The URL can be used to link to this page

07080038 7777777777777777. CITY OF CUPERTINOg�y�Ia��tL ��1 � �� . BUILDING DIVISION PERMIT `. PERMIT NO. BUILDIiC1 D�R-ESS RANDY LN AAA FURNACE & AIR 07080038 UU ,jj ND I T I ON I NG PERMIT ISSUE DATE OWNER'S NAME: JEAN—CLAUDE ROY 1712 SAMA O. CONTROL NO, BUILDING PERMIT INFO ARCHITECTIENGWEER: REPLACE FURNACE 80, 000 BR1J BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION ECOND Job Description 7 ,... .. ,.. .....,_� - i_ I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing y with Section 7000)of Division 3 of the Business and Professions Code,and my license is i in ful�i�A Z LicenLic•4f - p DatContractor C m CI-S DEC N I understand my plans shall be used as public records G U F" Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the c�L following reason.(Section 7031.5,Business and Professions Code:Any city or county {i which requires a permit to construct,alter,improve,demolish,or repair any structure :,,4 prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of ApN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law docs 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.If, 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law' B&P C for this reason ❑I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: U I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers compensation . compensationnsurance carrier and Polity, number are: CarrierPolicy No.:��C RTPI / i F rION FRO ERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less.) I eertify 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Codc,you must forthwith comply with such provisions or this permit shall be deemed revoked. C) CONSTRUCTION LENDING AGENCY 4 rte- 1 hereby affirm that there is a construction lending agency for the perfornancc of the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lenders Name Lender's Address 0 I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorirc representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmlessthe City of Cupertino against o r/) liabilities,judgments,costs and expenses which may in any way accrue against said City Zin consequence of the granting of this permit. Date OF 6 .- A* APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUCEREGU APO, P NS. sy ' �;2 Re-roofs Signature of Applrcant/Con"mor t. Dtye Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 Codc,Sccuon 25532(a)? All roof s shall be inspected prior to any roofing material being installed. ❑Yes o If a roof'is installed without first obtaining an inspection,I agree to remove Will the applicant future building occupant use equipment or devices which all new materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? ❑yes o I have read the hazard s materials requirements under Chapter 6.95 of the Califor- niaHcalth&SafctyCode, Ons 25505,25533 and 25534.1undcrstandthatifthcbuilding docs not currently have a tenant that it is my responsibility to notify the occupant of the Date requi mens which must be met prior to issuance of a Certificate oI Oc paney. Signature of Applicant All roof coverings to be Class"B" or better caner or auth :cd agent are CITY OF' CUPERTINO 8 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: B7.k: Lot: APN 3:.624024 . 01 DATE ISSUED. . . . . . . : OE;/06/2007 RECEIPT #. . . . . . . . . : BS000002269 REFERENCE ID # . . . : 0''080038 SITE ADDRESS . . . . . : 10243 RANDY LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JHAN-CLAUDE ROY ADDRESS 10243 RANDY LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JM RANDO CONTRACTOR . . . . . . . : RiUNDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP . . . : SJ�N JOSE, CA 95125 TELEPHONE . . . . . . . . : (,108) 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 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 BREMRECEPT NO. OUTLETS 1 . 00 1 .20 0 .00 1 .20 0 . 00 BSEISMICRE VALUATION 9, 500 . 00 1 . 00 0. 00 1 . 00 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 176 . 74 0 . 00 176 .74 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 07e�? 0C) CITY OF C UPERTINO FURNACE/AC CUPS TINO PERMIT APPLICATION FORM APN #3 ( / ( Date: Building Address: / L. Phone#: Owner's�N,a�jme. Y—W_"I?r;1 5--9_9C Ai r—� 1;F10 lle. Contractor: �7,�f f,/ Cupertino Business License#: Co tact: Phone: Building Permit Info: rtv Bldg ❑ Elect F lumb ly Mech Job Description: _ S�a� z Residenti [,' Commercial ❑ For Residential Intallations: Attic ❑ 1St floor � 2nd floor❑ Adhere to min set back requirement For Commercial Installations: replacement same weight nAdditional weight (structural calcs)❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Occupancy ou CostE oject: Type ofstru�,tion: p �� p' Bonded I Sq.Ft. Floor Area: Strapped ❑ On Platform New Location Replacement eKJ Qty. if Fee Description Fee Grou Applicable Fee ID BUILDING BENERGY Energy BREMFURN Furnace MECHANICAL jX Unit> 10,000 cfm MECHANICAL BREMACOVER MECHANICAL ( BREMAIRHAN Y�/C Units<= 10, 000 cfin lZec tl Switch& Outlets ELECTRICAL BREMRECEPT p BUILDING BSEISMICRE Seismic Fee Res BUILIDNG ELECTRICAL BSEISMICOM ,Seismic Commercial E �?lec Permit Issuance ELECTC ( EPERMITFEE MECHANICAL ( MPERMITFEE Mech Permit Issuance Plumbing Permit Issue PLUMBING PPERMITFEE BPERMFEE 13ldg Permit Fees BUILDING BPLANCHK :'Ian Check Fee BUILDING BPGAS el Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 uCITY 0F` Fax(408)777-3333 'VEkTINO Buildin De artment JOB ADDRESS: PERMIT # 010 900 OWNER'S NAME: - - PHONE # -oZS GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signatur6 Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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