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06090089 (2) CITY OF CUPERTINO 'BUILDINO DIVISION PERMIT CC1NTRr1.CTOIt�INF'�}Iti�'It1TIaN�s`: BUILDING ADDRESS: AAA FURNACE & AIR CONDITIO TNtNO06090089 10925 NORTHVIEW S OWNER'S NAME: PERMIT ISSUE DATE GRAIG ROURKE 1712 STONE AVE 09/13/2006 NE; SANITARY NO. CONTROL NO. (408) 293-4717 ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 00 LICENSED CONTRACTOR'S DECLARATION Job Description �u yFF 1 hereby affirm Nal 1 am licamed ummr pmvi+iam of Chapter 9(m mm reins .zlS with Secdon7Of10)ofDivision3aftha Businevmd Prefessiam Cadc.anderylicenmla EE in fall farce and fpc REPLACE 40 GALLON WATER HEATER Z License elm+ Lic.M i a• Dam — Conaumr RCHffECi'S DECLA p� &�,.a "a��c�� .wgnr_ / A ON ' p 1 understand my plans shall be used as public meads L ,ot, Licensed Professional m� OWNER-BUILDER DECLARATION i $ I hcmhy.mrt Nm am Afford I exempt from the CanUxh Li tacence Law far the .t]D following mason.permit t RO L3,Busies and improve. dca tins Cale:Any city or caunry ^ j$ which IN issuance. a e.shut re cores ft ohm,ire fmw,demolish,care a xis any atrmwm (f $800 Pdorss iuiauan jumusal Mthd tet apions,o thefor Coderermr's LuxeasLaw statement G thal(Comae dcanseJ PSesuam 70th)of Di+lam of the Ca usines'diicanmlaw(Cbapmr9 Sq.Ft.Floor Area Uatlon e€$ (eomtsis exemit therefrom and of Dtut,fion 3oflNBedexa and Profession,vi Cee)of tsel e u exempt ibcm(mm and the bmia for the alleged eamptton.Any violation of Section 7031.3 by any applicant far a permit subjects dm applicant to a civil penalty of 3 er Occupancy Type not mart than five hundred dollen($5110). ❑l em ownerk.Um d epetty,m my ut imeycn whh wean a Nev ec.eompenadon, will de tbewodt and the he Com over s License Law de d act apply toad.Budrca and property carie:The Coamctoed rad who dove don rot appy ir an nwrcr is _ Required Inspections property who Wilde artmprovesh imps and who dmf ouch workbimalf car dough his owndes.th Wie.lding proven improvements wiitartmtnar of cdl mllfered for mantis, builder the Wilding cartmprovemmtg midwithinorc yea or improem.tseowrco- butlderwill have tse Wrdm of proving Nat be did not build m improve for purpose of ale.). 1,u owner of the property am exclusively contracting with Iicamed commators m construct the project(Sec.7W,Business and Professions Cadet)The Countesses Li. ceme Taw does not apply as an owner of property who Wild,or improves t moon.and, who canmcta for+mh projeels wits a conlractar(U licensed purnunt in den Contractees Lmense Law. ❑1 ort exempt under Sec. .B k P C fm this mason Owner Dam WORKER'S COMPENSATION DECLARATION I busby affm under pemlly of perjury em of Um following declarations: I be.and will maintain a CeNBcam of Conant in self-Imua far Warkees Camper. nation.an provided far by Section 3700 of tse Labor Cade,for the perfarmmon of Use work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,a mqutmd by Section 3700 of the la W,Code.far Ne performed"of the work for which this permit is Nmed. ' My Workeri Compensation handsome Cartier and Policy number are: Carrier7/`R ! 41Policy N , ��, q CERTM AWOFEMP ION FR�� COMPENSATION INSURANCE (This action mad not N completed time Parrott Id Toro.hundred dollen(SIM) or less) 1 certify Not In the performance of the work for which this Permit is issmd.I shall act employ any person in any manner so as do become subject to the Workers'Compensatan ' Laws of Caliromia Dam Applicant NOTICE TO APPLICANT.If.after making this CeniOcam of Exemption,you should become subject to the Worker's Compensation provisions of the labor Cade,you must .JO forthwith comply with such provide.m NU Permit shall W demand rewound. CONSTRUCTION LENDING AGENCY je I berehy affirm tett ft.i+a canstructian rending agency for the perfermarme of yv► tse work for which this permit f issued(Sm.3097.Civ.C.) WQ Lenders Name 6i 0z Lendees Addm•• U 0 1 catfy that 1 have mad this applica ma and date Nu tse mese information Is Lau(.. conal.l agree in comply with all city and county ordinances and sou laws relatngto 0U building construction,and hereby auhhorix represenolivm of Nis city m enter dorm the 4 alaw-mentioned property for inspection purposes. (We)agree m save,indemnify and keep harmless the City of Cupmtino against hF•h y liabilities.judgmms.costs and expenses which may in my way amme against said City V Z APPLICANT UNDEuarem of the RSTANDS ANof this D WILL COMPLY WITH ALL NON-POINT Issued by; Date SOugCE REQUNS, eI mol'Ap/J -ems ems— ./�7- Re-roofs �—� S' attire of AppllcaHAZA or H use MATERIALS DISCLOSURE Type of Roof Wilt ft Cupsxcar future Wildingampaptnom or handle dth Health admamrial m defne by Ne Cupertno Municipal Code.Chapter 9.13,and the Heath and Safety Code.Seem 35533(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yet ❑N Will the applicant a m. ilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hmardom air canuminsnts as dcfncd by the Bay Area Air Quality Management all new materials for inspection. Disuta? , —` ❑Yet u Ihaw&Safct the hand manials.25533re 25534.luaapudthaifJm Calif.,. nu Halts&rentlyhowI Imamd et It, myr md353M.1mdersumduatfuant of tng he Does not currently haw a mnanl,tsel it h my responsibility to notify tic occupant of the requlreccoN which must W mel prior ss issuance ofa Certificate of Occupancy. Signature of Applicant Date car a ed ogee Da All roof coverings to be Class "B" or better CITY OF CUPERTINO om 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31636002 . 00 DATE ISSUED. . . . . . . : 09/13/2006 RECEIPT # . . . . . . . . . : 36025 REFERENCE ID # . . . : 06090089 SITE ADDRESS . . . . . : 10925 NORTHVIEW SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : GRAIG ROURKE 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 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- - - - - -- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • CITY OF CUPERTINO OU ugONq oo WATER HEATER • CUPEkTINO PERMIT APPLICATION FORM APN# 3i v A - O� Date - ^© Building Address: c"G�/ c� u Owner's Name: Phone#: Contractor: IPhone: License#: U C - f0 ' C ntact: Phone: Cupertino Business License#: d � - o Bui ding Permit Info: Bldg ❑ Elect Ell" PlumbMech Job Description: D Residential Commercial ❑ Cost of Project: Strapped Li On Platform El Bonded Iff • New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMrfFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING