06070057CITY�OFCUPERTINO
°=�.CO�NTI2AGTORAINT'',QRMATION
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
VA1111h Y HEATING, be COOLING
P --MIT ND06070057
10341 N BLANEY AV
OWNER'S NAME:
PERMIT L55UE DATE
MAUREEN KHOO
1171 N 4 TH ST
07/12/2006
NE
SANITARY NO. CONTROL NO.
(408)294-6290
ARCHI7ECT/ENGINEER:BUILDING
PEUIMff INFO
�BLDO ELECT PLUMB NECH
LICENSED CONnlACLOR3 DECLARATION
Job IieSCrl
1 bcmby dfciv dw I w liavrd vodcr Plo^uou of Ov1Au 9 (mmmcMnt
y9AL�®
with Scalar andof aDi vbn J Mthc Buena, ad Profcamm, Codc, ad my 1'c<dc u
mruurm , aen
p��-,]AyvBJ,
REPLACEMENT OF FURNACE AN C
_z t
Litter ,
Dam Cwu,aac
ARCHITECTED 'ION
1 unmsvanJ my pluu s1W be usd u pabdc rtsaM
JUL
]]]
Licclucd PNr.i ..I
OWNER-BUIIJSER DECLARATION
I ko,hy "no that I w =m from the ConlaactVs Lim= Law for the
f (Section 7Q5 i. 7, Budwad Code:Any eitrmminty
p��y/tl7 a��'/jtJt
ot. cooli
hichingoh...o,
which . pvmlt tomo e, eandttb, o rtpair ur amemm
t johor.pplic
for mchoaour, Li.. ttdnae^mt
U issu tb rl 11.
pdoWiu usuuce.darmquito thcappins uaroroUw l,prm9
Sq. Ft. Floor Area
Valuation
Of
dutinia l;&witpnl,,,m Inft 0Mof,;,ul,,,nhec,Buo. mons Code) or
J or drcu and Proon.
(mmmeMnt with Sadoo 70nd M Doone
eawpdm. Any vklauoly of
f allc My
doll&,c heat exempt wmrmm and baric for de
r
Occupancy Type
w doe
7071.7 byallyappllalafarapewatmbjewtheappdontwacilpmWya
or
two mina dm free hlmdmd dNWa (5.500}
non.
❑ L u mmer of de W,paty, or my cmpbytea will wta u Ibe4.wk mmpenaadm,
Re wired Inspections
q I
wwmw .,L wwe m n,e� o wenn d, ,na.drm i .Bu�im
and Praeasimu Code Th, Caoaaemh I,. Law doe tea apply b N — or
poopaty won hu0da or imli. Namn, turd who drca,urJiwork bimelfu duough oV
owe aoploycm, pm dcd div mch Imple+emmlu an, vat mmded mnRead for ole If,
hbw r, the buildi,t or impmsemvn at mW within me yea ofoompktim, de owner.
builder writ haat on, b min, of pmNng thou he did wl bui or Impaysc for puryoe Of
okJ.
❑ 1. u owe of the popcoy. w eaboisely cwuaclin5 will, Ramad mvoaaaa W
.
atmtron Ik P,j,a (Sec. 7014, Bad. and Pmfead,m Code) Tho Cont aWa (;-
cine law coca mol apply an an ower a paapcny who build; or impose, thcicm. and,
who eonuaaa for inch t o,leelt with a conuarot(f) ifmrled pmauam to doe Conuatora
..
C] I.law.
❑ awpveda See .B lPCfar Vtia neasn
Owior Date
`
WMKL'RS COMPENSATION DECLAIUTION
I l,emby affirm under penalty of perjury one a the fdbwin
1 halm mal w01 mountain a CeniOmm aCoamot to xdf-th.R fa Woher.Cwpat-
admt, u pmridcd fur by Section 3700 of the Labor Code. fm the pclformanco of de
wort for which thin Icrmil u inrcd.
1 hese and will oh o4dn Wmae,l Cmopeva uouo Irouru¢, u r�®d by Secnm
.
J of de tabac Codc, for do pufama� atha wort for which thia pamh U tm,d
My Wotda Owpemdoe blauNla aMc and Pdrey number
a/�rtm,,a
Camra: Policy No.ly
CERTI CATEOFEXEMMONFRO' WORKERS' - -
-
COMPENSATION MURANCE
'
mus orlon reed MI be mmpiced tide pamu at forove bmWm1 do0ua 0100)
a lcav)
1 ttrufr del in de perfomaac of We wort In, w4cb this mnil u ia,d. l "I nm
cotploy any pcowo J. my mmrcrm u to bemme subject to the Wortta• Coopenmlon
{ of Coifomi,. Dasc
NOTICE TO APPIUCANT: If, after mating that Cmuficato of E hbrouo,. you andoW
become wbjcn to the Wmtera eompcmadon loo ori of be Labor Code- yav mnv
forWwitb comply with such pmNdo s or (b t perolk"l be dccmcd mwtc 1.
ONLENDING AGENCY
i
hull ut.c agmcY for the pMmmmtt of
I haehy affirm thu Bert u con( u
. 3 . Cint
Vu want fa which duo Mortis loucd (Sac. Jd97. Civ. C)
IcnSYs Name
'
7 Icdcrs
1 cc ify that I hare and that applicdm and sue tha the mmc iofommiie is
cc m 1.gine a conPly with all city and county wd . a duc law: iciuint w
building consuuclion. and hcmbY.uthorirc rcoceroafi s of Nie city m cntaupnn rile
ahuve-mmuuncd propcny for inepouun Eutlwaee.
y(We) agmc to arc, indemnify and lump humus the City acuperd" agdoe
n Iiurlida,jodginema,<mu andapcmm which may m my way acroc agdmt mid Gly
Z in comccluena or the tr„IWL of that Pamir
APPLICANT UNDERSTANDS AND W COMPLY WfTH ALU. NON -POINT
Issued by: Dale
SOURCE REGULATIONS. _
Re -roofs
Type of Roof
sit of US MATERIALS DISCLOSURE Dw t
IB do ap I 2—Us'buWing aa -up... n hadk loomlotu masaid
u ii filed by tie Cupnr no Municipal Cade, Chapter 9.12. and rile Holds and Lfay
Coullo, S«0on 25532(,)7
All roofs shall be inspected prior to any roofing material being installed.
All
0y.
a roof is installed without first obtaining an inspection, I agree to remove
Wdl the applicant or furore balWint a pmt tom octuipmeot or devlaa which
emit h alloua at cmumWnu m dcfmM by de 9my Ana Air Quality Mmalgmhen
allnew materials for inspection.
Divrirl7 �.
❑Ya
v
I hue mad die norNoiu muciabmWvcmcou u Chmwr695titheCdifar-
idaI altbt: Wcly Code,Satiun25X15.25557W 25554.1 mrdaevd t oodde bwldutg
deo int cwmnlly have . tmmm thw it k wit, to notify one omtpmt a de
tryubcrtent which be incl aro of
Signature of Applicant Date
All roof coverings to be Class "B" or better
ower thov fit
•em 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN
... I..... 31633006.00
DATE ISSUED.......: 07/12/2006
RECEIPT #.........: 35206
REFERENCE ID # ... 06070057
SITE ADDRESS .....: 10341 N BLANEY AV
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: MAUREEN KHOO
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: VALLEY HEATING/COOL
CONTRACTOR ... ATKINSON, THOMAS LIC # 141
COMPANY ..........: VALLEY HEATING & COOLING
ADDRESS ..........: 1171 N 4 TH ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)294-6290
•FEE ID UNIT QUANTITY
BREMAIRHAN
NO.UNITS
1.00
BENERGY
PERMIT FEE
1.00
BSEISMICRE
VALUATION
12,000.00
PPERMITFEE
FLAT RATE
1.00
EPERMITFEE
FLAT RATE
1.00
MPERMITFEE
FLAT RATE
1.00
0FLOW Ylmd-oftiL0imA
METHOD OF PAYMENT AMOUNT
----------------- ------------
CHECK 161.43
------------
TOTAL RECEIPT 161.43
VOICE
ID DESCRIPTION
--------
301
301
= -------------------
--------------------
ROUGH PLUMBING
304
ROUGH ELECTRICAL
507
FINAL PLUMBING
11
AMOUNT PD -TO -DT
10.26
0.00
0.00
34.86
0.00
0.00
1.20
0.00
0.00
38.37
0.00
0.00
38.37
0.00
0.00
38.37
0.00
0.00
�IVVMN ��11190Z87
NUMBER
------------------
14935
THIS REC NEW BAL
10.26
0.00
34.86
0.00
1.20
0.00
38.37
0.00
38.37
0.00
38.37
0.00
�JD:f�#�llffllll
VOICE ID DESCRIPTION
-------- ----------------------------
-------- ----------------------------
303 ROUGH MECHANICAL
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE # -
GENERAL CONTRACTO ,,f5
FAX #
I am not using any subcontractors:
i afore Date
Please check applicable subcontract d omplete the following information
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
Date
e
0
49
mI C051
CITY OF CUPERTINO
FURNACE/AC
t
CUPEP,TINO PERMIT APPLICATION FORM
APN# 31 (P— 3.z, fO0(r
Date:
sol.
Building ddress:
10 I N.8
h
n��e�r's Na r6Xi v
�O°wf
Vi-�"I or: i1n�J-:
iyV��l ��
c�1 C.l
LicceenYssee�CJ`E'�Y'�
ntac�tra \
Cupertino Business License #:
Building Permit Info:
Blcl❑ Elect Plumb ❑
Mech lam
I Description:
CN �ZCQ�
lC,
Reside tial Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor ❑
Adhere to min set back re uirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning A22roval Required
Cost of Project�,ETType of Construction:
Occupancy group:
Strapped LJ On Platform Li Bonded LJ
Sq.Ft. Floor Area:
New Location ❑ Replacement ❑ -
Qty. if
Applicable Fee ID Fee Descri ti
BENERGY
BMFURN
BREMACOVER
BREMAIRHAN
BREMRECEPT
BSEISMICRE
EPERMITFEE
MPERMITFEE
PPERMITFEE
BPERMFEE
BPLANCHK
BUSLIC
p on.
Energy
Relocation of Furnace
A/C Unit> 10,000 cfm
A/C Units r- 10, 000 cfm
K= if, Switch & Outlets
Seismic Fee Res
Elec Permit Issuance
Mech Permit Issuance
Plumbin Permit Issue
Bld Permit Fees
Plan Check Fee
Business License
Fee Group
BUILDING
MECHANICAL
MECHANICAL
MECHANICAL
ELECTRICAL
BUILDING
ELECTRICAL
MECHANICAL
PLUMBING
BUILDING
BUILDING
BUILDING