The URL can be used to link to this page

07110136 CITY OF �'UPERTINO ��.�� BUILDING DIV1510N PERMIT ' :: :.: , .: :.: _ ,<: _ .. : ..._... BUiLDING DRESS: PERMIT NO. 10t5�5 DRYDEN AVE AAA FUFNACE & AIR 07110136 . PE[ZZM1T I$UE DATE �NER'S NAME: WARD ROBERT L AND NANCY L 1712 .�TONE AVE � 11/26/2007 SANITARY NO. CONTROL NO. PHONE: (408)2�3-4717 BUILDING PERMIT INFO ARCHITECf/ENGiNEER: BLDG ELECT PLUMB MECH � � � 0 � o o LICENSED CON'!'RACfOR oecLnRnnor, Job Description � I hcrcby afGrtn that I am liccnscd undcr provisions o[ Chaptcr 9(commencing �� wi�h Sccdon 7001)) o(Diviaion 3 of thc Buvncss and Profcuions Codc, and my liccnsc is R E P LAC F: FURNAC E 10 � K B RU & DUC T S & ADD A/ C 5 T ON °� y in full force and e(f � !' � v� Z Licenac Clazs � L�. ��7-- � Da�c Conuactor x e5 i/ "1 ' u.�l li �:' L/ = �"' ' RCHITECPS DECLA A ON � ' � 1 undcrswnd my plans shail be uaed as public rccards --�l� � mt � Q y Licensed Rufcssional y 3 OWNER-BUILDER DECLARATION ' I hcreby allirm that I am excmpt Gum ihc Canuactor's Liccnse Law for U�c � p O following icuon. (Sxtion 7031.5, Busincss and Profcssions Cak: Any city ar rnunty y�� which rcquims a pctmit to conswc4 aitcr. im{xnvc, dcmol'uch. ar iepair my s�cucmrc prior w ia issuancc, a4c� �cquires thc applicant for such permit io filc a signcd sta�cmcnt _< lhat he is liccnscd pursusnl to thc �xovisiona of ihc Conuactur's Li�tnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation y F$(commencing wi�h Scction 7000) of Division 3 of ilrc Busincss and Profcssions Cadc) or $110 9 2 y �.. ihat he is exempt tl�eeefrom and �e basia for the sllegcd exempdon. My violauon at Section 7031.3 by s�ry applicant for a pem+it subjecu ihe appiicant to a civil penalty of � Number Occupancy Type not more than f w hund�ed dallus (SS00). 3 5 6 1 4 0-_ 1: C 7 � ❑ I. u awrcr o[ ttie property. or my employces with wages as their sok compensadon. willdothework.andihestcucwmisnotintendcdoroftecedforsale(Sec. Required Inspections and Pcofessions Cade: The Conuactars License Law does not apPly to an ow�r of property who builds or improves ihereon, and who does such wwk himself or through his awn emplayces, provided that such improvemenit are not imm�ded or oQered for sak. [f. however, the building or improvement is sold wilhin one year oC compleGon, the owneo- builder will hm the burden of proving ihat he did nat build or improvc Cor puryoae of sa1cJ. ❑ I, u owner of �he property, am aeclusively conuacting wi�h lianaed rnnaut�s w wnstmct the project (Sec. 7004. Susiness and Profcssions Code:)'I7rc Coatraceor's Li- ccnse [aw docs not apply w an ownu of propeny who huilds or improves themon, and . who convacls for such projects wi�h a conuactor(s) licensed pursuant to �he Contractor's Licenae Law. 1 am eacempt under Sec , B& P C for ihis rcaaon _,vna Date WORKER'S COMPENSA'i'[ON DECLARATION 1 Nereby aflirm under penalty ot perjury mie o[ �he following decluauons: ❑ i hs.�e and will mainuin a Cenificate o! Conunt lo ulf-insure for Workcts Compen- sation, as providcd for by Sec[ian 3700 of the [abor Code. (or Uu performanx of thc work for which this permit is issucd. ❑ I have and will mainlain Worker's Compenastian Insunncc, u �equired by Scction , 3700 0( thc Labor Codc, Cor Ihc pedormance of the work for which this permit is iuued. My Worke�s Compensation�nmcance carticr and Policy numbet aze: � Grcier. � �r -+ 'f� r Poliey No.: � � ✓ �L ��TE OF EMPI70N FROM RKERS' ' COMPENSATIONINSURANCE � (This section necd not bc completcd if the permit is for anc hundred doliars (5100) or Icss.) I cenify �h¢t in ihc per(ormancc of �hc work fw which �his permit is istued, 1 shall not employ any person in my manner so u w become wbject to the Woricecs' Compensation Laws oC Caiifomi Datc Applicant l N077CE 7'O APPLICANT: I, a1Ycr maki ��his Ccni�ca�c of Excmptlon, you should become subject w thc Workcr's Compcnsstion provisions of the la6or Codc, you must � O (oMwilh comply with such provisions or �his pecmi� shall bc dccmcd cewked. z "" CONSTRUCfION LENDING AGENCY H � I hcroby a[Grm that thcre is a consuucdan knding agcncy far thc performance o( . p� . ihc work for which this pertnit is iuued (Sec. 3097, Civ. C.) W Q Lendcfs Namc � z Lender's Address () � 1 certify ihat 1 havc read this application and suic Ihat the a6ove informauun is w� cortec� I agree w comply wi�h �II city and counry oNinances and s�a�e Iaws relaGng w � U building conswction, and hercby autharin reprexnuGvcs of U�is city w cntcr upan ihc � w atave-mcntiancd property for inspcction purposes a (Wc) agree to save, indemnify and keep harmlrss ihe City of Cupertino against �� liabilities, judgmcnLS, cosu and enpenses which msy in any way accrue against said City V z in consequence oC the granting of ihis permiG Date �"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roof:, Signaturc of ApplicanUConuxtor � T of Roof HAZARDOUS MA7FRIALS DISCLOSURE YPe �11 Ihe applicant or futwc building occupant storc or handlc hanrdous matcrial iefincd by the Cupertino Municipal Codc. Ct�aptcr 9.12, and the Hcalth and Safety ,� Scctlon 25532(a)? All roof � shall be inspected prior to any roofing material being installed. � Ycs No Will thc applicant or turc building occupant usc cquipmcnt or dcviccs whicA If a roof is installed without first obtaining an inspection, I agree to remove cmit ha•r.ardous air conwninan�s u dcfincd by thc Bay Ama Air Quality Managcment all new naterials for inspection. District? ❑Ycs ❑No I havc rcuf the hvardous matcrials requiremcnu undcr Chap�cr 6.95 of �hc Gli[or- nia Hcal�h & Safcry Codc, Scctiau 25505.25533 anc125534.1 undcrsrond thaz iCthc huilding does not curtently have a icnan�, that it ia my respoasibility io norify We occupant of the rcyu' mcn�s which mus� be mel prior to issuancc of a Ccnificate of Occupancy S1gi18t13I e Of APpIICSIIt Date � � - � �. � .r � ,, •- ' �' � � � � � All roof coverings to be Class "B" ar better Owncr or authori�cA�agcnl �� . ��i� �r�� CITY O)� CUPERTINO FURr1ACE/AC CUPEI�TINO PERMIT APP:LICATION FORM APN # Date: j ' S � � � r' � ' G �• Ct ,,� Building Address: ` �, _ .> �.� !` �' c.-' r wner's Name: Phone #: '`� ,� i'� j �/' - j � c:' �. 7 � �. Contractor: � Phone #��_� ��.. �� n ,�F��v �� l�.Il✓ �1 � �,�c �,��. F� #: Contractor License #: Cupertino Business License #: !' . , �' � / ;`� —� Contact: Phone � �,� '�� ,, � , /� � y' �7 w - L r � Fax #: Building Permit Info: Elect � Plumb �� Mech Job Description: l ,r , ,,� ' ? ' �,� a G s , . , �./ c / • � "� Re dential ` � Commercial For Residential Installations: Attic ❑ lst floor �] 2 floor ❑ Adhere to minimum setback re uirement [�� For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installatio�i ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): , �,., S r pped � On Platform Boncled New Location Replacement _,,,: Valuation: Green Building: Must attach GreE�n Building Check list to this application CITY OF C'UPERTINO , �� °��` FURN��CE/AC CuPE�T�NO � FEE SC:KEDULE FURNACE: Qty. if Applicable Fee ID Fee Descri tion Fee Grou Permit T e � MCRAA Furnace N1 FURN/AC MCREPALT Commercial Mec:h Repair/alt/add M MCSUSHTR Commercial Sus��end WalUfloor M Heater PGASCOM New Gas Piping System 1-4 Outlets P Commercial � BSEISMICO Seismic Comme�•cial B ' MRRAA Residential Mecli Repair/altJadd M MRSUSHTR Residential Suspend WalUfloor M Heater ,/ / BSEISMICRE Seismic Residential B MFLRFURN Install/relocate Floor Furnace M � MECPLNCK Mechanical Plan Check M MFR=<100 Furnace Syst <1�)Ok BTU M MFRN>100 Furnace Syst > 100k BTU M MRAIRHAN Comm/Res < 10 �k BTU M �/ / EPERMITFEE Electric Permit F'ee E � MPERMITFEE Mechanical Perrlit Fee M BREMRECEPT Electric Receptacles E PGASRES New Gas Piping System 1-4 Outlets P Residential BPGAS Gas Piping Syst�;m 5+ Per Outlet P � TRAVDOC Travel Documer�tation B BUSLIC Business Licens � B ; , CITY OF CUPERTINO FURI�TACE/AC CUPEf�,,TINO FEE SI�HEDULE AIR CONDITIONER: Qty. if A licable Fee ID Fee Descri ti��n Fee Grou Permit T e � BCAIRHAN Commercial A�C Units <= lOk CFM B FURN/AC MCRAA Commercial IV(ech Repair/alt/add M SEISMICOM Seismic Comniercial B ✓ � BREMAIRHAN Residential A/ � units <= l Ok CFM B MRRAA Residential Mr,ch Repair/alt/add M � � BSEISMICRE Seismic Resid �ntial B ✓ � EPERMITFEE Electric Permit E ,� MPERMITFEE Mechanical Pe;rmit M ✓ PPERMITFEE Plumbing Pennit P J � / BREMRECEPT Electric Rece� tacles E PGASCOM New Gas Pipi;ig System Commercial P 1-4 Outlets ,/ � PGASRES New Gas Pipi:ig System Residential P 1-4 Outlets BPGAS Gas Piping Sy stem 5+ Per Outlet P � -TR.AVDOC Travel Docurr�entation B BUSLIC Business License B � CITY OF CUPERTINO $ ITEMS OF 8 PERMI�.' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1J:: Lot: APN ......... 35�i14011.00 DATE ISSUED.......: 11'26/2007 RECEIPT #.........: BS�)00003319 REFERENCE ID # ...: 07L10136 SITE ADDRESS .....: 10335 DRYDEN AVE SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............: WA�D ROBERT L AND NANCY L ADDRESS . : 10335 DRYDEN AVE CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4745 RECEIVED FROM ....: JIK RANDO CONTRACTOR .......: RA[�DO, JIM LIC # 8050 COMPANY ..........: AAA FURNACE & AIR CONDITIONING ADDRESS ..........: 1712 STONE AVE CITY/STATE/ZIP ...: SALQ JOSE, CA 95125 TELEPHONE ........: (408)293-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ---------- ---------- -------- 1BREMAIRHA NO.UNITS 1.00 61.19 0.00 61.19 0.00 1BREMRECEP NO. OUTLETS 1. 40.79 0.00 40.79 0.00 1BSEISMICR VALUATION 11,092.00 1.20 0.00 1.20 0.00 1MRRAA UNITS 2.00 122.38 0.00 122.38 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 TR.AVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 388.72 0.00 388.72 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------- CREDIT CARD 388.72 VISA --------------- TOTAL RECEIPT : 388•�2 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ---------------------------- 113 SLAB 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL � 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL