06050058 (2) CITY OF CUPERTINO )2t;
'BUILDING DIVISION PERMIT 'rtCONCRs�C �R 2t;": RMIA
s m(9•"taw r-s..v°du_. rr,:a'�wS°a.. ,a etaj„ .
BUILDING ADDRESS: JIM' S AIR ,CONDITIONING P�IM�NO'06050058
22472 MC CL13 RD
OWNER'S NAME: PERMIT ISSUE DATE
COYLE ERROL J 917 QUERCUS CT. -1 , 05/08/2006
NE: USAKIT RY NO. $ I' CONTROL NO.
(408) 655-0491 dsa. -
ARCHIIECf/ENOINEER: BURRING PERMIT INFO
BLDO aELECr PLUMB MECIJI
�y�� (y� �I� 0 t�
;off LICENSED CONTRACTORS DECLARATION Job [J
Ii I hereby afRlm Nn I am IkensM under provisions of Caspar 9(commencing P
s< in fu ScotiaadaffecDivision 7ofWButlneaandProfaaviva Code,and mylkcnseu
< nrmlforce rClass erten r/ REPLACE FURNACE ADD AC •r j�CJ�y”
z Licenm Class -�-n�Lie.N T
i Dam / rim/l) I rat Cowaster
AR SDECLARATION
f I ubeamad my plans"I W used as public mcerds
U
Licensed Profeaionel
OWNER-BUILDER DECLARATION
1 hereby so a0irm than 11. exempt from the CssionstCo Licence Law for tite
p pO{ furrowing massa permit ar co I3,Business tad Rdem u h.a Any Illy m county $6200 3 WMC CgVImF a permit b construct,al m.improve.dC demolish.m repair my PNLIVm Y 6 Z O O
prior to it issuance,also requires the applicant for such permit in Om asignul stabmmt
F C
that he is licensed Puaumt b the provisions ofthe Com male,License Law(Carter 9 , Sq.Ft.Floor Area Valuation
$ (commencing With Section 7000)of Division 7 of the Business and Pmressioa Code)or
that he is exempt thenfixtre ad ham;for the
olad an of
_ Section 7071.5 by Lary applicant four a permit bjecu Ne pplicaannt b a civilipenalty of
sot mom Nan live bosomed deltas(S500). r Occupancy Type
❑1.u oWmr of tM property,er my omplaycu with waW u tram dale eampeamtian,
will doth sdon'ands: he Cort heats License
Law
does ,apply
in owner
of Required Inspections
Preand arty, W bu Code:The Cs flumen,U^"W law dons ant apply lf rt owuer of q p
own em wlb builds i lmpmvmthFinaaand awhonts wessahwork h r aelfarlhmugh his
awn emPloym,pmviorI IMI ate ImPna<mmu art not year
of aeralfcred Ter comm e.
builder..me building er Improvementisthat
within sue Weld armmpve forn.me oWuer-
Wilder will have me burden of proving met M did not Wim er Improve for Purpose of ,
sale.).
❑1.u war of the prnpmy..B exclusively contracting with:)The
contractors U.
����
construct LA the an an (See.7 a Business rod ray who a Code:)7M C thecon. d ts�
whotow does sot apply je ts own.of properly once seiba or W promo memaa,and. �`�W`:W'II
who mnuacta for such projects Wim a mnuatar(U Ilceaased purawnl b Ne Conarscorl '
Lkeae Law.
❑Tun eumpl under See .BAPC far dtis moon
Owner WORKER'S COMPENSZON DECLARATION 20U6
1 hereby
ndwalumunder pemilemlty of perjuryoroof Oamoom(ng dedsisdioWomtesaae �n, a f{ AT'•*� {Pv tt Aye
Q charm LaM will mainuina CeniOmm of CoaentbselblauR fm Workees Compen- If�i)Vl)(yl) Ilgl'�- � ���\\\�I�)7b\`'.��/7—/,
wim,u provided far by Section 7700 of the Labor Code.fm W performance of the
work for which this permit is Issued.
❑f have and will maintain Wofkees Campeaadan Insaaee,u required by Section -
7700 of me Luber Cade.for the performance of the Waris forwhlch this permit is issued.
My WorkeeL Comps A on buxtr mn as 'cr end Policy number am:
Castles. ling No.:
CERTI CATE EX• PITON FROM WORKERS'
CO ENSATION INSURANCE
v
(this section recd ml W completed If tia permit Is for one hundred doom(S 100)
or leal
I CmN that In the P f anon W or whim dais perch is issued.I mail out
employ any peman l my ante a mbeelbthoWmari Compemadan
Laws of Califtmia van
Appncent -:.c m of Ex
NOTICE TO APPLICAI .1(,offer saltin{m4 Cenifinm of Exemption,you should
become mbject b me M/ If.
Compensation provisions of me Labor Cade,you most
,JO forthwith reply u,12hpmvium.m mu Permit Nell he dmmW nonmed.
CONSTRUCTION LENDING AGENCY
[r Ihereby IMM del mem is a matnaction lending agency for me Performmm of
Cisthe Work far which this permit is caused(Sec.7097,CN.C.) .
Q lattices Name
z Lendees Address _
U Q I mnify that I have mad this appliculm and sum that that am.Information is
W U Carmel-1 a{me to comply with all city and county ordinances and mm laws miming b
O Wilding construction,and hereby aummire mpmantatives ofmis city to enter upon the
Wabove-mentioned property for inspection purposes.
C (Wc).gree Is ave,indemni%and kap humleu the City of Cupertino against
nn f/1 IiaMii gmenu.cow and expenses which may in my my Lana agalatwd City
V.Zin cc of. APPLI A U RSTA{oS SANDWILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R
Re-roofs
Signature pplicauConumbr Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fubre Wilding occupant store or handle hazardous material
a dellned by the Cupertino Municipal Code,Gaper 9.11.ad the Hcalth and Safety
41
Cade.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes pNe
Will the applicant
or Tooth Wilding
oavpant era equlpmot or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit Maroon air conuminmu u de0ad by IM Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 0 N
I have real me huuNm rialsmquim uese, crChapmrh,97ofthe Callfor-
nmlfaldi afcty Codc.Smd L7 ZSS77um75734.1oedcmed"if emtildmg
data ant c eptly �lo a moa I ponsibility b notify the occupant of me
myulmmco hi cat Wm rt W crti0mtearogwpuay. Slg of Applicant Date
sonar or arioeda ent 67 All roof coverings to be Class"B"or better
CITY OF CUPERTINO
Sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot: ,
APN . . . . . . . . : 35604029 . 00
DATE ISSUED. . . . . . . : 05/08/2006
RECEIPT #. . . . . . . . . : 34291
REFERENCE ID # . . . : 06050058
SITE ADDRESS . . . . . : 22472 MC CLELLAN RD
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : COYLE ERROL J
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2753
RECEIVED FROM . . . . : JIM' S AIR CONDITION
CONTRACTOR . . . . . . . : JIM TURNER LIC # 25053
COMPANY . . . . . . . . . . : JIM' S AIR CONDITIONING
ADDRESS . . . . . . . . . . : 917 QUERCUS CT.
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 655-0491
•FEE 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 6, 200 . 00 0 . 70 0 . 00 0 . 70 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 . 44 0 . 00 176 .44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 176 . 44 11489
TOTAL RECEIPT 176 . 44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
a. Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SCUPERTINO
Building De artment
JOB ADDRESS: PERMIT #
as 47a- Me- C/e// kL as`�
OWNER'S NAME: PHONE # /o SS p
GENERAL CONTRACTOR ^ , ,. FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractor 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 ouo5o05�
- ' FURNACE/AC
OCUPEI,TINO PERMIT APPLICATION FORM
APN # Date:
510- q- 022
Building Address:
0�1 #?C ! / w
Owner's Name: 0p Phone #:
Contractor: �L Phone: License#:
y /�v
Cont Phone: Cupertin Business License#:
✓Ne ✓ �vK6s"5 a �S a 3
Building Permit Info: /
Bldg ❑ Elect B Plumb C' Mech
Job Descriptio
Residential Commercial ❑
For Residential Instaa tions:
Attic ElI" floor ell 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: 40 Type of Construction: Occupanncy oup:
Strapped 2 On Platform Bonded 21 Sq.Ft. Floor Area:
New Location 16 Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm 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
PPERMrfFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK , Plan Check Fee BUILDING
BPGAS I Gas Piping System Fee PLUMBING
BUSLIC I Business License BUILDING