06060016 CITY OF CUPERTINO n*,� r�na.+.'^
BU1LDINO DIVISION PERNIIT
Aon d.�i..uPA.e„
BUILDING ADDRESS: A & H HEATING P°1M1TNO06060016
10436 AVENIDA LA
OWNERS NAME: PFN.Vr ESUEDATE
WELLS WILLIAM C ET AL 770 CHESTNUT ST 006
O�E. SANRARY NO. CONTROL NO.
(408) 279-0722
ELECT ARCaT EC7TfENGINEER, BLDG FBILECTc PEA INFO
PLUMB MEC7L
0 0 0 0
o� LICENSED CONTRACTORS DECLARATION Job Description
�iC 1 W,oby.fafm TOA I And limned unlcr pmvldou of mailer 9(=nonan{
W WmSeedm JOnol aDmroon J Jibe Bud.and POO(eadmu Code.W TOY 1o4
inrdlr.w bc94?2 R & R FURNACE AND CENTRAL A/C kn�p ��
o.�—` z c DEC fF �9`1® LED
ARCHITECTS DECLARATION
A
IuodtvanJ mypWsdWl he usdup.blk memtl+
i u Lx dPmfcsion.l JUN �� f1
OWNER-BUILDER DECLARATION 2006
y I trmhy mil.0.1 1 am acme frontftCmbaaK+Lkcmc Low for IK
.0 C folloWnl mums(Smdm 70715,Budnns w Proleuiom Code:Any city On wanly
;2K which rtyuinn oo pmol[d mnuucL.Idr,inpmw, kro-fsb.m mpdr M Aon
.xr PiwmlLs
W.. roqulm+tho ppliunl for Wch pumit m Od A Si Wd Aadmwt
< Nu be ulketucd purcw to ho pronnb ath, aarztor,Iim LAW(CT+p=9 Sq. Ft. Floor Area a
S (m rnewidt Aim Section 7000)d Dividm l of me BOA."Prdamom Code?u
thus he h.,,tb=frao Aid de bad for me W%A—Pton Any vbhtioo Of
Sc 70715 by Any appWmfmaporohabj--theaPPl d,av0pvWtYOf r Occupancy Type
nat mme moon Ow handed MnAnt(LM
❑1.M ower of me property.or my®ploym wah nlu u ttrb Ne emo.Pemtd^,
ArW do me waL aM me+v.eme Is mt lnuedad or aff tOl for uk(sw.ROH.Bvdrcf+ Required Inspections
w Pmfevn ds lacaThewdoth ho,T3 w Lr donom Apply m an a of q peC
popery wdn buiM+rc/mPote memo,And Ar hO dan+um wort h:....1 f or mm W E his
.ernpl yc4 pmvldcd TOA mch Imprawmmu An,mtid,d err ziod for nle U.
It".,me Wilding or impmvsmeu u+ald Timm one yea a(cmapedes.me.-
WOderw hane me bndm of pnNg TOA ha did non bond a itp for puPr@of
Hr.i
1.uo or Ih PfoPeuyAnn=lodlwly coh ain{Arab 1¢ wno to
nonblCt tK ptoJen(sec.7044,Balinwg.nd Prufetti Code:)Tic Cmo.m zU,
<eav Ua Wes.a.pply An An ower a proWry woo bulls or impnon merem.00nd. .
Arbo mmsct+[m tutor pmjesv Mm a conuaeror(t)Ocwxd poro+a+n me Coafaerd+
ma JAr.
❑tun exempt tndrf See .B6:POfw Oona mvo.
OArmr Due
WORKERS COMPENSATION DECLARATION
1 hrtby a/fim.sder pmahY of perjury not,of the(oOaW nL dwJ.ralime
1 hawAd Ar01 mainWa oo Ce fi=of Cmucm dxV-o.forWortcY+Conpcn-
Hdars u pmHdod for by Smtdn 7700 of the Iy—Code,for the pefon000nw of me
wh fa rh4ch coif Pema is lso .
I bad:And will maidain Worlds CmoPvoW m Insurma.n mtluim by sc .
3700 of0n LAbor Code.fa me Pefdrdd—of mew for Arhitli mu permit i+imed
My Wartee.C.P.M.htmfu+m n'nnO non Pdkr number Ac cn
Carrier. MIA+IN.— PoIk7 Na.:���l ll�6p
t - CERTIFICATE OF EXWFrION FROM WORKERS
COMPENSATION INSURANCE
Cnns sadm nood tet Wwmpdud eme Pefma Y fuox hotdlN 46a05o(SI00) ,
octut)
1 cedfv thou in me per0amancc d me wort for N mif Pfmil b Isaad.1.1 oll not
emPlry.yK..in any murcrfo u to Mmme a bet to me Wwirrf"mp-m•nto .
�a C&ia.L Due
NOTTICEOICE
NTO APPLICANT:looIL aRa noobat/mif CO,,Oog..th E.empdm,rm shmd
bm'am suanni y ma z*0 Ceo .thdAt prroft"oW lybw CodO ym mm
.,O raNwim comply with+xh providom err thu perm,Nall W dremd reveled.
Z d7NSmUCT1ON LENDING AGENCY
[rK Ibefeby.ffirm mu mere u a mmuucum Iwa+ns agency for de PoormAae of
fYi > me w in,wsdeh Ws p h or iuued(Sm.7 .CN.C)
QLsdds Noomc
z Ltrukes Mftds
U O 1 unify Wt I Mvo rod Ills.ppleadan ad fwe mu me oobore infOmuth o u
anther Ialrw m<oeply with At city weWnty asNnureaw swe lawf mWalIn
�U Wilding coo rvtion.W hcmby Anhonm mmu,Uni t of this city to cucr upm me
r0. ba.c.mentiunca Pmperty forlupcWan purPases
(Wer)almO to sane,murnnify and p h.rmkv the CUY a Cupcniao.gunn
.Fi In Ii.bilito,JWimow,cowwea hkh wrdmy wyamue+lonmtadCiry
U Z io wu q e err h t permit
^' APPLI UN ST s AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SW
Re-roofs
awm of App HAZARDOUS MATERIALS DISCLOSURE IYAa Type of Roof
Will IM app0am or ruwm hWddl occupux Axe a hudlc hnv or Acral
As dcfined by th Copmim MudapU Code.Dupes 9.12 And dw Holm>m SAfey
CWO,Sewm 25532(')+ All roofs shall be inspected prior to any roofing material being installed.
❑Yn
If a roof is installed without first obtaining an inspection,I agree to remove
Wilt me WilemtOr ruuae WaWal,a„p m= c,uipmem orae.m.eKe
Omit lot, om At coomonmw u defined by do,Bay Any Air QWity MAnVOWM all new materials for inspection.
DlAria7 /
Y GTNo
I —
haw road the Nf/t 115(mAcri+HIcgoinfmtmiwtr Cbape1"ofine Ctlifor
do room k SafaYCOde.Swdoo 25sm,x3577 u.1253N.1 undervma INR Bone hiFtivl
don cote ndy n,.e.twanA TOA itvmy repmdeBbynmbry meawtq.m err de
nOfol wn bemespnard un war.eutiBne !aF r Signature of Applicant Date
w mwAm+tea D . . All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
*CfTY
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
$JPERTINO
Building De artment
JOB ADDRESS: PERMIT #
/Q(fjG A VEAI6 ,
OWNER'S NAME: WjJ $ &ItL PHONE 79"07.2
GENERAL CONTRACTOR:AfR 14ptrP946 W FAX #
I am not using any subcontractors: _2-86
Signature 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
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34245031 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . : 34667
REFERENCE ID # . . . : 06060016
SITE ADDRESS . . . . . : 10436 AVENIDA LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WELLS WILLIAM C ET AL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : A&H HEATING & AC
CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A & H HEATING
ADDRESS . . . . . . . . . . : 770 CHESTNUT ST.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 279-0722
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- --- ---------- ------- ------- ----- ------
BREMACOVER NO UNITS 1 . 00 17 . 82 0 . 00 17 . 82 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
TOTAL PERMIT 106 . 36 0 . 00 106 . 36 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ----------
OTHER 106 . 36 MASTERCARD
TOTAL RECEIPT 106 . 36
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 Q (0
FURNACE/AC
�J EI kTT`IN0 PERMIT APPLICATION FORM
APN # Date:
4 S 031
LUC
Building Address: 0 V36 VEM16A L40
Phone #
Owner's Name:
996 3939
%Contr r: t' _G Phone: 7n_ License #:.r0 Y417..
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech
Jo4 Description:
Residential ,$j Commercial ❑
For Residential Ins allatious:
Attic ❑ 1" floor LJ 2"d floor❑ �
dhere to min set back requirement❑ r'i
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation
New installation PlanningApproval Required
Cost of Project: op Type of Construction: Occupancy group:
Strapped 0 On Platform L Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
i
Qty.y. f /
A f e Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BgEMEURN Relocation of 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
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
• PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING