08110065 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C01tITRACaRI"OTtMATIOk '
BUILDING ADDRESS: ^ PERMIT NO.
. 11220 MONTEREY CT AAA 'FURNACE
OWNER'S NAME: CONDITIONING PERMIT ISSUE DATE
ONE: SA CONTROL NO..
ARCHITECZIENGINEER: BUILDING PERMIT INFO
REPLC FURNACE 80, 00 TU BBLDG ELECT PLUMB MECH
0 0 0 0
goo LICENSED CONTRACTOR'S DECLARATION Job Description
ZC 1 hmeby affirm Nal 1 am licensed under provisions of Chapter 9(commencing -
<t� wish Sccfion700dB.f DiAA 3a(dmlommsandP ofessimu COM.eM my license is
in full f Cma and ✓
License Clan Lk.N
qq Daw Contraztor
ARCHITECTS DECLARATION
77 I understand my plans shall intoned as public rtcorels �— C
JyV
s G 1n Licensed professional
3 OWNER-BUILDER DECLARATION
I hereby from unit 1 am exempt from fhc Contractor's License Law for the
00 following mann.(Section 7031.5,Business and Profs'one Curie:My city or county
which requires;a permit m enwroct alter,improve,demolish,or repair any stmewre
prior to its issuance.also requires the applicant for such permit to file a signed sutemenf
FSG Nat heuliconseJPuramntwtheprovisoaoffhoContrazturil.hxnrehw(Chapfer9 Sq.Ft.Floor Area Valuation
y v- (commencing with Section 71100)of Division 3 of me Business and Professions Cade)or
y S
that he u exempt tbnm(rom and don basis for the alleged exemption.My violation of
Section 7031.5 by any applicant fm a permit subjects due APPlkml to a civil penalty of .APN Number Occupancy Type
not mom man five hundred dallms($500).
0 I,a owner o(di pmpmty,army moployua wire wage as timir sele comPevadon,
wjltdo d ework,and timsfrucmrt is notinended Or offered forrale(Sec.]014,Bus •
M<
and pmrc Andes Caere:The CoWamm's L arae Law does oat apply to an Owner of Required Inspections.
property who builds or improves thereon,and who does such work himscl f m through his
own employees,provided that suit improvement,on,not inferAed m offered for sale.IL
however,me building or improvement is sold within one year of completion,she owner-
builder wall haus the buNen of proving mat he did oaf build or improve for purpose of
nk.).
0 1.as Owner of the property,am Exclusively contracting wit licensed contractors to
construct to project(Sec.7004.Business and Profusions Code:)The Contractor's U.
Oman Law dose not apply to an owner of property who builds or improves Norton,and,
who eommucts far such projects wire acommactoo(A licensed pool mt Be the Contractor's
Licenz law.
0 1 oars exempt under Sec- .B At P C for this tenon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby Aram under penalty of perjury oro o(te following declaration:
Iheroandwill for MbymaCcOibcateofil] e1 oself-iaumfar Wf'mEZ:af due Don, r provided far by Section 3]00 of me labor Code,(er the peafaaman¢of me _
work for which this permit is issued.
0 I have and will maimt,in Warkerr Campeaatio t Insurance,as required by Section
3700 of me labor Code,far me performance of the wart for which mu permit is issued.
My Worker's Compensation In rmen ca 'u and Policy numMramf:�/ J
Cartier. 1 C Policy No.:2 ✓ J iP J�O
C I Fb \TE O EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need cothe completed if to permit is forone hunteddollvs(SIM)
nr least)
I amfify that in thepc,f ssmmee of The wart for which tis permit is issued.I shall at
employ anyperion in any manner an as w become subject to the Workers'Compensation
Laws of Califemia.Data
Applicant
NOTICE TO APPLICANT:if,aBar making this Ceeiftcate of EsemPfion.you should
become subject he the Wenccrs Compensitinn pmvisioa of she Labor Cade.you most
,J 0 forthwith comply wit such provisos a this Permit read be doorman revoked.
„Z„y CONSTRUCTION LENDING AGENCY
[—t I hmreby affirm shot tern u a construedon lending agency for de Performance of -
FL to wart for which this permit is issued(Sec.3097,Civ.C.)
11.7 0 Lenders Name
z Landers Address
C.7 Q 1 certify that 1 have mad this application and row Net she above information Is
1, F carter.I agree to comply wit all city and county mirminces and sum Ito mlming to
0U building construction.and hereby Interim representatives of tis city to enter upon me
r U above-mentioned Property for inspecdon purposes
gy
(WE)agree to save,indemnify ad keep harridan the City of Cupertino against
rFa r/I iimilitiu,judgments.cats and expeaes which may in my may acme against said City
V z i of she granting Of this permit.
ti
APPLICANT
CANTNT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATIONS.
x'-z /�// < a/ray Re-roofs �*L% �
Sig....of Appli -✓Conuacmr D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or factum building occupml arm or handle hmardous material '
az defined by the Cupertino Municipal Cede.Chapter 9.13.and the Health and Safely
Calc.Section 25532(a)7 '-,.y All roofs shall be inspected prior to any roofing material being installed.
ED Yen 4y�s
Will me applicant or future building asnae equipment ea device,whim If a roof is installed without first obtaining an inspection,I agree to remove
It headman air conortnants a:Bned 0.5"",c BArca Ata Qualify Management all new materials for inspection.
Viet?
0 Ya
llovencaddichisociall mawrialsmquimmcnts under Chepmr6.95 of me Glifor
nix Halm&redly have aScmons id.it i my
res an 15534.1 m mAryW fhaif de Wilding
docs not curtcntly have a taunt,shat is u mY responsibility w notify the acupant of me
requ' menrrwhichamWmetpriorEdissusnccofoCcNfeamofOccupancy. Signature Of Applicant Date
41 owner or aamori ed Isenf Dae- All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621025 . 00
DATE ISSUED. . . . . . . : 11/18/2008
RECEIPT #. . . . . . . . . : BS000006641
REFERENCE ID # . . . : 08110065
SITE ADDRESS . . . . . : 11220 MONTEREY CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LANG DONALD J AND MARY L
ADDRESS . . . . . . . . . . : 11220 MONTEREY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4739
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 2 , 725 . 00 0 . 50 0 . 00 0. 50 0 . 00
1EPERMITFE FLAT RATE 1 .00 40 . 79 0 . 00 40 .79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 .00
1MRRAA UNITS 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
•
TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
U?// 0 0
CITY OF CUPERTINO
At Jal FURNACE/AC
ra
• CUPERTINO PERMIT APPLICATION FORM
APN # 2� �a I Ua �- Date: /
Building Address:
oZ C :-
Owner'sName: Phone #:
!�e-42
Contractor: Phone #:
J&dO 02'5'3 S'7/,2
C Fax #:
Contractor License#: Cupertino Business License#:
14-Fe7/ �bSo
Contact: Phone #:4jo� _o? Y71,2
Gd Fax #:
Building Permit Info:
Elecy[/ Plumb nLMech to
Residential Commercial
• Job Description: .
If G v
For Residential Installations:
Attic ❑ I" 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):
02 Vas-
Strapped L On PlatformLl Bonded El New Location Replacement
Project Size: Express Standard ❑ Laz e ❑ Major ❑
Valuation:
7 a,
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
G. FURNACE/AC
CUPEkTINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
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.
I MCREPALT 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.
IMCSUSHTR 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
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
I MRRAA Residential Repair/Alteration/Add to M
ca 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.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
IMRAPPVNT 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