06050074 -
Bumt:�Nc DfvlsloN PERNIITC,ONTRATQ' RIF'�R. M- TIdN
BuIIDINGnDOREss: AAA FURNACE & AIR CONDITI °'06050074
2036BOLLINGER RD
OWNER'S NAA ME: I'ERhQ[BSIJB DATE
LOO WAH L AND SHIRLEY 1712 STONE AVE 05/09/2006
SANITARY NO. CONTROL,NO.
(408) 293-4717
ARCNITECIYENCIN BUILDWG PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ion LICENSED CONTRACTOR'S DECORATION Job Description
-� 1 hereby arf4m Nu I as ii¢n rder poo wont or n.n..9(mmwrcing
Z rlN Sadon TUW) fDlrWon Jaf NaB�Isvaad PofC ..hdmylkeos b
ode" 7/ ADD A/C
Dto cmmo, C
FINA'- ARCHIT� wECTS .romr,DECLARATION (�
l � IdvuanJ mypWaNl
ul be ltsdupvbhc rtcortla Ydy
cy Licc.d ProfeNonal •/ 1v/
O� OWNER-BUILDER DECLARATION
�>• I hcmby affirm Nal I am=W1 foam dm contractor's Licrnac IAv for the pp 1
C O follo. rcusw.injl (Saban RD u.Buand sh PoafadAM
on Codn: Y clay to c«mtY P � a` gcya 5 5 0 0
3$f wlrich ti Baba a Pump N crocarocaM ahem.improve,Eao«bh.m n:pair any Yromum
«W iu iamnm,also mquim the applmot I.a«h permit to fk a si ocd aumrxu
Fxbo ;t
It,bEicc„Rdp,,,abao,Wdai rownribsaibct—Ljw(chaptnt9 Sq. Ft. Floor Area — d'U(( 4Yfarlauratign
eF (coromendng voith Salton TDDO)or Division 3 ar the Busirc and Pmfaai«o Cod,)o,
20$- tlua M b exempt tbercfmm.ltd Ile baab for Ibe.Ikgcd pior.A"Wriation err ` " �_V'r{I
SectIw Ml S by alty.pplk�lt rur.perch still lite appBanl N a doll Faulty of r Occupancy • lam
MI Vlore Ills fiK locoo d dollus($5001
❑I.0 awser Orth pmpaty,«my uoplo/ra ait11 ra5eau Jebmlecmnpraullm.
.iumNe.111..mNebr,Co b-mesI. Laetmr«uk(sa.m«.Bmnua Required Inspections
and Prafeas{ma Cade The Ca ib
Limas Vlo don nal apply Nan a.ner err
prapveylobe pvvim tbia such jibp . rho danaucbloork hB offead hoacP for
aWn employm,pmvldN W I acb imps soEd...,•art eat hueadcd a oQad fa s�H,
hwerv.Ihc hdMinS«Impmsemeot b ald.ithm sac ym of mopledm ds ow+v�
builder riB base Ne holden of Poo^V Wt is did nm hover«improve f«pulp9a N
ak.1
❑1.u a of Ibe pmpmY,.m udoaivcly conitrin{rlah 11—r,contr.clars N
ctcaN Ne poajm(Sec.7044.Bualrlea and Prafevimm Cab:)The Coot as s U.
c.a'-L doea oat apply to,a mover of X.Party.to bolas or bnPo'ra Nesw,an,.
lobo aaaau f«sac!PtaleCa rhh a ewbacf«p)Ilmrad P,raau n Ne Comoa ur',
I.lca eLAW.
❑lam eaemp Thr See .Bl PCfordW.
Goa Due
WORKERS COMPENSATION OECLARAnON
1 hereby aRLv imdcr Penahy or pMM ore a Ila folloatt-9•.�__.__-
L]1ha.e andw mdmala.Culi6mN a Conant N rJr-i,uurt f«Wort is Caropeo-
utloo.a ptovidrG fa by Sm m 3700 of Ibe Labor Code,for de Perfotmnm of the
wort f«v ich this Pamir vt iaoed
1 base and Will mai...;.Worlds Comperlatlan Inauranx.a rccl c by SeNw .
3700of critic Lana Codc,for Nc paf«maac of Nc.vt fa lo Tis parch b'"—1
My Wa .CampeauGon h.Qraa coria and Policy numbs ata `
Cartier. S '+ /-I ruin o; Pdky Na.:�/7 JG Jam{ -L'3
_y CERTIFIUTE OF E%FMPr10N FROM WORKERS'
COMPENSATION INSURANCE v
rnis acs3m ncd rot becompkted Btbe parch b forme 1woQrW down($100)
or kat
1 mtih Ilia N IlK perra,maue of the loch fa rhid Nb parch b Iavcd 1 ilull ole
aopbrar0' nlnwymanarauNbcarmabjmwlh,Wartcn•C=Paoadm
Appi a Caiifarviu Doc
A
NOTICE TOAPPLICANT:If.es ailer Coimaking Tia Vons a of FLaborC .,yo,,
brcome ru orop N We ccbb r Coro s oadan p livau d de Luc«Cock,you IwY
.J O fmNloiT comply WIT such ptavbbnr or this pe,mlt shall x d¢mN Iesvked.
z ^ CONSTRUCTION LENDING AGENCY
E
Ilsmdm TNa
y.IBrat a b.eaawcYm lkM:ngpe
. ncy for Ne PeR«mal¢car
> Ilr acotc I.Whiob thio permit b w d(Sec 3041.CN.C.)
W0 Lender''Nato
7 Z L<Idefa Add,as
U0 1 ratify that I h tvA Ni.appliai®ab rue Nat Nc.bo.e worm.tian b
u. Fcortect I riga to comply wIT ill city olid counry oNiluncv and suer Ire rebdnt N
OU building construction."hereby wobC(M mp,esnUdi or Nu city to enter clow the
r OW. ahavc mwuuned propuLy for i,uRcdw puryosa
(Wc)a5R to uvc,itdcnmify sad trop ha,mka Nc Cly of Cgcrtow 89x1=
F" LO li.bilkica,jwFocri,cm r d upcmn wblcb may in my wy ata«against said Cly
UZ, ucoaequxe of Ne orating ofNis auric
APPLICANT UNIDERSfANDS AND WILL COMPLY WrTH ALL NON-POI!? Dale Issued by: r U6
SOTJE&CE REGUOTIONS. A�l
Type
�---
Slgvalux of ApplicaUCHUS MATERIALS DISCLOSURE Dom— ype of Roof
Will the pplbm aful«e building occupant Yore a brook hmNaua loasw
u&fl d by the Cupioloo Munsipal Cod,,Chapar 9.I7,aM the Hm11b told Way
Cae,Sabm 15537(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y. /¢"°
WBl Ne appllnn,anralme brol[ding mcupm=e9ulpmml«Ikvim.dd,b If a roof is installed without first obtaining an inspection,l agree to remove
emit barirdaa air a coolnaou as dcD,ed by Ne Bay Ates Air Qallty MmWm or all new materials for inspection.
D wh.7
❑Ya No-
1 bave read Nc bacZmarcdab Iequimlrnu mxkr Cllyuer 495.Hite Caw..
ma HnINB Safay Code Scctiae255M,15533 sd15534.1 wdvatod Na BNc Wilting
don nor Cm,mdy hast•IOItoA Wu It b mY,eryvlGMllY a nOdfY IIs«copal a Te
rola maawbkmm�YmmalRiortic.afacwlamoroccupocy Signature of Applicant Date
.1"C4'y[ All roof coverings to be Class"B"or better
orto,lhmb<d agcm Oa¢'
r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: 1, Z Z,,o PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: aL.-P�
Signature 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 dz.2a Am zZZ1.4e
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 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . : . . : 36936004 . 00
DATE ISSUED. . . . . . . : 05/09/2006
RECEIPT # . . . . . . . . . : 34315
REFERENCE ID # . . . : 06050074
SITE ADDRESS . . . . . : 20367 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LOO WAH L AND SHIRLEY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BARBARA MANGAN
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 AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ------- ----- ------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 5, 500 . 00 0 . 60 0 . 00 0 . 60 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 .37 0 . 00 38 . 37 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 160 . 83 0 . 00 160 . 83 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------
CHECK 502 . 25 2640
TOTAL RECEIPT 502 . 25
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
CITY OF CUPERTINO �
av FURNACE/AC
OUPEII;TINO PERMIT APPLICATION FORM
APN # Date:
3Coq-
Building Address:
Owner's Name: Phone #:
yon , y.
Contractor: Phone: D License #:����7
Contact: Phone: Cupertino Business License#:
a 3 - Z12OSo
Building Permit Info:
Bldg ❑ Elect Plumb ET Mech
Job Description:
Residential ❑ Commercial ❑
For Residential Installations:
Attic ❑ 1' floor 0 2°d floor4FF ❑
Adhere to min set back r uirement B"
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation PlanninLkpproval Required
Cost of Project: Type of Const[uction: Occupancy group:
Strapped On Platform — Bonded LO Sq.Ft. Floor Area:
New Location Replacement ❑
Qty. if
A livable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 efm MECHANICAL
BREMAIRHAN JC 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
MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping Sy stem Fee PLUMBING
BUSLIC Business License BUILDING