08120065 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTQRINFQRMQQTION -
BUILDING ADDRESS: PERMIT NO.
7390 RAINBOW DR APT 2 R&B HEATING AND All" nP1200 9
OWNER'S NAME: PERMIT ZSUE DATE
kc LLG WQQW-HIYE� AVE A CONTROL NO.
(408) 977-1401
A0.CHI7ECfRNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
u O p LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Inas l w festeredunder provisions rf Chame,9(mmmcnpn{ Job Description
with Section 70M)off)II..3ofthe Business and ProfcssCwm Cade,and my[1...1.
H in full forceanderfec6�ZC3 '�I 7Z�-�- RPLC FURNACE IN CLOSET,
Licarue Clw !' Li, '
F Dae Character
ARCHITECTS DECLARATION
1 understand my plans wall be,used u public records
'6
'Wt;O4mw1 bene"Professional
OW NEm BUILDER DECLARATION
Sys 1 hereby affirm
that 11. .Bump,from dss Cerin. o IJcense law for the
E 00 which re Rama. Pantie i 7631.5.Busher and vis. tans demolish.oe:Any rity s county
S$ which rtquires n permit w ruim th L mer,nt par su ermtior repair ed tmdue
prior to it lRaaM4also lCquithe lneapionso rhe,such muse macefile s,Law(ChICTent
ss Nathislicensedpurman,rod¢provisionsoffcChnuacmrsLic�salaw(Ch.pmr9 Sq.Ft.Floor Area Valuation
yF 9 (commencing with Semon 700M of Division 3 of the Biomass and Pmfessioes Codc)or 15 Q
— that he s exempt damfmm and the basis for Ne alleged exemption.Any violation of
Section 70315 by arty applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nen firs hundred dollars(SIM 3 6 619 018 .APT 2
1,as nat¢r of the Property.art my employers with wagesu dab mIc wmpenudon,
will dodevwona andth<he Conaawtintended, awdo(saute(See.7014,owner••
aro property
who builds
Corr:The Improves
trcmrs cad who Taw dors set apply if rt owner is Required Inspections
own
that
thueonandwba dcesaochwork hswlfor forage of, r
however.the Wilding
provemimprowmentsmne ewofdmo@rM for monex, ,
however.the building orimP a pr000 scold within oneyear orImprovefortheowrer-
ask.). w10 have Ute buMn of paving that h die set btiW a imptaw for purpose of
talc.).
❑1,as natter of ft property am eachadvaly contracting whin licensed onnmctoas m
construct the Project(Sec.7W.Business add Profwiom Coda::)This Com seem'&Li-
came law does not apply m an owner of property who builds or unproven thtaon.and.
who contracts for sure projects with aeonrxmo(s)licensed puremnt a the Comeactoes
Deena law.
❑I am exempt under See .BAt PC for Tisa
Owner Data
WORKER'S COMPENSATION DECLARATION
1 bereby aDrm under penalty hr perjury arc of the following deeWatimsc
have ole will maintain•Certiricmi of Cownuo self-instate for Wooers Compen,
an.u provided for by Section 3700 of the labor Code,for W performance of to
wart for which this Permit is issued.
❑1 have and will maintain Worker.Compensation Imwancs.u required by Section
3700 offt Labor Code.fon the performance of t e woe for which Tis permit is issue 1.
My Worker.Conalwdem Wurana ca 'er and Policy numhr ate:
Grier. Polity Na.: //eUL��
4CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Inds action=it not h completed lith Permit Is forces hundred donass($1001
or Ices)
I cenify that in the peri nnance of this wart for which this permit is leaned.l shall not
amplry any person in any m smarm w to bahme subject to dss Warken'Csmpewtion
Laws of California.Data
Applicant,
NOTICE TO APPLICANT:IL after making this Cenirteate of Exemption.you should
become subject to fc Wahcrs ComNmdm provisions of the Lahr Code you mut
., O forthwith comply with such provisions or this permit Nall h dcemed revalued.
Z^ CONSrRUCnON LENDING AGENCY
[—, Thereby aff.that them lea consructinn leading agency,for da perronnancehf
rL the work for which the permit is Issued(Sec.3097,Ci,C.)
QLender's Nurse
z Lender.Address
U O I«airy that 1 have read Tia application tab mass that the Now misrmadun is
torten.l agree to comply with all city and county on insnces and sue laws relating to
.� building construction,and herehy euthodm representatives of fts city in enter upon the
.nom-mentioned property for Impression purposes
Er+d (We)agree to taw.indemnify and 4ep harmless the City of Cupertino+{sunt
fn
liabilities.judgments.cos;and esperaa which may in any way..against said City
U,z in consequence of the{ranting of this permit.
^� APPLICANT DERSfAND D WILL COMPLY WITH ALL NON-POINT Issued by: Date ��'
SOURCE ULATIONS.
Signat r es Dec
Re-roofs
HAZARDOUS MATERIALVISCLOSURE Type of Roof
Will the applicant or future Wilding occupant sans or handle baaudow material
as dented by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0N
W II the applicant or future building occupant the equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
havardnus air contaminants sed lined by the Bay Area Air Quality Management all new materials for inspection.
Is
❑Yes ❑No
I haw feud the huamrwmaedssrequirements under&Ncr6.95 of the Celirm-
niceHealth&S yCade.Sreth.2550.25533 and 25534.I understand deaffe building
dace rat cv y how a team t that It s su vpofa Certificate
in rodfy cc occupant of de
require which muttrw'Jtpoor(tai;`\wmrxar.cen irtntearecaPanay Signature of Applicant Date
2-5��
ter or authorized,g m / ateAll roof coverings to be Class's"or better
CITY OF CUPERTINO
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36619018 .APT2
DATE ISSUED. . . . . . . : 12/04/2008
RECEIPT # . . . . . . . . . : BS000006761
REFERENCE ID # . . . : 08120065
SITE ADDRESS . . . . . : 7390 RAINBOW DR APT 2
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ORION EQUITY LLC
ADDRESS . . . . . . . . . . : 7390 RAINBOW DR APT 2
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RAMIRO BEJINEZ
CONTRACTOR . . . . . . . : RAMIRO BEJINEZ LIC # 29480
COMPANY . . . . . . . . . . : R&B HEATING AND A/C
ADDRESS . . . . . . . . . . : 12610 FOOTHILL AVE
CITY/STATE/ZIP . . . : SAN MARTIN, CA 95046
TELEPHONE . . . . . . . . : (408) 977-1401
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------------- ---------- ------ ---- ---------- ---
1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
IMPERMITFE 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 338 . 85 0 . 00 338 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 338 . 85 VISA
---------------
TOTAL RECEIPT 338 . 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --- ------------- ---
505 FINAL ELECTRICAL 507 FINAL PLUMBING.
508 FINAL MECHANICAL
•
Community Development
10300 Torre Avenue
E�^I Cupertino CA 95014
`MJ Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS' Y '(t, Z PERMIT # �( 'L-. O
OWNER'S NAME: ea v - L PHONE #
GENERAL CONTRACTOR: jC12 //,<z I FAX #
I am not using any subcontractors: .K eve" ,��
Signature Date
Please check applicable subcontractors and complete the followin 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
Owner/Contractor Signature Date
641 aa�5
CITY OF CUPERTINO
d FURNACE/AC
C1 OF
:CUPERTINO PERMIT APPLICATION FORM
APN# 3 �P tP I C�/O Date;
Building Address:
I�-
Owner's Name: Phone#:
py/(_lv !� v/�y
Contractor: W IPhone#: Yap F77 7 /C/O/
C/t'r/Xr6 . ��� e_ Fax #:
Contractor License#: Cupertino Business License#:
z
Contact: Phone#: (/a S, S�/S'-o 7- 6
yBl� `Ss'-G���o yv�r �R7
Fax #:
Building Permit Info:
Elect Plumb Mech ar
Residential ❑ Commercial ❑
Job Description:
I o GCQ• iw C���T
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):
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Ej�—
Project Size: Express e-'—"Standard ❑ Large ❑ Major ❑
Valuation:
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
at
CITY OF CUPERTINO
FURNACE/AC
CUPE(,TINO 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.
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.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS 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
1MRRAA Residential 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.
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 ¬ incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type .
Gronn