06050024 CITY OF CUPERTINO rt�3*lt,,tt''tt y,�� m�Tr�' 'm"'�"ea
BUILDING DIVISION PEnyY11TC�t�"+- �%Q��S1'{'y,�O0 :
BUILDING ADDRESS: SOUTH BAY REFRIGERATION PEaMrr No.06050024
10849 BARRANCA DE C PER'S NAME: PERhIR SUE DATE
RIKA SOOHOO 4 MORSE AVE SIE �91 niz; ln'112oor
E. SANITARYNO. CON ROL NO,
408) 267-4503
ARCHrfECT/PNGINEER: BUILDING PPRMff INFO
BLDG ELECT PLUMB MECH
t�
I0C
LICENSED eroNrneAcroas DECLVlAT10N Job Description
1 hcrtdr M.nut I un IiamO u cProH Of Cbprr 9(tmmmcnclnt
witb Sccdm 70 W)aDlvLdm3afnta Budaa,and Prof•x-Code•W my lka,ch
M Wfull rmeWarPr3._ �( r�o3n REPLACE FURNACE ADD. ON AC
3�i Licrnx Ow IY.t
� Con
Fp Dam tnerar
ARCHRECI'S DFLLARATION
Iundcmaodmy PWUWlI hooded.Puhlk Moo,i,
lad
`t�G LieemeI b,,oby oml ® 1'I
33 aw NER-BUILDER DEcuannDN
RV�• I hereby,ITirm Wu I em eumpt frm the Cmtr.cmY, :ArY Y for the
pf folkh ,ros. ort u, lIS.BminwW .dotaol Calc:Mr yamunty
5$�i hick tryWrm. .obo m mwrtLt..lkr.tnfeove,dcmalhtt fi tgmir toy nn,num
z� �«niBiauuLc.tl,aRaulrmtm,PPlk�trIX�hl�°it�ee.a{rcu— $ F[. F1oorArea �"Valw'ttion
,.
< nutk alieem,,ltarwutt to Ne Pmvi,iom a Ne Co�°slor',Li zl..(Ch.lut9 q' ,f �G. 200p
�'. c (cmmettdtt{with Sad.7000)a DIWde03 of the Budrc„W Profeviom Cadc)or � .
Ye u euempt Ibucfrom W ftbuh for the.Uged e,miPU—My N°I,Joa of
San.7031.5 by PpliCat for-prrril wbjem tbc.PPBcmt W a civil Moitya F U U pg ❑Oycc`+upgancgY F'Iype
mtroac tbao nK htmaM aau,m(tsOm. �YdIL_lP .S'Ir A LPN
❑1.o o w,Of t1i PI°prxly.amYuir"do with wapnIb (l .CmP9nne°. _
will delbel=Cod-The ooebmtlnzodcdaaw dooanle(See.W M,BtWOfess Required Inspections ��
W myw,an Cada The Co d,,Mo.Berne Law doe Ira.pply n n rmua a
proper/wm htiM.orlmpravm nvcm,W rmdeomcb wort hiroulf OdWouth hu
owo aoploYa.Ping orithw,ah'nnpro old within
oot Kuruf PLCUM for erre If.
boil v the building a&o aaomti.,aa w d1d ooeyw or lru l m.deowty- .
bolldc Will h.rc the btvdm a p,ovttt{thu be dW tta hub a Impmc for PttNoz of
nk.}
❑1.n darer a the M,,ny.ad ndmlvejy cordlaam{w Uc m d mta.cra,to
cauwct the Profen(See.7W.Btuirca W PrNrsderu CadL')The Conuatof,U'
come Irr aom.mappy n an owar of Property w'bo hWN or boptovn tbereat.ad.
wmconuum for ur1 pmjcat riotatmapaaor(s)0 d panni to the Comr.caY,
Pena Lar.
O lw nwpt wtla Sec .Bk PCfathi,teuo.
D.re
WORKERS COMPENSATION D
1 bezby,Rrm under Pemlty of P=L°y W a the folbwiy oltdAradu.:
Ibs.e.M rlO mdwin.CW/1onaCmzntrorJr.lmomrvwatehe°mpm-
nnm•u prdvi for by Section 3'/()0 a nw Luber Cede,fm Ne Nrfenwtm of the
wart far wbkh mi,permit u laced.
❑I N K,K,will m,inuW WorteY,owpeoatbn Itutnnm,a M,.md by Scnbn .
3,Wu Nc Mbar Codc,for the mmmaatb<work fa uikh dtu pctmh 1,tvuea
My Wor m m,r7v .,l P. nwoborm:
Urrlc. EMPTIPolity No_J r 6
TE OF EXON FROM WORKERS
COMPENSATION INSURANCE y .
(nd,zalm ot,o,l tta bccoropk"a Ibc pmoh h foam hmdmd doom 15100)
I mnh Thu W We pufomurcc a We wart far rhkh thu Pamlt h tsRa:d.I,6,0 mt
LKpof
rryperran m�t�m.vrcrvanbcc®cstblm to Ue Wa1aYC
LJw,a C,IiforaL Dow
Appll—
NOTICE
bot C TD APPLICANT.1,o Wor.If.aurporour{thuC of th Em`w CodyouorooW
bua it,ubjmy theta pr C --obo, ptm'iiamaNc rocel Code,roe mun
OO rawrim comply wbh,ahP.o"am,athi,Pemn.b.Il Ec armed tewea
'Z CONSTRUC71ON LENDING AGENCY
(-+14 1 aoby.lntm tbu dere h.mou,uuw lmdin{.Fay roc ntc paoat or
C4 > tic wort for which du,Permit h W K d(s WYT.civ,c.)
W 0 Lntdeh Nude
z I e.AdAeu
U0 I earify N.t I hKW r tbi,Wpliotim W,ta,uon toe ao.e Worro our h
L, H comet 1,{me w Imply With JI dty W cowry ordir- —.W wz hrn mhnat to
ib�
O U buiNin(Wrwrrtcu to W.ire rr'utyW mpm,cnnkvs aCitya to mW upI.iout
W .m.e.Mrtioned rKW=Y for viNtr4m purP=&
G (We)a{me w nae,iMumdly W keep h,rrnle,the City a Cvpenieo,{.imt
v7 Ii.Nlit{m,JM{mcoU.co,uW which m.ym anrwuy,crnc.tdw rid dry
Uz Aweue ANT,,r/the trmalo dth pamiL
,-. APPLICAN--T,��,yyrrr��/NDE0.STA S WILL COMPLY WITH ALL NON-POINT Issued by: Date � .3 �
SOURCE,Rt.WJLAijOS Re-roofs
SI{ ///a1l//!!////�ii��i SSHAHALJtDOUS MATERIALS DISCLOSURE Type of Roof
WW de•PPltnot a(twLc doldlot aaupant nae IX handle hvudan maun.l
u
6e0revt by the Cupemm Moron*C.&.Chaper 9.11 W the He.IN W Wery
.S¢ 23532(U7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea EINo
Win t,,3pplkutt or ronin Wwiot om-o am too epulPmal a a r wfikn If a roof is insta ed without fir obtaining an inspection,I agree to remove
emit haruaau ur cmutod.m a dcllyd by the Bay Arca Air QuJhy Ma ul,a a all new mate ' s for inspe 1
Dbuict7
❑Y0 ❑No
I bti crodthe h.mdou,vuu.M6,requimovasWerOup.693adhoCOW-
WaHaINBWaY Ie.Secnvu 23705, X77' ]5574.1 mkmwd Nnif Nc hdtnnt
door ML c r tlyM e.enuL tltu It y banY u mdfy the occulwnt nr the
myu'�°gwn/51j uvbem 9da °f'canne"e°foawy. , Sig ature o Applicant Date
d6 All roof coverings to be Class"B" or better
r wthab<da a Oa
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 4
Sec: Twp: 'Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32601014.00
DATE ISSUED. . . . . . . : 05/03/2006
RECEIPT #. . . . . . . . . : 34224
REFERENCE ID # . . . : 06050024
SITE ADDRESS . . . . . : 10849 BARRANCA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RIKA SOOHOO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0101
RECEIVED FROM . . . . : SOUTH BAY REFRIDGERA
CONTRACTOR . . . . . . . : DODGSON, CHUCK AND JENNY LIC # 20715
COMPANY . . . . . . . . . . : SOUTH BAY REFRIGERATION
ADDRESS . . . . . . . . . . : 1014 MORSE AVE, STE #21
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94089
TELEPHONE (408)267-4503 .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00
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
BREMRECEPT NO. OUTLETS 1.00 1.20. 0.00 1.20 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38 .37 0.00
BSEISMICRE VALUATION 6, 705.00 0.70 0.00 0.70 0.00
EPERMITFEE 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 176.44 0.00 176.44 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 176.44 106
TOTAL RECEIPT 176.44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION '
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
+ Community Development
9j 300 Torre Avenue
CuA
pertino CA9 014
Telephone(408) 777-3228
Cot Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
v �-ce a, 6�k ' 066 Saiz
OWNER'S NAME: PHONE # UFj _a G7 Y3'O
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 8z di
Z O
Si tvre date
Please check applicable subcontractors and complete the followinginformation:
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
SunCITY OF CUPERTINO
FURNACE/AC
OF
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owner's Name: P I `G Sad I l o o U&�
1—
Conone: Y0yJ1c267,yj6,3 License#:3_
Con t rl Pho Cupertino Business License#:
U&k, d s o� c) 7- sa3 0s
Building Permit Info`.
Bldg ❑ Elect ALP Plumb ®' Mech
Job D rip 'on:
Residential;2z, Commercial ❑
For RrAidentialtions:
Attic u 1"floor 2`d 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 Projeci^ 70
S Type of Construction: Occupancy group:
Strapped 0 On Platform EJ Bonded Sq.Ft. Floor Area:
New Location Replacement 0
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Roleeadea-of-Furnace ov, MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAJRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMTI'FEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMPI'FEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING