06050072 (2) CITY OF CUPERTINO
•BUILDING DIVISION PERMIT 9c,OMTRACTOPONFORMATION'
BUILDING ADDRESS: s AAA FURNACE & AIR CONDITI ]SHNUO'06050072
22821 LONGDOWN RD
OWNER'S NAME: PERMIT ISSUE DATE
RAUSCH DORIS B 1712 STONE AVE
E: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG O PLUMB O
300 LICENSED CONTRACTOR'S DECLARATION IObDCSCTI Description
I V I homey&Man shat I am Massed under province,of Chapter 9(commencing P
nth Section 7")of Division 3 of 0se Eastman and Profesuom Cade.W MY license is
+� in full fame and REPLACE FURNACE 88, 000 BTU AND 3 TON A/C
jp Lk<Mau, Lp Lk.0 _4kaU -
s JF Comsular - L 4
ARCHITECTS DEC RA
f I undcmtand my plans shall W used u public recitals
!tO,
Licensed Professional
y OWNER-BNIDERDECLARATION (1� pj y��3
a I hereby.(Sero on I oro camps from the Contractors License Law for me �\ pI li.,
OO following remon.(Salon 7oo,stBuaimas op Rousslum Cade:Any city of county rf/�.'\M{Pt�1d3-'
which requires•ousels as consmW4 tiler.W oma,demolish.or mpnir any sanctum HN 512 0
_ZSe prier m its issuance,also requires lM applicant larsuch Permit m lik a signed suumcnl
< thnheislicensedpursuant toNeprovisions ade,Commodes udeand aw(chapter 9 Sq.Ft. Floor Area Valuation
152.2 (Cards cingwleh Secdm7ODD)of DivWon3offt Oosixu PmfcWom Codc)m I' r/� 2006
Nal he u uemps Nemismn W the basis fm the tlk{ed exemption,My violation of
ny
Section 7031.5 by aapplicant for a permit mejecu the,ppllant W a civil penalty of r Occupancy Type
not mom thus live bundrN dollars(550(3)
❑I,uownuofdopmpmy,termywployeuwirdm{muthe)mka pemadon,
and da thewodt and Wemuesont h eel s I IMMSm a w du Faruk(See.7oN,—Of
and Pro.ho W Cade:The Contractors Umue law des cot apply as at awucr of
Own con wW Wilds mimprowahimpr vewho ducs,mhwae braffmm Nmsah his
Own ever,Me m,Provided!thuamh Impmvecsanu am nusinl rafo mosemd far use B.
however,Nceuil the Orden of pmentIcehathwithinoneyw or improve for purpose
ore of
builder will have the burden of Droving dist M did us build m improve far puryase of
ask.).
❑I.u owou of the property.me exclusively caeeacting with Iiansd canuavo e as
consumer the praises(Sec.7044.Buuned,W Pmfeatiam Code:)The Contractor.U-
cense Law dean not apply as an Owner of property who Wilda m Wpmw themml.and.
who contracts for such pmjeau with a amaxamoO)licensed persona as d[C Contractors
License Law.
❑I am exempt under Sec .B h P C for this reason
OwensDau
WORKERS COMPENSATION DECLARATION
I hueby&Micro under penally or perjury nit of the fallowing declensions:
I haw and will mdntam a Carcinoma of Cement to sel6iasure for Warkd,Cempm-
udon,u provided fm by Section 3700 of the labs,Cade.ren the Performance of the
work for which this permit is issued.
❑1 have W will maintain Worker'.CompemWon IsuurarRa.u required by Secures
3700 of the labor Code.for the performaae often work forwhich this permit is issued.
My Worker Compellmation lmmranee maim and Policy number
Carrier. •2 /S �L•lLn� Policy Na_�f S.5
CERTIFlGTE�F PXEMPI70N FROMOaKFRW S'
COMPENSATION INSURANCE
v
(This scums nnuas nut W cmnplemed allies permit is foraec hu beddogan(5100)
or less.)
1 ari fy Wal In the performance of the work for which this permit is kvued.1 shall not
employ any person in any manner as as in becamesubject an tie Workers'Compematian
lawn of California.Dau
Applicants
NOTICE TO APPLICANT:If.after making this Ccninmm of Exemption,you dmuhl
become subject W the Workers Compcnudan provi.iam of 0u Ulm,Cade,you a-
z forthwith comply with such prevision or this permiL,hall W diamond mvaked.
zyes CONSTRUCTION LENDING AGENCY
51 Wmby afrmn dans them I..comuuctlnn lending ag.uY fm the performance of
> We work fm which mis permit is issued(sec.3091,CW.C.)
IQ QLender,name
.7 z Leader,Add=
U0 I artily that I have reed ibis application and sok this be.hove information is
is, correct I agree W comply wise all city and county ordinances and sum laws mining to
Obuilding construction,and hemby authOAM mpresanutiw alibis city so dater upon the
U
U .hove-mcndond property for Maranon pu pm&
a (We)agme to um,indemnify and kap humlms the City of Cupertino aPimt
v.t rA Iiabilidesjudpmamacosu ad expenses which may In anyway acemc Balms aid City
C.) in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS.
4 e - ^c Re-roofs
Sigheamof ppliant/Conuactor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will that applicant or future Wilding eccu mustom or handle buudous material
u deRned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Conn.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑yc, ❑Na
Will tiro applicant or future Wilding mreupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
omll huirdoas air cuuminanu u deaad by she Bay Area Air Quality Muagemem all new materials for inspection.
DiNict7
❑Yon C1 No
I have mal the beuNmu materials under Chapter oft eCalifof-
me Hulse 8 Safety Code.Smrdom 25303.25333 W 25539.1 undemuA dist ifthe Wilding
does not currently have a[Came,sen II a my respamlldllly to sWfy the excupens of the
m4mmmenu which mus be sen prior as issuance of a cenifma[C of occupancy. Signature Of Applicant Date
All roof coverings to be Class"B"or better
Oweer or authorized agent u Daw
Community Development
10300 Torre Avenue
,' /' Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMTr #
G�
OWNER'S NAME: D m- w PHONE # .y j--)
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Dat' e'
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 4/4 q 414 c v
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
�m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34233051 . 00
DATE ISSUED. . . . . . . : 05/09/2006
RECEIPT # . . . . . . . . . : 34315
REFERENCE ID # . . . : 06050072
SITE ADDRESS . . . . . : 22821 LONGDOWN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAUSCH DORIS B
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BARBARA MANGAN
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
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
BREMRECEPT NO. OUTLETS 1. 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 5, 120 . 00 0 . 60 0 . 00 0 . 60 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 176 . 34 0 . 00 176 .34 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
CITY OF CUPERTINO U-0050019
' FURNACE/AC
WUPEkTINO PERMIT APPLICATION FORM
APN# Date:
3�a-33- O� I S= ��
Building Address:
020, L ow
Owner's Name: Phone #:
Con actor: Phone: License#:
UAC _
Contact: Phone: Cupertino Business License#:
6 4 , y S"o
Building Permit Info:
Bldg ❑ Elect Plumb 25� Mech
Job Description:
G c.e_ . D
Resi ntial %ommercial ❑
For Residential Installations:
Attic ❑ 1" floor a 2"d floor❑
Adhere to min set back requirement[]
or 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 C action: Occupancy group:
Strapped On Platform El Bonded Sq.Ft. Floor Area:
New Location Replacement ❑
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 cf n MECHANICAL
BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
Ali PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC I Business License BUILDING