06060184 CITY OF CUPERTINO
'^BUILDING DIVISION PERMIT .,��NT„=RAC TORTM'�_RMAT,FN
BUILDING ADDRESS: A & H HEATING """"ND06060184
21920 BYRNE CT
OWNER'S NAME PERMR ISSUE DATE
PRADEEP SHENOY 770 CHESTNUT ST 06/20/2006
SANITARY NO. CONTROL No.
(408) 279-0722
ARCRMCTYENGINEER: BUILDING PERMIT INFO
BLDG EI.ECI' PLUMB MECH
0 0
Boa ucEuseoCONTRACTOR oE<:uRAnoN Job Description
w I bmcby filum that i w Ikstnd ondar gra,"._^^of Chapur 9(caotmnciny
Wth Section 70tr.f Div 3ofihe Buwr aal Praf¢dwti Coda.a dmylkcncIs
� yisdcff 2tJ �, pVcf R&R FURNACE ADD A/C. 220 VOLT CIRCUIT MIN SET B
;�y Doc B ' -O�ContramarREPAIR
ECTS
SCS ARCIT[TDECLARATI N
W� I uttdetmaod my pWu,hall he wed a gothic aeaJa
`o.
a� Liccufntb
cd Ptaa.l
`D5 OWNER-BUIDER DECLARATION
aj i mI hereby i ff.Um 1 a n rumps from the Cantramul,IJecwa lav for ft_O o falbrinl..(Scum 7W 1-5,Buainua and Nofaaiam CoJc:Any-1 or aunty
whim tcquirta a patmh to coearuaL ahc,hnPmw,d tfldb,or tc Wr any oructom
_ii priumiuiawac,WomWltu om fa tuhperttofik•dpcdtutuocm
< ,h„xbnmwpu.mmLbn,aP.Aid . oncanl„ator'rYLiw(chartcc,9 Sq.Ft. Floor Area Valu TbR000
(commcminy with Sccd..7000)of Divtdm Sof the 8.9r.W Profudau Codc)a
-. ansa bO I.ewnpt twOr.and the baab ror ft alk/"a 0co,Any aids.of
Secdoo 7031.5 by tiny applicana fur a peatoh orbic=the applianL b a rndl Pm Y of3 5 71 O V O 2 .r 0 0 Occupancy Type
oa nae thea five hoodtW&I"ISM
❑1,uawncr of the ptapeny.amY empbym with vageau Netr mktompcnnuoa,
WB dofinalm atd tb The Cowbm LicensuaRead ra WL
apply IDN,B Of Required Inspections
ab Profeulwu Code The Contrcmra License lav dor mt appy lf an gh of q
pmpcnyvto wive a'vopme,thvcnn,andv ,dnaotWawh or.fiemtI.sd hb
ow empty Midi,.i thu mcb Im is acid au art mt I.ofc uaRvrt,fm aale.U
haudaar.the anthucleaof alb oldvdid arcyur ora pona,fo.theow�-
w0dtt W B Iuw tk Gudm of purring thu Ec Ad m ddk a knpww for potpae of
akJ.
❑L rc own of tk S oRm,w escbdwlY contraeuay Coda')
Ikamd cvaanmus b �Y ��®
mwrty the project(Sec to a of tied rty wito Wi Cude)Tlta Cone .act.
VV
rmm lar doe tips apply m m owner of prapenY who wiW or impmwa thump.tiM.
who(dlo=a r., "J"UY da tiCTVi1a1(f)IIC11Yd pIV4YN b the GdllfClar,
Lken.e ..
❑I w eampt uttdm See ,B&P C for dda naaaoa
Ow D u
AuG: 2:2, 2006
WORKERS COMPENSATION DECLARATION
1 baaj atm unfit C= of pujuy arc of the fo fW dectanLiatR p as IL
L�+In H pt�
I haw ad Wil ma by Scuon 370 al ft 110 Codt%fwcra Wahcra Comp co- I1YII.IYtIt ItI�J/\N� IIryV�Ui`�4�1]
action, r paridW far by Sctioo 38111 ar th lobar Code far Bur petfumatt¢of the lu/
vat fu.him Nb pmala b umN.
I h and WB annat in Wo .compcwa orn Ism .u twldrN by Section .
3700 a(thc Lahm Code,fu the perf.of de tut for whkh Ous pc mil b hawed
My WaM1era Cemaa �m Iwwatcc caaricr tiM Policy�nornbcr ve:
Cankr.�f Z( ✓ I; / micy No.-1916eO�L�J
C'EgIRCATE DF EKEmMoO FROM WORKERS
COMPENSATION INSURANCE
tThb acmm vad.oL be caopkted If tk puma b for one hWN doBan(3100)
u kaa)
I cuufy y In We h, y to.ocof the tart fu tLkb dda gamic l bsued.I aba0 b
Lm Om0permnlna c mae¢rmubba(ame mbjm toth Waatv,'Canprwtlan
law,a!Califamia.Dmc
NOnCu ff.
N .TOAPo dbc wo : ,,aftermatlnlo Ce ..r of Faea,cbdym ,
atocatw
bcmmeln..Py the Wakal Compeu unix c.idam of the lab Coo,ym mm .
,Jz fmWWth comply with aixhpaoNduuu Nb permit,hallw dasrd tewtrd
zCONSTRUCTION LENDING AGENCY
Ihertby.Iflrm tld Ove is a®tnnctbn kodlny aµa,far the peRorma a
ai > the soh fu whim t pumit b bated esti.3091,Cb.C)
QLendcla Name
Z) z mower,Addw.a
U0 1'cray tho t 1 haw tad thu.p dl on ave,uc Ota the above infomuuuo b
1LF career l a&=to coreply Wth all city and county atdiurva.Mtute lawn wlating to
OU building eonwoctian,and hemby authndm mptemnutiw of Nit city to curer upon tw
r W •Iro.a.menU.d pnr cri,for itulccdan putpwea
(Wc).lure to eve,in&.,fy and Yccp hannlua the 01,of Cupnunoalai—
UzIiNilkio,judlmau,,cwuaw ea P.which may in any wy avuc.ldwt aid City
In....�--af the[aetlnl of thio permit. 6 CL
a-" APPLICANT UNDERSTANDS AND WI OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE�'CiULAnONS.
r5 Re-roofs
SiyutweofA IicaolCdrfl or I Due
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win the appticua u Io wBdlnl ocaputatac or hawkh.wtlau otaubl
u deftrcd by t c Cuperum Munkipal Coo.Cb10 9.12 atq We Fkalth and S+Iny
C-dr.3ccilm 25533(aH All roofs shall be inspected prior to any roofing material being installed.
0y.
Wm tee tilrpliaaat m forum wilding pant=egWpmmt a dem atkb If a roof is installed without first obtaining an inspection,I agree to remove
cm3 luyudatn dr contwo .nu u dc0ud by the Bay Area Air Quality Manatiorr d all new materials for inspection.
Dutricn
❑Ya �W
1 bme toad the bavadannwerl W tryulrctrcnu undo ChaPv&93 of Nc Cahraa-
Na Hoalth&Safay Code,Sacbna 25A15.25573 ad]55}1.1 unduautd W Vrbc btdiGnl
doca tun cwrttuly haw.sena.lbu n h my no ouibility to modify tic omq.vt ar Jlc
r , urMcbmtaabcmetprior or.Cml Wof Signature of Applicant Date
oven a aatha'vcd tilC 05A4 e �„�. All roof coverings to be Class"B"or better
ACommunity Development
10300 Torre Avenue
-/' Cupertino CA 95014
Telephone(408)777-3228
CRY 0, Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
z � zo Ov 00Z0S`oel,<-47
OWNER'S NAME: P _ 5 f,�r�s- PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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 Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35716082 . 00
DATE ISSUED. . . . . . . : 06/20/2006
RECEIPT # . . . . . . . . . : 34951
REFERENCE ID # . . . : 06060184
SITE ADDRESS . . . . . : 21920 BYRNE CT
SUBDIVISION .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PRADEEP SHENOY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : DALE PHELPS
CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A & H HEATING
ADDRESS . . . . . . . . . . : 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 279-0722
*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
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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 12, 000 . 00 1 . 20 0 . 00 1 . 20 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 : 176 . 94 0 . 00 176 . 94 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ------------ -----------
OTHER 176 . 94 VISA
TOTAL RECEIPT 176 . 94
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 CUl ER1iN0
welt
am
F1JR1NA,Ili ,/:!c
�cUPEkTINO PERMIT APPLICATION FORM
APN 35 716 0$,, -- — �t :� _ o--- -
Building ^/
Address: Q� / - --
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SHFaIo _,�`?�4biz��_ 'fo8)rll 0Y17
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4pphcant/Contractor: ,
Buildin-, Penut Into: - --- -- -- -- -
Blil- Blcct _ I'luni cil:
lobll_scriptiun: mo=o✓o�Y �QeG�'f Mtn gg-r,P�t--K tpcot .
1 Restdential: Commercial
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Sq.Ft. F!oer �'.rea: � ---
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r\rcItiiucvEe�ineer: VdUation:
I, vpe of Consuuctii n: Occupnn Glut :- ------- ---
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A plic'r.blc 1-cc 1D -- - e Duscri tion —_ Fcc_G_ro_:�_.._,
BE\'ERG1'
—_ BRiMFURiv' Reloeaiiunui' Futitacc MECI!At`11CrA.
—__ BREMACOVER -- -_A/C Umt > 10,000cIIII MECI-IAICAI,
13REMAIRHnN A/C Units <= 10, 000 cfm NIEC:IIA:\IfCr11
Ree tp I, Sv;itch &', Outlets _ E_LEC'I'R1CAL.
I BSELSNIICRI' -- Seismic Fcc Res
— 1.PER14Cf'F'BE Elec PVrinit l.,suance —_ ELEC] It-]CA1
_— A4PERM1"I FfsL N1c,h 1'erinit Issuance NIECIIAt`11CAL
! PPERiV11TI-Ti- ---- Plumbim Permit Issue PI_U:\'IBl G -- -'
--_ BPER:\9FI E; __ I31 Pu'n_:it Hees -- -- L3U1!_!D\(i
---__ -- BPLAN011K — — -Plan Chrck Fue 13UIL_LD_.'\G
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