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06060029CITY OF CUPERTINO svr /�v��+r+ra.--*�^'� �i'�]]" �VL�: C Q�IF�VQRMATIO1` r7UILDINCIDIVI SION PERMIT J, r ✓q.r am4.. r. tfs.. BUILDING ADDRESS: AAA FURNACE & AIR CONDITI ffflft3*0-06060029 10481 BAYWOOD DR OWNER'S NAME:l PERMIT ISSUE DATE KOHLER DONALD 1712 STONE AVE 6 NE SANITARY NO. CONTROL NO. (408)293-4717 ARCHRECr/FNGINEFR: BLDG EIFCrLEC'rBlG PERMrr INFO PLUMB MECH 0 0 0 UCFNSED CONTRACTORS DECLARATION Job Description 1 hruby . t,,h this I w li¢ tmxr provkdms a Ch.per 9 (aim rtj; with S«am]OW) d Divirio. 3afihe Buda .4 Nofeulom Code,.M MY Ikctm is drwl rata am « �� tea`, p� REPLACE FURN ppW�ITTH 80000 BTU o,t �n crlrlEc�rs o nor �/�A�• � y A Y Pn I uedcrc.ml my pWu shall h mcd u pubac r«atda WWW,6^'7t9s II Ucensd Profaioul OWNER-BUILDER DECLARATION NLpt 1 bertby .frtrm leu I I = ( U. far th exempt fwm th Cmuxtoh :AcY c i Boredom Code: MY city a cOvuy folMwing casco. (Scum ]0315, Bu. r/ 0A Akita $2536 whirl) rtgwmu. wilt w corlwst..Itm, Impote. xmdW, or pWr y . icyM pkcues iuumc thapplk,m far aceracice Li==ercde,2 9 Uaezlm ro.ra9 on Sq. Valuation teahi.cicll cL puaunt 70th pov Wan3 aft ftkll =lad. pw. lythe with Sanlm ]000) D Code) of rUUte Butimr aadcxt. "cctltl()6 rel My .M Ue bub far th .I MY vbhtloe a! this h b e.emp this b p t M th.ppbontw.tivB puuey of Sealm 7031 b Ppil ft PP r Occupancy Type huccicci ddltn($Pumlt.objcw em mot duo Bae bwdrtd aall.r. (sSao). ❑ I,uowO«of Ne prt,pmy,mmY voploym wore v.gnuthe'v mkaempetmtb4 - Required Inspections mBmua.oh wme a«mma.atwewa«m<Ra «.krs«. a+,B�m .b Fofculeu code: The Caavctnfs Lien, U. aces .1 &Wy n .n awoc err pmpaty wh bulk. m impmaea tevrmc.M wbo dms.aee wit bivue7m thraogh bis aw emplvYees, prwixd that aeh imprmetmus m mt Inmdrd maQe+d fm isle IL ' hOvevCl, die bWkieg 0f ImpmVO�a.V.1LL 1, bid wllllln Dae � Of COOPIel1011. ale OwICr� buUxr wN h..e th bwdut O( prodng Uut h Tid MI band m YOprmc fm PmPee tK ❑ L u M. of th popery. m atlttivelY conu,elia f with llcc a eaeucwrs w crosuma th p.)cci (Sec, ]0.4, Bu ithd Pmftaslmu Code) Thc Civ+ - LL mase U. .a.pply u.n owner apropmy wlw wiWa« ianptovu thrtm..nd. . who mnvr.'urm mete p,*=wlN.emv.mm(a) Bcvued pcn+•t n ur Cmv.mer. - Lkmte< . ❑ I w amcp vOder See B h P C fm this chum Owrcr Due . WORKERS COMPENSATION DECLAMnON 1 hereby .IDm ter p- .U, of p j., ..f the following cic<Urulons 1ba.e.ld will m.inuin. eeNrlote c(� wvhr- rm Wm sc.m vem, n provided fm by Seuan 3`10()d lee IAbor Code, for the perform.nm of th work fm which this pvmlt is Isucd. 1 h..e .rtl w H m.inuin Wm , CompcmWth Idur.oa, u trytdaea by Srmoe . 371)0 ofthI Code, fm the thrf— of Ne werk fm which Thil p ft i. Luded. MY W.Camptau Imm�nm artier od Palky numbs vc Cuter. �OF _. EXEMPr10N FROATWORKS' COMPENSATION INSURANCE flLi,ucam vied to h cmtpk Umc pctmu I. ra.mc hmdrcd doom(S10% m las ) 1 m fyr than k f pufmm.ms err th wort fm whkh Nu p 114 hued, l shall nor . wploy.vy Perin 1. y .•.,.rmuwbrmme albjeclw the Wm 'Caepe Law. d Catera.";• Disc A NOTICE TO APPUCAM. U..(sr making this Ccsti iirnc of Ea p&,,. You ID ld beemm subject m th Workes Cemthm.am Vo IRM d th Ven Cttle, Ym vwa fmtbwith .ply with arch pi vbd. w ode permit a l h dice d mwtcd. ' CONSIRUCf10N LENDING AGENCY cy (m Ute prfmmulmN 1 hWwhkh4m aw aide u.c,l(S=. kn kndil. C.) the cuts (m whkh oras prmlit 41auM (S«. 31141. Civ. G) Isndcl. Name I' Icedrf. Mdla � 1 mNfy this I line rvd thu.pp4cuim and sate this litc.hme hamm.tkm b crt 1,grte wcomply with all City .nd chanty chute tcitl wte 1a MWiegw u a rix rcpmvttali.es this cityt upm Ur Wildia(Wc) Wilde-mcnYwcd.,"f.by. mpurpeu4 c Icili (We):mccwc=itdcmniryand k«v hulalea the enY erraputi C . .mdc.if, -Wcitt Z ih...tJdGmc thcciv ud4 this whkh lyra ntY w.Y uer«.PiastuW Gn Z in «4zgmn¢ of th of this p- // � � APPL ANT UNDERSTANDS AND WILL COMPLY WfrN ALL NON-POINT RSTAN D WILL LS$Ued by: Date J -(J C S EREGu}.All0M. Re-roofs Type of Roof . � /n - a.,,, '4/6_10J46 Sig"�,�of ApPl' UCM OUS MATERIALS DISCLOSURE �e It�AAZAAR Will ft Vpllc m a fmua WildloG oaalm l ami m hutdk hvudam wcrW ss dented by the CupeN.o Municipal Cote. Duper 9.11, and lh FY..IW uta s9ey Cox. s«Uca 2+531(.)] All roofs shall be inspected prior to any roofing material being installed. ❑YuNo If a roof is installed without first obtaining an inspection, I agree to remove Will ala w fid m`rllmR wining a=tpam. e9Wprmtlt or x.+m. wbiah anit haru air conmirunn tn xatad by am B.rt, Air Qy At ky M.mpcum all new materials for inspection. Dlmim] I tent und�GMpm 695 Cf th V' a aR hYSx6(.na3W, 2..y-�..fI W td. Holt of uldcny tl U-s ddldit Codc, Sctimsh,tl imy', ch .[,y it cc don tut curemh ha.e . tvul4 Nu h V my rapanibilily n mUfy Uc ae4 t of Ur 21ST revel mawnke tirmapicrwiaa d.cwrta„ 01D;a•Y'. Signature of Applicant Date * �'""� ��" ►""� �GV�f �� All roof coverings to be Class "B" or better r or autnmvrA .cent �' Dasc . . CITY OF CUPERTINO om 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31630003.00 DATE ISSUED.......: 06/05/2006 RECEIPT #.........: 34681 REFERENCE ID # ... 06060029 SITE ADDRESS ...... SUBDIVISION ....... CITY .'............: IMPACT AREA ....... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... 10481 BAYWOOD DR CUPERTINO KOHLER DONALD OPERATOR: amyw COPY # : 2 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 *EE ID UNIT QUANTITY BREMFURN NO UNIT 1.00 BENERGY PERMIT FEE 1.00 BSEISMICRE VALUATION 2,536.00 PPERMITFEE FLAT RATE 1.00 EPERMITFEE FLAT RATE 1.00 MPERMITFEE FLAT RATE 1.00 TOTAL PERMIT AMOUNT PD -TO -DT THIS REC ---------- 14..31 ---------- 0.00 ---------- 14.31 34.86 0.00 34.86 0.50 0.00 0.50 38.37 0.00 38.37 38.37 0.00 38.37 38.37 0.00 38.37 ---------- 164.78 ---------- 0.00 ---------- 164.78 NEW BAL METHOD OF PAYMENT AMOUNT NUMBER ----------------- OTHER ------------ 164.78 ------------------ VISA TOTAL RECEIPT 164.78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ______---------------- ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • 0.00 • u Ic Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: leyrl A, PERMIT # 06060 OWNER'S NAME: PHONE # �O- W_ Z GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating p Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date OUPEI�TINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # 3►1.0-30-0 3 Date: a.6-os-�� BUILDING BREMFURN Building Address: MECHANICAL 6 ywoo � 04 11Phone A/C Unit > 10,000 cfm Owner's Name: #: -d z s`o Contractor: Phone: License #: BREMRECEPT Rec tl, Switch & Outlets Contact: Phone: Cupertino Business License #: 6 7, � si7 Building Permit Info: Seismic Commercial Bldg ❑ Elect Plumb Mech Js Elec Permit Issuance ELECTRICAL Job Description: D SCG o 4Ce �Oz412, c, d -,O Poo /5TJ Mech Permit Issuance Residential &a5� Commercial PPERMTTFEE For Residential Installations: El floor d 2 d floor ❑ PLUMBING Attic I" Bldg Permit Fees to min set back requirement ❑ BPLANCHK _Adhere BUILDING or Commercial Installations: Additional weight (structural calcs) ❑ Business License Replacement same weight ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: —; Occupa7 (L y group: �3� Strapped On Platform El Bonded Sq.Ft. Floor Area: New Location ❑ R lacement -24/ r L Qty. if rm m FPP Decrrintion Fee Group n 11 .aulc BENERGY - -- - -- Energy BUILDING BREMFURN 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 EPERMTTFEE - Elec Permit Issuance ELECTRICAL MPERMTTFEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING