05110099CITY OFCUPERTINO
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BUILDING DIVISION PERMIT },CONTRAQTQRJNE'�URMATION.
Bu1L.DINO ADDRESS:
ABC COOLING & HEATING
PP"MRNO' 05110099
10434 ALICIA CT
OWNER'S NAME:
PERMIT LBUE DATE
CARL SANFORD
31845 HAYMAN ST.
NE
SA ARY NO. CONTROL NO.
(510)471-8181
ARCHITECT/EN('INvw'
BUPERMff INFO
' BLDG EI-E(7 PLUMB NECH
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LICENSED CONIRACIORS DECLARATION
Job Description
1 hereby rfiam Wt I w I{¢evd ..&r PmWdmu d Cb.grr 9 (®mcocinL
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NN swofort 0() d OMMon Sof the Bloow ud Prafu Code. my a�"ab
REPLACE FURNACE -
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OWNER-BUILDER DECLkRAnON
1 Itrtby woo, " I r ==opt front tote Corm oes Lune¢ far for Nc
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fafo bg rano. (Soctim 7(713. Bubas ed PMfetdou Code: My city m camty
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$2563
Num m i= . p if n cancan. Wer, m , loq &rfoR.h. m -Poll WY .wmart
Sq. Ft. Floor Area
Valuation
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f L.(Cb+pfor9
Nu m b lk=.ad Na jntm Pa,n Oroof Oc Camr.Moir m
(commas gn ScNoto 7000) d Diva. 3 dtm Budneu.ad PMfaumrC )ur
N , m b Amato,, ftod. and & b.dr for We JIeKd —Pum Ady'Wotd- d
T Occupancy `7W
Scaim 7031.5 by .oy.ppluam for . Wer mbj= Nc.ppbwn n. ciil pm-1114
oa mart tbm fie bmdrtd "tl (5500).
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Required Inspections
W Pmfafimf Cade: The Caod.aars LJrme Ir' m .PPIY to errata of
proper•/ r m bWlds m iM Aab Necm..ed w m daea mcT rak himui! a WmuN hot
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Of
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UK Q0 2005
mdmaa Ne project (Sec 704. Bu» nm.dd Prdettiou Codm) llt COWKWes 1-1-
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rm mau.cu r. .¢b paycm rW . cmv.ma(s) Baued puw.nt b de CmuatahIn
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WORKERS COMPENSATION DECL.AAX R
1 bertby.Cum ander perW ty d prjmy me of the fwlari-9
I twte itci r01 MWWn. calk dCo to fOK4,ofMc for Wm 'Canpcn.
f Wm, n pro idW for by Section M of (c Labar Cade, for the pufa d Ne
avt ror rbid Ni. pmah Is imtd.
and rW matub W.,O e3 Compm..fian Innu.acc. n otti red by S—
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d dt Mbar Code. rm me pufo,M.me d tm cart fa rYlm Wi. ,amus b vued
y wortcr�fem�p�1 W m laCmuac artier nd Pairy namba.r� ,r
Policy N.4L/L S10 T
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CERTIFICATE OF EKEMPITON FROM WORKERS
COMPENSATION INSURANCE
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aoplq b.oy amrcrmnbbecome ubjeab Ne Wartca'Compau.um
Clpawn
laMi of C.lirotmt Due
NanCE TO APPLICANT. If..ftr mWog dd. Ccwrtte d E.mptlm, you.IMuW
baoat Wblm b ft Worker. Campcvuuaa piwbiou d Ne tabor Cods lou twm
Z fa vriN comply wM Weh po'i9on• a Nb permit "I tt m nakN.
LENDINGLenck AGENCY
tIoo ft o tt coON
IhertbycMi for Nc pertorm.+tcd
Vert b.Ui(SM3
,CTI C)eaeY
> dt curt for which Nb pmwtbinuW (See 3M, CWC)
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1 mtuy duf 1 btv rod Ni.. Lp doo..d rut dor Nc.m.c for .tim b
cartcct I at= n comply rvh cal city voi camty Wdiun.ra.ad out I.rr mbung to
JWild, cmn^cvon..rd mmby iouth a rtpruouurs of Nis city to apb tit
.m..uottd prupeny for itupeNm POOP.
cnify W ta tap iuora tic City d eupmiro .Lwm
(Wc) .Cmc n ere. Itdm
nIimilWei Jud{txmt emu ud e. rhkhngln ury r.Y. git1ast.6d Ci1Y
to often L.d permit. n
Z SOPPLIC ��ND �A'NyDS"—�D-W"ILCO W A NON-POS
�%P"y
Issued by: Date
oofs7Re-r
Sirywanpplo�btF
�s MATES DfOSURE
Type of Roof
Witt Ne.pplo mfutwc bwld].,omget Oom a hulk b.wdau mitrid
u &fLN by Ne Cupmea Muvldpl Code. Ch ,w 9.12 mid tit I1u1N toot! WNY
a&.swlm zsmz(.I7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu p
If a roof is installed without first obtaining an inspection, I agree to remove
WL t.,<
wW Ne .ppliad a raucc wlabL ul, m m &,i=; .horn o¢ues
mit huardw. ur mnumbWu u &futN by Nc B.Y Aro Air QWllty Moto-F—
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all new materials for inspection.
Divria7 I'
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tootHdN h S.fmy Ca&, smlom 73503.13533 Wd 25.534.1 undcr"d Out if & buiWg
Jon mtcwrcnl .c. Jut my ,apo bllitY n naflfY Ne=.P. or Jt
Date
mgaircrttw.� rWnxo.Caufrat err
Signature of Applicant
/4/17/,0
All roof coverings to be Class "B" or better
DYnGrm WIIINIrtd.LCM D"'
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESSIOL13 4 � p' �
�l�c� r�
PERMIT # 0-5// 0,Q f 9
OWNER'S NAME: f�_
PHONE # L7— b'7 O
GENERAL CONTRACTOR C
FAX #
I am not using any
Please check applicable subcontractors and complete the following' ormation;
U os
Date
Owner/C tra orSignature Date
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/C tra orSignature Date
4
CITY of
CUPERTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
o s -o " "
APN #
�Si Date: ��/� 7
/o -5
Building Address: q C� C
Owner's N 7 Phone #:
�7s
Contractor: License #: 3 �Z 3 6�3
Contact: c � Cuperti�Business cense #:
r� CJ
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech
Job Description:
Lam_ /!d, ddu -BTl{
Residential C mmercial ❑
For P,,e 'dential In tallations:
Attic),.,1" floor LJ 2nd floor ❑
Adhere to min set back requirement[-]
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) El
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
Strapped 11 On Platform13 ] Bonded ElSq.Ft. Floor Area:
New Location ElRe lacement/"
Qty. if
ADDlicable
Fee ID
Fee Description
Fee Group
BENERGY
Energy
BUILDING
J BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfrn
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfrn
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
UILDING
Qty. if
ADDlicable
Fee ID
Fee Description
Fee Group
BENERGY
Energy
BUILDING
J BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfrn
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfrn
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
UILDING