06090091 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT COrITR'ACTORINFORMATION
FBUILDING ADDRESS: DUNAWAY JAMES F AND LOUIS PTN"TNo'06090091
22617 ROYAL OAK WY
O W NEWS NAME: PERMIT ISSUE DATE
DUNAWAY JAMES F AND LOUISE E 0
HE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG
t ELECT FIT
MEC0H
0
LICENSED CONTRACTOR'S DECLARATION Ib Description
uF 1 hereby affirm Nat OCSCTI I am licensed under provisions of Chapter 9(commencing P
�Zt3 with Sccuon 70110)of Division 3 of the Business and Professions Cade.and my license is
!.�N in(Oil foueandeffem. REPLACE FURNACE AND A/C
;4Z Lieensm Clea Lim.k
r O Dam Contractor
V££ ARCHITECTS DECLARATION
C< 1 understand my plans shall be used as public records
'yu
Licensed Professional
OWNER-BUILDER DECLARATION
1 I heuhy allium Not I am exempt from the COmractmrs License law for the
e 0 0 fallowing mason.(Section 7191.3,Business and Professions Code:My city or county
which requires a permit to ennswet ally.reprieve.lsmolW,or repair any suuctum
prior lis its issuance.also requires thcapplinnt Orauch permit to file asigncd summem
< Net he is licensed pursuant Sq.Ft. Floor Valuation
t1
IFC (commencing with Section 7")of Division 3ofdicBusiness and Professions Code)ser $4284
Nat be u exempt the ofman and the buss for dm alleged exemption.Any violation of
Secdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mare than five hundred dollars(3500). P Y YP
pI,uowocrof Nerypmny,mmyemploycuwithwagesu Irk wlecompemdon,
will do the work,and Ncswctum is notintenhd or offered forsake(Sec.7066,Business
and Profcssimr Codc:The Convacurs Lions,Law dean nut apply as an owner Or _ Required Insp 'Drs
propeny who builchimimprom dmment.and wh idoensuchwohhimseJf m through his
own employees,provilsd Nat such improvements art notinunded oroffered for sale.If.
however,Ne Wilding or improvement u said within one year of rnre hmi.m.no own..
builder will Tuve the Wrde s of proving that he did hot Wild or improve for purpose of
Sale.).
❑1,as Owner of the property.am exclusively convening wit licensed contractors to
construct the project(Sec.7064.Business and Pw(esvou Cade:)The COnvaeurs Li-
cense law does not apply w an owner of property who builds Or improves theses.,and
wWconoacu(or Such cos widea eanlractor(e)licensed pursuant tithe Convacoms
Lice.LxP
❑lnot exempt underSec. .Bh PCfa "mason
Own
WORKER'S COMPENS ON DEC N
�I hereby affirm under penalty of ry can of Nc following declarations:
❑1 ham and will maintain sCeniOote o(Caucnt a self-iuure for WarkersCompen-
anion,as Proviced for by Section 3700 of die Labor Cade,far dm performance of the
waft for which this permit is issued.
1 have and will maintain Wortrh Compensation Inpuamce,as required by Section
3700 Of she labors Code,for the performance Often work for which his permit in issued. '
My Workers Compenaauon Insurance carrier and Policy number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section teed natbe conpleud if the permit u formic hund eddoBars(SIM)
or Icss)
I feni(v
Lot
the perfo cm of Ne Oh 1 thio Perm's u issued,I shall not
employ any perwni ymwncr Um WoO"a CO peossdon
Laws of
California
Applicant
NOTICE 70 APPLI 'NT:IL alms making Nis Cenifinm Of on,you a.."
become aubjcc Wahcri Compcuation provisio IaWr Code you must
.J 0 fo,.i,co ply with such provision or this Perm' a0 be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that then is a couvuctm.lending agency for dm performance of
C Ne work for which this permit Or issued(Sce.3097.Civ.C.)
W�Q Lenders Name
.7 z Lenders Addteu
V O I certify that 1 have read Nis application and sum that the above information is
U, F^ cored.I agree to comply with all city and county ordinances and state laws misting to
QU building censuuction.and hcubyamh....c represemativmSof Nis city to cnlcrupnn the,
r!A ahovomcntioncd property for inspection purposes.
Q. (We)agree eto sant,indemnifyand keep hay in andmyCity of CupcniIsagainst
fg Liabilities,uernec cnts,cents
reamu c iia which may in any way accme agaiesa said City
U z APPLICArcco(DEAuftidpl
As
PcrmdCOMPLY WITH ALL NON-POINT Issued by: Date
50QRCE RE LATI
Re-roofs
Signa a(ApplicanuDau
HISCLOSURE Type of Roof
WilllMapplinupant sure or handle horardeus material
u defined by do Cupehapter 9.13,sad Nc Health and Safetycels.Sc Y.e.2ss32a All roofs shall be inspected nor to an roofing material beim
❑res �� p p � y g g installed.
Will f applicant of future building occupant sew equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by she Bay Area Air Quality Management all new materials for inspection.
District? 1 /
0Ycs
1 have real the haraAnus materials te"irements undcrchapur Q95Oflbe c uirm.
nim He.10i Safmy Cols.Sccumu 25305.25533 and 23534.1 understand thui(dc Wilding
doy_rwt aartnd have a tenant Nati ' nihility u notify du occupant of the
-ffyuimmcnts wh hmutth rot once Certifuate of ancy. Signature of Applicant Date
o 1..th.A.n ag t p,m All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
iso Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
2 a6( O�/w0 O 00 �t
OWNER'S NAME: u v PHONE # 0 2Sf= z
GENERAL CONTRACTO M0 FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontra tors 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
3 gjiqz.
�/ Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot.:
APN . . . . . . . . : 34232009 . 00
DATE ISSUED. . . . . . . : 09/13/2006
RECEIPT # • • • . . . . . . : 36026
REFERENCE ID # . . . : 06090091
SITE ADDRESS . . . . . : 22617 ROYAL OAK WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DUNAWAY JAMES F AND LOUISE E
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : JAMES DUNAWAY
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : DUNAWAY JAMES F AND LOUISE E
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
•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
BSEISMICRE VALUATION 4 , 284 . 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 175 . 04 0 . 00 175 . 04 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---------- -- - ---- ---------- - - ------ - -----------
CHECK 175 . 04 2523
TOTAL RECEIPT 175 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO �
FURNACE/AC
OCUPEIyTIN0 PERMIT APPLICATION FORM
APN # Date:
SEPT
Building Address:
Owne{'s Name: Phone#:
J w aLSE v v61'r' t4 2-s5
Co actor: Phone: License#:
ova A�< Ncr�ti� aA� z 6 -
,q4l
Contact: Phone: 2 SS_ �-2- k I-/ Cupertino Business License#:
0/6000 3" �
Building Permit Info:
Bldg ❑ Elect Plumb 0---� Mech
Ef-
Job Description:
Residential Commercial ❑
For Residential I t llations:
Attic ❑ 1s` 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 ❑
Costof Project: Type of Construction: Occupancy groip:
L
Strapped ❑ On Platform Bonded Er 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 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
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING