The URL can be used to link to this page

07020079 CIT' ?PERTINO BUILDING MVISION PERMIT � �t 0 I} QRrMATI®►1�1' PERMIT NO. BUILDING ADDRESS: 21909 RUCKER DR AAA FURNACE & AIR 07020079 OWNER'S NAME: N I NG PERMIT LSSUE DATE JULIE PEARSON 1712 STONE AVE 02/14/2007 SANITARY NO. CONTROL NO. NE: (408) 293-4717 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 p p LICENSED CONTRACTOR'S DECLARATION Job Description W p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE H in full force an f License C1 19 Lic•R Da — Conuactar U Luv ARCHITECTS DECLA A y i a< I understand my plans shall be used as public records �W .Mu U.ti Licensed Professional h OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county $ff which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation - < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area ti Fz (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2700 i that he is exempt therefrom and the basis for the alleged exemption.Any violation of �pN Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 615 013 .-UU Number Occupancy Type not more than five hundred dollars(S500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended oroffered forsale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.11, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. Q 1 am exempt under Sec. B&P r this reason Owner KERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]1 have and will maintain a Certificate of Consent to self-insum.for_Workees Compcn- sation,as provided for by Section 3700 of the Labor Code,for.the performance of the work for which this permit is issued Q I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My worker's Cogtpensation Insurance carrier and Policy number are: carrier��LC/ Policy No.: `V ATE F EXEMPTION FRO ORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Fri-+ 1 hereby affirm that there is a construction tending agency for the performance of (� > the work for which this permit is issued(See.3097,Civ.C.) WCI.A Lendces Name 0 Lender's Address U 0 1 certify that I have read this application and state that the above information is ( correct.1 agree to comply with all city and county ordinances and state laws relating to rJ Ubuilding construction,and hereby authorize representatives of this city to enter upon the U ahove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date ►' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: s4ckw SO REGULATIONS. Re-roof: TafnaturedtApplicandgm.ractor DateType Of RoofH RDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or�]No rc building occupant use 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 the Bay Area Air Quality Management all new 1 naterials for inspection. District? Yes o 1 have read the hazard(uS s materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the re ' menu which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date `I �f��W�� ;L All roof coverings to be Class"B"or better '(1w-4er or authorized ager Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl.t: Lot: APN . . . . . . . . . 35515013 . 00 DATE ISSUED. . . . . . . : 02 /14/2007 RECEIPT #. . . . . . . . . : BS)00000463 REFERENCE ID # . . . : 07 )20079 SITE ADDRESS . . . . . : 21)09 RUCKER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JU1,IE PEARSON ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4759 RECEIVED FROM . . . . : RE2EIPT INTERFACE CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 STONE AVE CITY/STATE/ZIP . . . : SAV 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 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BSEISMICRE VALUATION 2, 700. 00 0.50 0. 00 0.50 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 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 164 .78 0. 00 164 .78 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 164 .78 VISA --------------- TOTAL RECEIPT 164 .78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL . e CITY OF CUPERTINO 0�0200�q FURNACE/AC r:UPERTINO PERMIT APPLICATION FORM APN # Date: 75510- I Building Address: UC �/'2. 11 Co Owner's Name: Phone#: /;& & Contractor: Phone: License#: f vIff 71 Contact: Phone: Cupertino Business License#: eor- Buildin Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Residential x Commercial E]For Residentiial Installations: Attic ❑ 1" floor F 2nd floor❑ Adhere to min set back requirement❑ vor Commercial Installations: Replacement same weight ❑ Additional weight(Aructural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Constniction: Occupancy group: ,1 Strapped On Platform El Bon ded 11 Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applica le Fee ID Fee Description Fee Group BENERGY anergy BUILDING BREMFURN ,urnace MECHANICAL BREMACOVER AJC Unit> 10,000 cfin MECHANICAL BREMAIRHAN .JC 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 BPGASGas Piping System Fee PLUMBING BUSLIC Business License BUILDING