR
OWNER'S NAME: PERMIT ISSUE DATE
REYNOLDS 355 E H9QL1NCY__LN STT�, T4 .08108120119
NE: SANITARY NO. CONTROL NO.
(408) 378-3868
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loo
LICENSED CONTRACIDR'SDEC ATID Job Descrition
I di 1 hereby sfRrm Nn I am Iimmad under pno ora of C mer 9(commencing P
qwith Smdan]IX10)ol inion of Nc Busin,e r dmyl' is
i Lft, to eand,ff u g REMOVE AND REPLACE HYDRONIC BOILER
F D GanleMbf
ARCHITECTS OEC N
i 1 uad rstaninJ my plashall he red. bl'
sdV
G Licensed Professional
OWNER-BUILD DECLARATION
io I heathy.(Tree Nm 11. nae t fmm the Contracted Lic,nu Law for the
22 follwhich requires
Permit
]e ter .,irm rve. io demolish,.,ag ycity or county
5$ which mquitas a permit re can alcor,improse, armttcare a sig any swaum $8900
_Z< thiormiu lensed p,akuntto ft theapplicantof thnuchpcnmilm NnasLawJ mmmcm
Nehciscingwiis pursuant to ft of Dislonsof tits Conwnessnd LicenseLaw(ClaspersCron)or Sq.Ft.Floor Area Valuation
eF (commencing with Section 7")of DivisionJaf Na Business and Professions Cam)or '
Nat he is aempt therefrom and the basis far the alleged asempdar,My violsuon of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally Of
r Occupancy Type
not mom Nen five hundred dollars(6500).
❑1,as owner of the property,or my employeer with wages as theirsoleeampensadon,
will do thework.and the structure not intended oraRered forsam(Sec.10",Business Required Inspections
and Professions Cade:The Conergoon's Liana Law doe Out apply to e an Owner of 9 P
property who builds orimpromea Neeson,and who duessuchworkhimself or through his
own employ=.provided that such improvements are not intended oraRered for sale.If.
however,the building or improvement is sold within aro year u(completion.the owns,
builder wRl have the harden of proving Nat he did no,build or Improve for purpox of
sola.).
❑1.u owner of she pmRny,am eulusiv,J,contracting with licensed mnuacmm to
mnstmcl the project(Sec.7044.Business and Profetdmm Code)The Cmtrutors Li-
mner Law dean sot apply to an owner of property he Wilds or Imp..Nataon,and,
who contracts for such projects wish a mnuaaor(s)licensed pursuant to the ConuaaaYs
Licesure law.
❑Iomeaempiunder See ,B&PCIer Nismason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 totally of iso under Xnasty of perjury,am of the following declmulom:
1 have and will..Irwin a Certificate of Camenuo self-inure far Worked Compete.
nation,an provided far by Section 3700 of the Labor Cade,for Ne performance of Ne
work(a soh Nis permit u heated.have and will maintain Workers CompemNon Insurance,as required by Section
37M of to Labor Code,foperformance of the work for which this Permit is legend. r,
My Wor �V_ilcrd Policy qur�cym� /� J
Cartier. (��� /NFROMWORKERS'
SURANCE
(This=arm need int he completed if the Permit is forms,hundred rollers($I0))
or lett)
I coolly Nat in the performance of the work fm which Nis permit is Wood,I shall not
employ any person in any mommru as to become subject to Ne Warkcn'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after ting his Ccniacate of Exemption,you should
become mhmt to the Workers C patent m provisions of Ne Ltlaor Code,y.0 mus,
Mith comply
with
.J O lowgentian crew is peemit shall be dmmcd tawkcd.
z CO RUCfI LENDING AGENCY
Ih,uhy a?umN dam Lsac traction lending aCcnry far Ne perfurmana of
!Yi w>i the work for which Ni ermit is Le d(See.3097,Ci,C.)
Q Landers Name ,
z Lcnfctiod
e
U Q at 1 have nd this applieadon and soon that the above info,muion is
Lf. P conto nom with all city and county ordinances and state laws relating to
C Wilaio d hereby authorim represenmives oftis city to enter upon Ne
momNrly for inspection purposes.
me to save,i nt and keep harmless Ne City.(Cupertino against
liabm ts.cr andcxpenan which may in any way seems against said City
U'Z in cthe amting of this permit. )))APN RSTAND ND WILL OMPLY WITH L�N-POIM' Issued by: Date
SOU A IONS. apf
Re-roofs
Si u pplica on nm Date
RDOUS MATERIA S DISCLOS RE Type of Roof
Wi Neap ie or future building oceupaat store or handle havandous material
mfim y u oina Munic'in otic.Chaptcr 9.13,and sh,Health and Safely
Cam, on 53(a)? All roofs shall,be inspected prior to any roofing material being installed.
Will th applicant or luta b ilain c use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
amlt heard. sit mmtsm" arca a d, a Bay Area Air Quality Management all new materials for inspection.
Diuria?
❑ s
I vein Ord, maurialsmquimmcnmunter Chapur6.95ofde Califar
nice Heai h l 'ors 355()5.25573 and 35534.1 ummmost one ifNc building
does t a nm.that It my taspamNility le miry am^�ant.fthe
reggm mono sMmet p' uieuanm cpfuauc U� Signature of Applicant Date
0 er or author cd en, M - Dow All roof coverings to be Class"B°or better
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35628018 . 00
DATE ISSUED. . .. . . . : 08/08/2006
RECEIPT # . . . . . . . . . : 35545
REFERENCE ID # . . . : 06080046
SITE ADDRESS . . . . . : 10920 KESTER DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . : . . . . : REYNOLDS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ANDERSON RADIANT
CONTRACTOR . . . . . . . : GLEN WAGNER LIC # 23141
COMPANY . . . . . . . . . . : ANDERSON RADIANT HEATING
ADDRESS . . . . . . . . . . : 355 E MCGLINCY LN STE H
CITY/STATE/ZIP : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 378-.3868
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BBOILER2 NO OF BOILER 1 . 00 26 . 19 0 . 00 26 . 19 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 8, 900 . 00 0 . 90 0 . 00 0 . 90 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 . 32 0 . 00 100 . 32 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - --------------- ------------ ------------------
OTHER 100 . 32 MASTERCARD
TOTAL RECEIPT 100 . 32
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
. . �_ n ���r�? �OIQ Date: Q ac0
Building Address/-
�(�� /v��
Owner's Name 7 (/ Phone#:
C one: �/ . d License
C to t: Pon : 7 Cupertino Business License#:
Building Permit Info: —/
Bldg ❑ Elect ❑ Plumb L7 Mech ❑
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1"floor ❑ 2"d floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project- n, / DQ Type of Construction: Occupancy group:
trapped ❑ ��On Platform Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ R lacement ❑
CITY OF CUPERTINO b3W P
CUPERTINO PERMIT APPLICATION'FORM �ll``
N# Date:
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: License#:
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
*roje7ctSize: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener y Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEkTF PERMIT APPLICATION FORM
roup —�ft
Quanti
ty Fee ID Fee Description Fee DIN
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. HousingMit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
EBPCESSPOOL
RTIME Ins ection Overtime BUILDING
KFLOW Atmos heric Vacuum PLUMBING
Cess ool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal— PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING •
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI A2pliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood ZELECTRICAL
ANICAL
BREMMISC Misc Apparatus TRICAL
BREMNRAPP Rem Non-Res Appliance TRICAL
BREMPOLE Pole/Platform Fixture TRICAL
BREMPOWER Power Device/Apparatus BREMRECEPT Rc t1, Switch & Outlets TRICAL'
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alt r Heating MECHANICAL •
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
PERMIT APPLICATION FORM
CUPERTINO
Aiwuantity Fee ID Fee Description Fee Group
IRV BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Ternp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fain PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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