06060166 CITY OF CUPERTINO ��^-+awe
ZUILDING•DIVISION PERNIITGONTRACT�,ORtINFQRiVIAT10
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BUILDING ADDRESS: AIR QUALITY HEATING & AIR MMTTN0.06060166
2 1850 BYRNE CT
OWNER'S NAME: PERMIT L6 DATE
CJ & MARCOS UNDERWOOD 714 NORTHRUP -2T 06/19/2006
NE: SANITARY NO. CONTROL NO.
(408) 293-7138
ARCHnECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
LICENSED CONTRACTOR'S DECLARATION - Job Description
C M1 I hereby.Rm Nat r 1 w iia. t eller pevvWom,of C pomr 9(vmmeacln�
U NScc6on]OD0)NDivirion 3 of Ne Boo.tLOd Praf¢sbm Code.Wmyliccueir
N 7.11fame.nd cf �b� w � ADD A/C UNIT
�OARCHIE
TLTS DECLARATION FI A3.e
ALED
D. l undemand my p Wu>wl be wed a puhlk meorda
10.
Lai Lkaucd Proruwn.lot
1
C3 OWNER-BUIIDI DECLARATION
W• I ncmby PITrm that 1 un cacmpl from the Cmtr.ao t Liccw f«ft u U
o folbwing roam,(Saban 7111",Bust^^.•.Ad Pmfessiom Godo:Any city m county $4000
$Pi which mc,d .pvmlt m cm oro0.uta.imp.c.dcmnllcmrt
h,«mpai,any muc
_za Pri9rmita iuvancc.aha mquMa Uc.ppliunt r«such permitm Ne.signcd sunnca
< IlwtcaHarucdpurauanttolhpo.ialwMNcCoarxmr'rLi¢ns:l�wlCLapiv9 Sq.Ft. Floor AreayL
ONU Valuation
(coatmencing wvh Section]000)of Division 3 of tnc B%mar.all Pmfenitm Codc)«
9 Nat M W c P(Nucfmm and Ne Aida f«Ne Wcvd aemptien Any NuWtian of
Section 513 I3 by arty.ppliam f«aperrnit b)=the.ppliont ler acWil PonhY of Occupancy Type
to mac tMa rive hund od doll,,(5300).
❑1.u awns of th p.operty«mY uaPbYa,vhh••�u Ne'u Peck canpentadm,
wiRdo the wvtkWthe.vucnum Wn«IntnndcdmoRmd fm Pale(Sec.i044,Busimss Required Inspections
and Pmf.uiam C.&Too Canucmrs Li,=law dam oat apply to u aw=r a q Pe
propcny.m builds«rmpndc Nvco.,.nd who doer Poch wo.t tlmaclf«Woullb hW
own cro loYaa,pmNded Nu mch ImPase.tmta ere n«Weedcd ordfnW(«Pale If.
howua,Ne building orimppd® is sold wIWn eQ yes of m.plctiam,tieawmv-
wildec w hays the btudat of Proving N.t be did not WW«hvprme f«purpmc of
talc.}
❑I.u awe a the Poperry..m.!Itrtvely cmh inz. lianvd mvDanon W
c«uava the pmjea(See 7044.Budtcu Ptd Pmftal«d Code:)Th Caomcw.U-
ewsawdoo. '*to.n o.r a gvpnY who huiba m hnpo,es Nertnn.all
who convum f«..rN P'•jeou w dh a Cd.tacmr(!)livered pvmw W Inc Conr.cm .
Lirsaw.
❑1.m urmPunda See ,BhPCrot,NW team
D.t
WORKER'S COMPENSATION DECLARATION
1 bemby aBhm tmder pwhy of perjury«c of Ne f0nb inll kA•^^ '
Ibt,eand"Iotd.w..cmm ttc a Cmsam to salf-mrvrc for wcx c.compen-
ution,u provided Into by Scm nn 3700 of(Inc LPA«Cade for dtc perf�Of tic
Pat
for which N W perm&it luuci
nuc and w01 maintain W et Compuu.tico Imes .a"ry by scctim
Tao of tic Lech«Code,for the atfan.ut¢aNe wort for. Wa pamh Wlewd
My wcr .Cm.pewtim).smut¢ and Polity mmba
CERTIFICATE OF OF9 PTION FROM WORKERS
COMPENSATION IiSURANCE
Cfltia shim Peed rot be.dOc l B the permll W(«onebomdN roam(S10D)
«ku)
I¢nify that in the perfarm.na of thm w for Which Nis fmni,u issued I"I to
employ vty pomtt in any man.,m u m hccom a mbjecl to the Warks'Cmmpamdon
laws or cduc.N..Due
NOTICE
NOTICE TO APPLICANT.the u.aficrcorn m.ti ti Nu CWllut th E.empticcd y sbmtl
became comply
m the W ch prdC orchis panic pn�.aNe Imed Cade,ym moa
,JO ranhwiNeamplr wlN weh Poviv.^P«NW pemtil shall be Mrncd mmtcd
Zpn CONSTRUCTION LENDING AGENCY
I hemdy aRlrm tJW Nae W•cattvvmm laWlog agency for the perf«mwa of .
st7 he mA(«whicht omit is iuued(Sec.3047,C..C)
4 Q Lendcrf Name
Lender's Actress
U0 1 vniry th.t 1 U.te.E thlP applkuim.nd,„r^cher the.hole inr«m.tion W
D. F Carron I.tra W cc mply.hh all city aN county an11m sP all...i.Ian mWti.9 no
OU Wilding cow,uctim,and hctcby AU0dfim Mp Ladta a NW city W cnur Ppm Na
r 0. .Awc.mcnti,,ncd property for i r�on pup
IWc)ap.to ta.e,indemnify and hoop hatmk tic City of Cupmitw ag.ins
Hy II.blliDa,judgmow,rnua and capT.••wbicb wy N ny urne.galmt said City
U in comeq =a Ne{main{of NW PmmIL
^ Dale
APPLICANT UNDERSTANDS AND WILL COMPLY WITI3 ALL NON-POINT Issued by:
SOURCE REGULATIONS.
(4 Re-roofs
Si HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W10 Ono"plinnt«rot.bouingomP. am o«bolIe hu.Nnu moO”
u ecE«.d by the Cu,,e n M«mci m]Code.Chapter 9.12,.M the H do and Lfety
Codc.Swico s53uo7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu aBNo
vrn Ne appliv««rause bu0ding oavpvm ase egwP.enl«dcvkv which If a roof is installed without first obtaining an inspection,I agree to remove
emit wud«n air ronumLunts a dcrtmd by the Bay Arta Air QuWfty Mwgemcnt all new materials for inspection.
Dm«n
Yn
1 hue m.d Ne h.aN«u ma 'O,WfmmrnPm Ch.pmb.95 ortbe CWfm.
MaHuINk S.fmy Codo,Sockm 25515.25533 and 25534.1 tndzwrd Nn dthc Wilting
coo to ctummly have.tnt.Nu II W no msporttibJny m tntify tic..Wt.f de
ma•� nu.hich bcmapdar �a aa•CmOu e9t_ o Signature of Applicant Date
0w or..tn«ia . « rJ D„e All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
! J Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
8 o C-r d G6�BGG
OWNER'S NAME: it coS U PHONE # q4S - 7 3 -83,V7
GENERAL CONTRACTOR ; urs r FAX #
I am not using any subcontractors: A--�A
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
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor ignature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: B1k: Lot :'
APN . . . . . . . . : 35716106..00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34923
REFERENCE ID # . . . 06060166
SITE ADDRESS . . . . . : 21850 BYRNE CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CJ & MARCOS UNDERWOOD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : AIR QUALITY HEAT/AIR
CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791
COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON
ADDRESS . . . . . . . . . . .. 714 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 293-7138
%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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 4, 000 . 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 161 . 93 0 . 00 161 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -------
CHECK 161 . 93 52370
TOTAL RECEIPT 161 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
•
9,09W K(2
CITY OF CUPERTINO
PAS FURNACE/AC
WUPEkTINO PERMIT APPLICATION FORM
APN # 2 5 I � —I O W Date: (-p l `,3
Building Address:
al a5� 13 c- e
Owner's Name: Phone#:
Czvi Ma cos e >xxD 0 - '73 -93
Contractor: Phone: License #:
VE L r - 2c7,3 13� Z(o
Contact: Phone: Cupertino Business License#:
in c,44 e�Aj -a r er oc5 - 93- W3S /
Building Permit Info:
Bldg ❑ Elect Q7 Plumb ❑ Mech
Job Description:
Residential Commercial ❑ .
For Rsidential Installations:
Attic f ls` floor ❑ 2"d floor❑
Adhere to min setback requirement
IMPFor Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs)
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type ofConstruction: Occ\pancy grcup:
Strapp d ❑ On Platform ❑ Bonded VJ Sq.Ft. Floor Area:
New Location ®/ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C 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
Ask / PPERMITFEE Plumbing Permit Issue PLUMBING
mop BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING