06040068 (2) CITY OF.CUPERTINO
BUfA.DING DIY'ISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: AAA FURNACE k AIR CONDITI ) °'06040068
20985 PEPPER TRE.E. LA
OWNER'S NAME: PERMIT ISSUE DATE
BILL BECK 1712 SjQNE, AVE a4'11
. PHONE: SANITARY NO,
CONTROL NO.
(408) 293-4717
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
i00 LICENSED CONTRACTOR'S DECLARATION lob Description
'.t uC I lereby grim that 1 and licensed under provisions of Chapter 9(commencing
ua tJ with Section 7IX0)of Division Sof de Business and Prcfeasiuu Code,anal my lkerueu
+ y infull to=dndgC Lr.ffam rL a ,7 . REPLACE FURNACE AND . DUCTS DOWNSTAIRS . RUN GAS
322 Z_ License Cie '
=mac Dam crmramor LINE FOR STOVE FROM METER
' ty 'ARCHITECTS DECLARATION n 'j '
So,< I understand my plans shall W used u m
public cnNs
5yU
'0 Licensed Professional,m5OWNER-BUILDER DECLARATION
f I hereby M.
that 1 am exempt from the Contracmrs License Law for ft
OC following mason.(Sacdon 7131.5.Business and Profusions Code:Any city or county
3 m(< which rtgti.a permit to emsweL shun,Improve.demolish,Or repair any swmua
_Z v, prior w its issuance.also requires the applicant for such permit to file,a signed moment
< tbe,hcislicensed pursusnt1.the,proom usoflhcContzctoriLiecnscLaw(Chapar9 Sq.Ft. Floor Area Valuati$4
O O 0eta (commencing with Section 7000)of Division 3 at the Busmen and Professions Cock)or
y Nat M u exempt therefrom aro the Wantfu the allcgod assure pton.My violation of
Seedrn7031.5 by a try applicant for a Permit subjects the apPlicamt to a civil Penalty of APN Number Occupancy Type
not more than five hundred dollars(3500). 35912018 . 00
❑L and.
owner e.die propmty,car is untended with wages v parole(Sam.
Bu inns
and Professions
and theswmum isnotlaLt. orawada hot apply 71%4,Busman Required Inspections
proand Rty who W Code Than Conuaarrs tart who law does rot apply m r t mums is q P
man enywho Wilds on ire proatchimprovedwbo d�es¢tint wokM1 offerer forage Au
ownemployees,providedthmsucnt improvementsartnot ear of,rorrRcmd roe savmmI however.the Wilding or improvement u said within Out
year of c prove for
the owmr-
sale).r will have the When of proving WI he did wt Wild m improve for puryme of
sale).
❑1.a owner of the property am exclusively contacting with Handed compact to
cnnstact the project(Sec.7014.Bunaw and Professions Code:)The Contractor's Li-
ccnse law dors oat apply m in owner of propeny who Wilds or improv lemon,and.
who contacts for such projects with a contacwr(s)licensed pursuant to the contractors
Lica.Law.
❑ Iamcxemptunder Seta .B@PCforthismaaon
Owner Dae
WORKER'S COMPENSATION DECLARATION
1 botchy affum under puulty of perjury roe of did following declarations,
1 have and will maintain aCerdriam of Consent w self-insua forWorkcrs Compen-
sation,as provided fm by Section 37M Of the labor Code,far the perf..of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as mqubed by Section
37Mofthe tabor Code,for Ne performance offs work for which this Permit Or issued. '
My Workers Come nsauon lnsuurluta casriumd Poliryummbcrm
Carriv J1 R�TIFlCA OF � Policy No.:PITON FROM WORKERS'
COMPENSATION INSURANCE
(Thu sermon coed not W completed inhe permit is foram,hundred dollars(SIM) a
sr less.)
I ccrufv thus in thepcarformarce of tW work fa which Nis Porth is issued.I shall not
employ any person is any mermen.a to Wcoma subject to the Wurkeri compematim
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,after making this CeniOam of Exemption,you should
become subject to Ne Workers Compensation provisions of the V Wr Code,you moa
.J z forthwith comply with such provisions or this Permit shall bis deemed mated. ,
OCONSTRUCTION LENDING AGENCY
[-+ 1 Waby affirm the thea is.construction lending agency far the pe,fdarm.of
0.! the work fur which this permit is issued(Sec.3097,Civ.C.)
led Q Tondos Name '
jz Lenders Address '
U 0 1 ecrtify that I have mad this application and some that Ne above information is -
ly P corms.l agru m comply with all city and county rNinaacs and sum laws relating w
O[) building eonstuction,and barely authonne mprescnutiva or this city to enter upon de,
0. shove-mcmioncd Pmpc on for impasses purposes.
(We)ague 1.....indemnify and kap harml,ss the City of Cupcnlno against 42 9
F,C1. expenses permit. may in any wayaccrue again said City
(J,z in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SODU/_WRryQE REGULATIONS.
Signature rrApprcadgCor on Dine, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future Wilding oceupartstor,or handle Woodman material
as&food by Ns,Copefino Municipal Cod,.Chapter 9.12,and the Health and Safety
eon ,Section 25532(a>7
❑Ya �6a All roofs shall be inspected prior to any roofing material being installed.
Will the spplinnt or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hapardam air aonm ones as dc0ned by the Bay Axa Air Quality Manag,mcm all new materials for inspection.
Dis nm?
oYcs �o
1 have mw the hvarMxwmamnals requirements undo Chapmr G9S rfth,Califon
niaHwW&Safety Cods,,Sccuom 25505,25533 and 25534.1 understood thatifthe Wilding
Joel ort cumad,have a tenant.that it u my responsibility M twufy the accupant or IW
regti meow which amtW met prior to issuance of a ccrdreae or Occupamy. Signature of Applicant Date
'/ �aM�v A9 7 bE
Owner or authodad agent Damg
All roof coverings to be Class"B"or better
' '
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
SfTYOF Fax(408)777-3333
OCUPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER' NAME: PHONE # Frf VV-3-5
CONTRACTOR FAX #
I am not using any subcontractors: /5 ///... .- .c �,a� _ /*
Signature ;/-,c Date
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 G
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date
J
CITY OF CUPERTINO
tem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35912018 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT # . . . . . . . . . : 33967
REFERENCE ID # . . . : 06040068
SITE ADDRESS . . . . . : 20985 PEPPER TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BILL BECK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95015
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
---------- ------------- ---------- --------- - ---------- ---------- ----------
BPGAS OULETS 1 . 00 5 . 40 0 . 00 5 . 40 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
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 170 . 18 0 . 00 170 . 18 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 170 . 18 VISA
TOTAL RECEIPT 170 . 18
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
0
CITY OF CUPERTINO
�--- FURNACE/AC
. CUP RTINO PERMIT APPLICATION FORM
APN# 3� _12 -ova Date:
Building Address:
0 - e i-
Owner's Name: I fPhone#:
Con ractor: Phone: License#:
Contact: Phone: CupertinoIjusiUgs License#:
2 zx-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description: fv� r/auc
4?"Alf« / Y oLe
Residential Commercial ❑
For Residential Insta ations:
Attic ❑ I't floor 2nd 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: Type of Construction: Occupancy oup:
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable, Fee ID Fee Description Fee Group
/ BENERGY Energy BUILDING
tl BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLOMBING'
BUSLIC Business License BUILDING