06100003 71
CITY OF CUPERTINO TaN-F( �(� :
BUILDING DIVISION PERMIT
BUILDING ADDRESS: AAA FURNACE & AIR CONDITI 0 610 0 0 0 3
18841 ARATA WY PERMIT ISSUE DATE
OWNER'S NAME:
ZOE THOMPSON 1712 STONE AVE 02 2006
SANITARY NO.
CONTROL NO.
)NE:
(4 08) 293-4717
BUILDING PERMIT INFO
ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH
i o p LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby arm that I am licensed under provisions of Chapter 9(commencing
z affirm
R, with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 50, 000 BTU WALL HEATER
y in full force and c
v�Z License Class Lic.M
t— Date Contractor
Ui
ITECTS DECLAR r, 'I .
2 a e 1 on nd my plans shall be used as public records C
>yU
H Licensed Professional
h� OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
C C O following reason.(Section 7031.5,Business and Professions Code:Any city or county $1525
e.ff which requires a permit to construct,alter,improve,demolish,or'mpair any structure
Z r prior lu its issuance,also requires the applicant for such permit to Glc a signed statement S Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �]
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of r 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).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is notintended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's 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 Contractor's Li-
cense Law docs 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 Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for the performance of the work for which this permit is issued.
y of
Com ens tion su nce ca
Inrrier and Policy number am:
Carrier: '' a Policy No.: G�
CERTIFICATE OF EXEMPTION FROM RS'
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
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z . CONSTRUCTION LENDING AGENCY
[tet tom) I hereby affirm that there is a construction lending agency for the performance of
(Z!> the work for which this permit is issued(Sec.3097,Civ.C.)
(Ll Q Lender's Name
f] Lender's Address
U 0 1 certify that I have read this application and state that the above information is
w correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
>• nWi (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 by:
SOURCE REGULATIONS.
lj L Re-roofs
rgna ure o Applicant ontractor D* T Of Roof
AZARDOUS MATERIALS DISCLOSURE Type
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 roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant o future 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 materials for inspection.
District?
❑Yes o
1 have read the hazards us materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
re ircmcn which must be met prior to issuance of a Certificate of Occup ey. Signature of Applicant Date
All roof coverings to be Class"B"or better
ner ora hori-zed igcnL Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"WEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
0c0 t 00003
O R'S NAME: Za �� PHONE # o
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
6�
Signatule Date
Please check applicable subcontractors and complete the following 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
CITY OF CUPERTINO
] 1 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37512033 .00
DATE ISSUED. . . . . . . : 10/02/2006
RECEIPT #. . . . . . . . . 36271
REFERENCE ID # . . . 06100003
SITE ADDRESS . . . . . : 18841 ARATA WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ZOE THOMPSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMFURN NO UNIT 1.00 14 .31 0.00 14.31 0.00
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BSEISMICRE VALUATION 1,525.00 0.50 0.00 0.50 0.00-
PPERMITFEE 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
---------- ---------- ---------- ----------
TOTAL PERMIT 126.41 0.00 126.41 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
CITY OF CUPERTINO Out O`DO3
T'. 'Y +
�SV
A .
CUPEkTINO PERMIT APPLICATION FORM
APN# 3-15 Oss
Date:
Building Address:
Owners ame: Phone #:
Zoe I10 oLfA2 a "ao� -
Contractor: License#:
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech
Job Description:
/ Ar4l Z461-4 ea
Residential Commercial ❑
For Residential Installations:
Attic '1St floor 2nd floor❑
Adhere to min set back 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: Occupancy group:
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replace ent
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
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
BUSLIC Business License BUILDING