06020030 CITY OF CUPERT(NO
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BUILDING DIVISION PERMIT UN'TRACTURX`TNFb MA"CIUN
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BUILDING ADDRESS: SAN JOSE AIR CONDITIONING PERMIT"°'06020030
NER'S NAME: PERMIT L4UC DATE
STAN YEE 1045 N 10T 006
PHONE: SANITARY NO. CONTROL NO.
(408) 286-2047
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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3o Z LICENSED CONTRACTOR'S DECLARATION
Jo((s DescnptlonY!S e
i� I kAhareby70 affirm Nm 1 am fthe Bu under prevision of shaper 9(commencing l'1 O U ,VB, L gn:7
m Zj� with SwtiOn]O(Nl)Of DiWain Sof NC Busiwv sod Profosdrn Code.ad mYliceruck
� � L�Co.cllass-mfill1finscomd �n.� nn REPLACE FURNACE MAR 9�a 2006
Z enxe Clw` C V Lk.N C
S m GOnnemr S
A CHITECI-S DECLARAT ON
d 1 understand my plan shall W used u public records
ket Licensed Pmfeasinal 1S-yy s,'I Il II II p p, Ir
OWNER-BUILDER DECLARATION ��yy�+�..yffffff lltt"JJ//77 I�f7L/N 1157
i E 1 bereby Rirm that I em exempt from the Canuacnfa Licenu Law for the
O O following mason.(Section 7071.5,Business and Profession Code:My city at county
$ which requires a permit to comruct.altar,improve.demollsh,m repair any sanctum $1500
ZEEprior to its iuuance.Also requires the applicant for such permit to rile a signed satemem
< that W is licensed Panama to thA provision of the Conranora License Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (AarnmeIMMS with Section 7000)of Division 3 of the Business and Profession Cause)or
that he is eumpt therefrom and the bask far the alleged exemption.Any vlrkthun of
Section 7071.5 by any applicant fn•permit objects Ne applicant m A civil penalty of r Occupancy Type
ret nam than five hundred dOIWs(5500}
❑1,u ownu of Ne pmpeny,m my employm with wagu u Nebule eompcn$tion,
willda Wwark,endtheavucmewhadunddmonemd forsale(Sm.70",Buuneu Required Inspections
and Profasai0n Cade:The COmsumr'a Lieuue Law dm e ant apply m an owner of (1 P
peopeny who Wilda An imprasva Nunn,andwhodmsuch wank himvlforthuough his
awn employe.provided that each improaemnu art not intend reoffered for sale.If.
howvea the building or improvement is sold within one year of completion,the owner.
Wilder will have Me burden of proving that be did not Mid n Improve far purpose or
ale.).
❑1,as owner of the property.am exclusively cantraning with licensed conuactoss m
construct the project(Sec.7044,Business Aad Proinstmas Code:)The Contractors U.
cense Law draw Out apply to an Owner of propertywho Wilde or improv thereon.and,
who cnuacu for such projects with a entracetr(G licensed pursuant in the COmrumh .
Lice.Law.
❑lamexemptunder Sea ,Bh PCfor Nhmttn
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby tlRrm under perW ty of perjury ore of the following declaration:
1 have and will maintain ACerificate Of Consent in self-inure for Wa learsCmnpen-
setion,As provided for by Section 5700 Of the labor Code,for the performance of do
work for which this permit is issued.
❑1 have and will maintain Warkces Compensation Wuranm,As mquired by Section
37W Of Ne Labor Codd,fm we performance of the wwk forwhich this permit is issued.
My WOrkets Compensation Insurance carrier and Policynumber art:
Q Caller: Ss1v �I�55�
CFl Policy WOK S QV
COMPENSATION INSURANCE
�
.
(Missce In wed not W nmplemd If thus permit Is far.hundred doll.(5100)
w ksa)
1 certify that in the performance Of the work for which this Permit is issued,I"I net
employ any person in any manner so As in became subject to the Workers'Comp saw atin
Laws of Calilmow.Dam
Applicant
NOTICE TO APPLICANT,If.after making this Certificate of Exemption.you should
become subject to the Workers Compensation previsions of the Laixr Code.you must
.,O Forthwith comply with such provision or this permit shall be docmod revoked.
z CONSTRUCTION LENDING AGENCY
E+ IWmby elBrm llatthortiaaeonsuuninn lending agewy Tsar Nr Performance Of
CYi;> the work fn which this permit Is]=and(Sec.3097,Civ.C.)
W Q Londees Name
r7 z Iander's Addmu
f,Q 1 cenify that 1 ham mad this application ad sum Nat the than information is
LU F carrom l aSme m comply with all city and county ordinances and sum law relating to
Q V Wilding contraction.and Wreby amhodm representatims of Nis city m Amer upon the
(�
.W.-mcmind propcny for Inpedon purpose.
(We)agree in save,indemnify And keep harmless the City of Cupenina against
w liabilities,judgmcau,costs and expenses which may in say my acerae agsost said City
V in cocrequewe of the Smoing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL I{ON-POINT Issued by: Date �G`V G
SOURCE REGULATIO 5Y1
® n�_ AM Re-roofs
Stgnuum a(Appt HI Or
MATERIALS DISCLOSURE Dam Type of Roof
Will thAappllcantn future build' g occupant store n handle hradous material
as de0ned by the Cupertino Munni ode,Chapter 9.11,and the Health and Safety
.
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yca ® a
Will the applicant or future building upon tau equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit huudow air Omaminnu u V<fi y the Bay Arta All Quality Mnagcmcnl all new materials for inspection.
Disoia7
(]Yes Ills Qw-,
I have mad the banrdns material mquimnanu underChapmr 6.95 of the Cal ifm-
nk Health k Safety Code,Sweats 25505.25575 and 75334.1 ndmwwd thuif the Wilding
dm not currently hem a mom,but it is my memorability At nudity tW occupant of tho
rcqubommwt which must be i dor lot u arra eerdfieam Of Ocnpncy Signature of Applicant Date
Owner or author' r All roof coverings to be Class"B"or better
cd a Dam
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: kiereaw
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32644015.00
DATE ISSUED. . . . . . . : 02/06/2006
RECEIPT ##. . . . . . . . . : 33089
REFERENCE ID # . . . : 06020030
SITE ADDRESS . . . . . : 10554 METEOR PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STAN YEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1326
RECEIVED FROM . . . . : NORTHWEST PERMIT INC
CONTRACTOR . . . . . . . : WILLIAM JENTILE LIC # 24783
COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1045 N 10TH STREET
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
• TELEPHONE . . . . . . . . : (408)286-2047
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 1,500.00 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 164 .78 0,.00 164.78 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 164 .78 5862
TOTAL RECEIPT 164.78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---'--- ---------------------------- --------
301 ROUGH ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
4knCITY OF
C��lAlo Fax(408)777-3333
fC '�1
Building De artment
JOB ADDRESS: kO 55� �g7go� ft, PERMIT # 0000cZOC.)3O
OWNER'S NAME: J PHONE #
GENERAL CONTRACTOR. `� , FAX #
I am not using any subcontractors: Tr- to-o
SigAature 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
Own / ontractor Signature Date
FROM :Mary Kurtis FRX NO. :415 276 2304 Jul. 08 2003 03:21PM P1
CITY OF CUPERTINO
FURNACE/AC
CU*PEP, PERMIT APPLICATION FORM
APN# 4 4- 015 Date: a _
Building Address: _
i7 Ls�
Owner's Name: C V PhonettJ� �,3-lt{o�
Cuntiactor: Phone: , oy y ueense#g-;'4 3
&k-0 -01,4t-, A-+R- CWbkTl&fJ10 /
P C.openinn s ess License#:
Contact: gJI)l)�Klk- a�toao� '
Building Permit IOU
Bldg ❑ Elea Ur Plumb l Mech ell
Job Description: f-,U
Residential Commercial �]
For per,,',',(,, !nttal tions:
• Attir. u 1 u floor 19'2"floor Q
Adhere to min set back requirement[]
For Commercial Installations:
Replacement same weight [9"" Additional weight(structural talcs)
Structural Calculations required for new installation ❑
New installation Planning Approval Required Cl
Cost of Project: 11 S—UV.,pp Type of Construction: Oocupanc gimp:
Strapped On Platform 11 Bon ed ❑ Sq.Ft. Floor Area
New La;atitm Re lacenrent
Qty. If
A .licehlr, Fee ID Fee Description Fee Grou
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C: Unit y 10,1100 cfm MECHANICAL
BREMAIRHAN A/C Units r 10,000 cfm MECHANICAL
FIRRMRA('.F ff Recpd, Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Rea BUILDING
EPERM111'F= Ries.Permit Issuance ELECTRICAL
• / MPERMTTI E Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Nees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING