08100165 CITY OF CUPERTINO sf r� zgx�x .<°.at�`x'ia fCtax 'xs ,F,A4a'>s:wN
BUILDING DIVISION PERMIT CONTRt1CTORT1!1FOILMAT�ION '
BUILDING ADDRESS:- PERMIT NO.
20607 PARADISE DR AAA FURNACE
OWNER'S NAME: CONDITIONING PERMIT ISSUE DAIS
ONE: A CONTROL NO.
r.rf nrnio
(408) 293-4717
ARCHI7ECT/FNGINEFR:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECN
0 0 0 0
LICENSED CONTRACTORS DECLARATION Job Description
1 hereby affirm that 1 and licensed under Pmvismns of ChaPlor 9(commcMMZ
with section TOM)of Division 3a1'the Business and Protinum u Code.and my license is
%+=nH inruurnmeand REPLC FURNACE 100, 000 BTU
gJ Z Liceme clew I.ic.N
mac Dam • Contractor JG
`may W CHf1ECf-S DFLIAR ION -
W6 1 understand my pkns 9,11 be used As public records
g6
pis Liccnud Prvfcssional
oat I am BUILDER DECLARATION
Countries
H2qy I hereby aRm o nl 11. ,usin s an the Contractors :Any c law for the
O O following lesson.(section 7051.5,Business and Professions Code:Any city or county
which mquirca a pmmit m amRrsst.alloy,impmw,dcmal'uh,or.,An any su amurt
—£?< prior W is issuance.alms remount the applicant forsuch permit in file a signed statement
that W is licensed pursuantto Me,prA,I..Of the Canonical'.License Lew(chain.9 Sq.Ft.Floor Area Valuation
3�S (mmmencing with Seen=7000)of Division S ofthe Business and Pm(cadms Code)or
dust in Is exempt therefrom and de b..a•for de alleged exemption Any violation of $3150
Sued.7031.5 by any applicant fora Permit subjects de applicant to•MAI penalty of APN Number Occupancy Type
set more urn five b°cored dolWs(S5a0} 35915011 . 00
wi Luowrvolnid pmpvty,mmy wPlendes withmgca uthc(mk mmPcwtim,
will dathmsms.Cedthe1.CornunminLi Lavertdfory Apply 70,114..of
W Property
who
cads Ile Conucmrs And
law does ml apply lf an owner is Required Inspections
man
who huBa orimpovu therrun and who Me nsuen wmkninuelr odthrough his
own empwor.mmsildiag ed thet nonem ut to whim
m occ tended orolertd fm We ll
however.Netion a ordnprovemmtS cast withinutWildyearofmmanforn.theowner-
builder weft neve the WNm of proving Wt K tlitl Out build or improve far purpose of
sale.).
0 1.As owner of the property.am exclusively cmuacting with licomed contacers m
construct the pmjen(Sec.7044,Business and Professions Code:)The Contractors U.
cone Law does not apply in an owner of property who builds or Improve thereon,and.
who cnntrus for such projecs with acamraner(s)Ikensd pmscom As de Conuanora
Lice an Law.
❑lam cscmpt under sm, .B&P C for this reran
Owner Date
WORKER'S COMPENSATION DECLARATION
1 thereby aRim under pwlty Of perjury arc of the falkwing declarations:
1 have and will maintain aCrtiOcateof Const,in self-invert for Workers Compen-
tian.as pmvi&d far by Section 5700 of the Labor Code,for the perfamane of the
wart four which Nu Permit is issued.
0 1 have seat will maintain Workers Compensation lasurmco,As required by Section
3700of the Ladr Conn.far de performauceofde wells for which mu pcmit is Issued. '
My Work ss ComparomonrWurance career and Policy number am/:: )
Cartier. /�y�1 ♦b n.,/ Policy No.:,�I-1.1 Gr0r'U/
IFl ATE E��CFMP ION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need notbecompined[Ionic Permit is fame hundmddaBan($100)
or IOL)
1 certify that in the perfomancc or the work for which this Permit is issued,I Nall not
utopia,any pcnon in my maorcr an n An brmme mb*t to the Workers'Compensation
Lam of Cahlomia.Dam
Applicua
NOTICE TO APPLICANT.If,after making this Ceni lem,of Exemption.you shmW
become subject to the Workers Computation provisions of the Labor Cade you mine
.J vZ forthwith comply with such pmvissi s or this permit"I W dcemdt rtwked. ,
ZO CONsIRucnON LENDING AGENCY. -
[r Ihereby afllm that chert u a.=..dnnkMinL agency for the pmrfarmanceaf
Cthe work for which this permit u issued(See 3097,CN.C.)
W Lcndcrs Name
7 z Ismilm"Adams
U O 1 certify that I bars read this applicium.and she the de.hour information Is
W E comm-1 agree m comply with all city and county oNitunas,nat sale laws rtlatinL k
.C)sr.'7 Wilding construction.a ad hereby mthonce mpresenutisss of this city m color upon ft
W aWw-mendoned property for impembon pugwseL
6. (We)agree to an,indemnify and keep harmless Oe City of Cupertino All
to liabilities,judgments.toss and eapnurs which may Wary my amine against said City
U z in consequence of to gnWng of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L'7 tit'
SOU EREGULATIONS.
7cofAWl 0=enl - , f D)AI Re-roofs
Signuurt of AppliwnHAZARDO Do
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant all forum Willing occupant amrt or handle Health anmamriW
C de.Section
io the 32(a)?na Municipal Code.Chapter 9.13,and the Health and Safety
Code.seW es 25s3zU)7 All roofs shall be inspected prior to any roofing material being installed.
O Yrs No '
hk
Will the applicant Arm Wilding occuWm use equipment or dcvivs which If a roof is installed without first obtaining an inspection,I agree to remove
On herallow air con amino ss dcrtned by the Bay Area Air Quality Management all new materials for inspection.
- urictT
pYca o
I ban maid the haandoosmmcriaurtquimescw un&rCWpw&95 Of tee Califor.
nia Health&SalclyGOdc,SxsicrenM5.25533 and 25534.1 undamoul Module Wilding
dues rot currently new a umans dist it u my responsibility to notify the account of the
7itiremmus which mum hcmet priarth issuanec afa certire.¢arampane/y./,' Signature of Applicant Date
o�o-e gt" � Za44y !4 All roof coverings to be Class'%r "or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35915011 . 00
DATE ISSUED. . . . . . . : 10/27/2008
RECEIPT #. . . . . . . . . : BS000006465
REFERENCE ID # . . . : 08100165
-SITE ADDRESS . . . . . : 20607 PARADISE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KOSOLCHAROEN CHAROEN AND WINNE
ADDRESS . . . . . . . . . . : 20607 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4063
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3 , 150 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
1MCRAA UNITS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
----- ---------- ----------
TOTAL PERMIT 286 . 04 0 . 00 286 . 04 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-------------------
CREDIT CARD 286. 04 VISA
---------------
TOTAL RECEIPT 286 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
0U/ (off
CITY OF CUPERTINO
FURNACE/AC
• IF
CUPEkTINO PERMIT APPLICATION FORM
APN # 67)// U Date:
Building Address:
Owner's Name: Phone #:
i�0
ir-
Contractor: Phone #: A/ol., 5,3 d �l 7
1-41PAO Fax #:
Contractor License#: Cupertino Business License#:
Contract: T� Phone #:yW P"71,7
bfQk' y /rcw�2/ Fax #:
Building Permit Info:
Elect Plumb ❑� Mech �—
Residential Commercial
Job Description
s:
nn
�G lace y v/ il4c� /00 moo /�TL>
For Residential Installations:
Attic ❑ ls` floor ❑ 2nd floor ❑
Adhere to minimum setback 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 (Usage Class):
Strapped On Platform Bonded New Location LJ Replacement
Project Size: Express [Standard ❑ Lar e ❑ Major ❑
Valuation:
I/ �D
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index. �—
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Tv
pe
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system;incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1 MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
r cooling unit,absorption unit,or ea
` heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type