06050006 CITY OF CUPERTINO
BUILDING DIVISION PERMIT j�'y O"s+1NiRlvA" RAN 'Or�RMAi3v �° 1 T1O"N
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BUILDING ADDRESS: AAA FURNACE & AIR CONDITI #3'f"006050006
1044 BUBB RD
OWNERS NAME PERMIT ISSUE DATE
LUM, ANTHONY 1712 STONE AVE 05/01/2006
ONE: SANITARY N0, CONTROL NO.
(408) 293-4717
ARCHTIECfYPNGINFFJI: BNIDING PERMfi'INr-0
BL!%'. ELECT PLUMB NFLH
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+Op LICENSED CONTRACTORS DECLARATION - Job Description
1 baebY sheet that 1.li¢naN under po.i+im.c f Cw^,9(mmmene(ni
i rlWSeeum 70M dDiriJon 30la,e Buurw Slid Pro("unto Code.md myrceareu
?� mmnrmamwq y. / REPLACE FURNACE AND ,WATER HEATER
t�2 Ila fOw SP 1(,
iF Dan // Comr.+", • LU i.
qq ARCHRE- D
wumECLARATION
faV Iuoocty plana Shill h mod u public cco,M
licenced Pmfeul«W
OWNER-BUILDER DECLARATION
I b,,rthy,timet Wu I em comp fvm the eontr n .Lcrosc UIt,the
C C folbrint meson.(Scc4od7031.5.Buircu and Pmfe.siam Code:Ary aty or eounly
$� whkh mq.1.a pconq to c«mrucl the.Impve.dandmb,«input-Y woo ure $1850
_i0 Prior mit,issnnrmne.d rcqui tholpWIca«foyr=hpermifmnk,uerca,l, k FL F1oorArea Valuation
EE < thu M u IkcnQd Paaun,m We pmvi.:,.,,.of We Coarct«',liana U-(mper 9 Sq
t�a (cm cncini r,bScction 70D0)of DlvWon 3 of the Boli.� Profcsiom Coo1c)or
r _ tbu bn It hemp tk e(mm srN We Twit for the Weird ruspum Any NW 61ft of
Seton 3031.5 by W,appy®,f«.parch subjeeu the applicant m s ciW"LY of r Occupancy Type
.«nmrc Dae res LndnH dello.(1500).
❑L u oroc of Ibe propery.«MY uoploy will rsiu u ftur Jolt c«npaw,lmt.
.nmWe.9tne°e.wlmea°°tn o-d«°"ter« k(s .ro ,B°e"eN Required ctio
ad Rmfetdou coat:Th Co,tlr.cmrs Lkrms Vr arc.oaS apply m an ownc W
pmpr,Y rho W TIM«Impm t Ihertmr,ana rho drcaa«b wat h'm..tf«Wouih bf. ,./�
aro emplaym,pravked tN,anh Imivo,emenu are tot INeMM caQerd rade U. L)
toxeter,tk bWldini«impmvcmmt b sola riWm one Yn•of c«epldoo.,M wac-
bWlhr wdl ba,e Ih I.INcn W proline tbu k Wa tot WIN it ilsc r«pop of
❑1,uothe of Ilk Sr 71tr•wuct t dy Pnof=urut Co%tis)Tbcd oat-tornn
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lbw don r« PIr m an ovoc of proper aEa b P«bnpow co cab.
rin conucu ret mrrd Pm)m•riW acmustW(t10ao><d pmwut m We Cotvrcmra
01vo.
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W o"ER'S COMPENSATION DECLARATION
I bereby s1lhm order peWty of pajuny nee of t rollowmS hcWvlans
❑1 h.,e.M riB murutio•GNOote of Caucnt m clfmsum In Wanda Campct-
,Woo.u Rorlded lin by Seuon lRA W the IAbar Cock.f«We pcdormura of td
work f«rhich tM.pencil u ivord.
0 1 have uN aill tru«un Water,Compca IRmrana,u roqdrtd by Semfan .
3700 of the tib«Cock,for dto pcformamc of the wrt(«whkh adt pmol a aRcd.
My W,rtds C«npeapfion nmra«c wrier sod PWky number>R:
E%EMPnN FRO41—WORK11S
COMPENSATION INSURANCE
frbir serW oe ersd e«bc ruopkcd a the permu V f«ane hmtWd doom(51001
«Int)
1 citify tbm In tM paform.am of We Wald for rhkh Thu pumit is ItsueE.I,hul oa
employ soy pater,in any maorcrm u in became R,bj=In We WortuY C«opauum
Laws of ilorma.pate
Applkam
NOTICE TO APPLICANT.If,.flea mating lbb Certificate W Esemptioo,you d ld
become Subject m ft Wohds Co ioNnuJc,pmvidona a the Iib«Code You mux
.JO ronhriW comply ri,t,vcb Pravoo..nr thu permil"I be�m.atd.
z LENDING DING AGENCY
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+ 1bcrrby drum"Werebacmw,ctkm kndinis15ncY fm do Pcbrrnna of .
f�> the vert(«Ntkh Wit peuou U ivued(Scc.3 .Ch.C.)
CL Q rrn es Nm
=z Lenders Addrrs
U O 1 mwy Jut I Nu read Win.pplkauon sna sur dun We.bo a IW«matiou b
U. H corrtct I.{rte m comply with W city ad camty mdiwcc.ad ame 1.r,!a t to
0Wilding coumcuao.cad hcmby.ulhonn rtprtuetuivn of Nu city to cmc upon tic
U aM,c mcnu«cd paperty for m c,,uon pure,
(Wc)ag.to v,c inul and tap humin,We City W Cupnioo.iuml
f0.j1 Iiabllltkt juatmcou,mc. l upcesa rhkh mtY in-Y-1 satin Id-a City y
U In corucglence of We truLLini of adt permlL � O
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —(]
CE REGULATIONS
n� Re-roofs
� `W HAZARDOUS MATERIALS DISCLOSURE "„' Type of Roof
Wiu We•poEciurrt or fumrc Wildint occapatl uarc«hadlc havNou,modal
u mMed by ft Cpm.Mcn,MW Code.Cbapta 9.13.uN We Hnith uW softly
.m 25772(0] ',. All roofs shall be inspected prior to any roofing material being installed.
❑Yu /
urn Wc.pplicam alrmaa bolldlni oavpun Istgdprvm(«m.iaa rEkb If a roof is installed without first obtaining an inspection,I agree to remove
omit Iwaraous ur coaamimnts u dcrrca by the Bay Arta Air QuditY Msnatcmcnt all new materials for inspection.
Oimrin7 / -
❑Yo No
1 bre road ac b.wd,vr materials mqukcmcw t rClbp 697 of We Ca5lfnr.
Wa Hnitb k Safcty Codc,Serti«u 17X)7.]5733 and Z553d.1 u-, -..Wirtfo,butting
d .currently hoc a roam,aw his my rnpomlhility m unify tic«c L of the
mtN1 nuwhkhmucbctrafri°`m w.off.Ca rk-.ti 0.cqucy. Signature of Applicant Date
0�� ...� .w,✓ 1 LCu-.tip Df-�/'6% All roof coverings to be Class "B"or better
atom Doc-
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
U PELF Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT #
D 06D S`oD��
OWNER'S NAME: K PHONE #
GENERAL CONTRACTOR: — FAX #
I am not using any subcontractors:
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 014 h
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
�n 2 of 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 2
SeC: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36204016. 00
DATE ISSUED. . . . . . . : 05/01/2006
RECEIPT #. . . . . . . . . : 34200
REFERENCE ID # . . . : 06050006
SITE ADDRESS . . . . . : 1044 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LUM, ANTHONY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
RECEIVED FROM . . . . : BARBARA MANGAN
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY AAA FURNACE S AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4712
O
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 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
BSEISMICRE VALUATION 1,850.00 0.50 0.00 0.50 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 175.57 0.00 175.57 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ __________-_______
CHECK 351.14 2626
TOTAL RECEIPT 351.14
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
a10FURNACE/AC
*CUPRTINO PERMIT APPLICATION FORM
0050m,
APN # Date:
Building Address:
lel
Owne 's Name: Phone#:
rZ'
Contractor: Phone: License ���,/
e, 0 3 -y-2
ontact: Phone: Cupertino Business License#:
2 0e- J- O O
Building Permit Info:
Bldg ❑ Elect C/1 Plumb B' Mech
Job escription:
G4�— ca
Reside tial A Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2"d floor❑
dhere to min set back requirement[]
MWFor Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy coup:
lPiQ9 C
StrappedOn Platform H
K Bonded Sq.Ft. Floor Area:
New Location El Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec fl, 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
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING
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