06070176 CITY OF CUPERTINO 0 'pt17,_aa,w 3l-ami£.•^' r �r
BUILD'
Ni:DIVISION PERMIT
`COIVTRAGTOTt TNFOItMATION,�
BUILDING ADDRESS: s JIM' S AIR CONDITIONING Pa"""NG06070176
10078 RIDGEWAY DR
OWNER'S NAME: PERMTT ISSUE DATE
MELNICK 917 QUERCUS CT. 2006
NE:
SANITARY NO. CONTROL NO.
(408) 655-0491
ARCHITECDENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0
00 LICENSED CONTRACTOR'S DECLARATION Job DOSCTI tion
,UE hmcby grim Out 1 am licensed under Provisions of Chapter 9(mmmaming P
;zru with Selman 7Mf))af Oividon 3ofthe Business and Professio,u Code.and my licensee
e„ mfull lCl.merrqq 4z ( I O REPLACE FURNACE AND .ADD A/C
,ya? License elan `•1V Las.#
•r o Date 7-r1,-.0 7 Conlrurar Taw S / r_
ARCHRECI'S DECLARATION
i 1urnamand my plans shall he used as Public=arm
ayU
G y License)Pmfcssimnal
gOWNER-BUILDER DECLARATION
iI hereby arum Nat I am=mpt from the Camraaars License Law for the
:C O following mason.(Section 703 1.5,Business and Professions Code:Any city car county
S ff which mgaims a permit on construct,almr.)mpmsc,demolish,nr mpwr any structure $5600
30 prior at its Lummee,alma requires the applicant(orsuch permitm file a signed summer,
;Mthathe is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation
(commencing with Section 7000)of Divuian 3 of the Business and Professions Code)or
Nat W is exempt tMrcfaom and tW basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civll penalty of er Occupancy Type
not mart Nan rise hundred dmllam(5500).
0 1,as owner of the property,or my employees with wages as their Is eampenudon,
will do the work,and theswcmm is not imm�dedar Offered(.sale(See.7014,Business Required Inspections
and Professions Code:The CaamcmYLin tie ns
s cense Law dot apply m an mumer of q P
property who builds mireprous s thcrton,and wM dumusch weak himandfor through has
own employees.provided that such impmsements any not inmMed oraRemd for sale IL
how...me building ar improvement is sold within one year of ecmpleuon.the.-
builder will now the burden of proving Nat W did sea build or improve for purpose of
sale.).
co I,as owem or ct property,,B exclusively contracting with:)Th ed mnu oat's i.
construct La me not (gee.n an Business and Professions Cade:)The Cm Ounces.
nd
who contracts taw dote oat apply m an Owner of proper(wce Wilds m rom to O Corton,ces
whonseLfor such projem with aconuamea(s)licensed pumuam m da:Contranoh O
Licence Taw.
❑lam esemDt under Bee ,BAPC far this matin
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Wmby aPtrm under penalty,of perjury mu of the following declarations:
1 hsm and will maintain a Ccruficamof Consonuo self-insure far WmIlm's Compcn- .
sation,as provided for by Saran 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 1 have W will maintain Workers Compensation Insurance,as required by Section
3700 M Ne Labor Cade,for the performance or me wort for which this permit is issued.
My Workers Compeosadon Wurnme carrier and Policy number am:
Cartier._ �/�--lel./✓ Policy No.:
C RTIC FlC�PIION pR6M WORKERS'
COMPENSATION INSURANCE
(this=am tined tit mcomplewd if the permit is fmonc hundred dollars(SIM)
less.)
I cenify Nat in Ne Performance ad me wart no which this Permit is issued.I sha11 not
employany'perse onyno o ss w become subject to the Workeri Corepensadon
Lawsaf Califo a te
Applicant sibs 7
NOTICE TO APP NT:If,afmr making this Certeaificam of Exemption,yould
became subject to a Workers Compensation provisions or me labor Cade,you most
.J O forthwith comply with such provisions or this permit shall be domed mnkcd.
ZN CONSTRUCTION LENDING AGENCY
[•+ I Wreby M.dot more,it.consumobw lending agency far dm performance of
the work fur which this permit is issued(Sec.3097,Civ.C.)
6W. Q lenders Name
5 z Lenders Addmas
O Q 1 certify that 1 have read this application and sum mat the about infarmamm is
comm.l agme to comply with all city and county ordirunce s and state laws misting to
V building construction,and hereby authmiaa representatives of this city to enter upon the
r k7]
aWvc mentioned property for mmpcuon purposes.
to xx�.indemnify and
l.Una
ty of C.penJux, g.inx,
For fa/1 liabilivat.judg.9.
nu•costs and expenses which may in any way rsee=agairutsaid City
U 2 in consequence of the granting of this permit.
QPLICA STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RC GU
(i-e9 (9 Re-roofs
Sit um ofMielicanuoConammorHAZARDOU Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant apDlicant or fuWilding oavpant mom ahandlc haaallous material
u defend by tbe Cupertino Munk i I Code.Chapter 9.12,and the Hcalth and Safey
Code.section 25532(a)'
40 C]Y. Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building mcupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havand us air mnumimnu as dc0 y tW Bay Area Air Quality Management all new materials for inspection.
District'
0 Yes
I have mad aNmo.2 N5.255uirtmcn534.I.CWpmr6.95 of the Califon
nice Fkall S yCodv ecuom25505.25533 and 25334.1 undersuul O20(Nc Wilding e ' ' -49(,
�` �pr��
does not dy mc nam that it u my responsibility m amity the occupant of the ""-��� l0 O
_Q
require erpialtoiuuanceor.CcmfaateofOccupancy. Slg re of Applicant Date
ter °�
Owner or thomcd agent Dow All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
/00 .7 5 ' o `7 0
OWNER'S NAME: 10 PHONE # ¢-O F'-
GENERAL CONTRACTOR I FAX #
I am not using any subcontractors: 7'
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 Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34241019 . 00
DATE ISSUED. . . . . . . : 07/26/2006
RECEIPT 4 . . . . . . . . . : 35385
REFERENCE ID # . . . : 06070176
SITE ADDRESS . . . . . : 10078 RIDGEWAY DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MELNICK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM ' S AIR CONDITION.
CONTRACTOR . . . . . . . : JIM TURNER LIC # 25053
COMPANY . . . . . . . . . . : JIM' S AIRCONDITIONING
ADDRESS . . . . . . . . . . : 917 QUERCUS CT.
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 655-0491
•FEE 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
BSEISMICRE VALUATION 6, 000 . 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 175 . 14 0 . 00 175 . 14 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - - ---------- ------------- - --- -
CHECK 175 . 14 11607
TOTAL RECEIPT 175 . 14
VOICE ID DESCRIPTION VOICE ID DESCRIPTION502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
SA
CITY OF CUPERTINO 0(,0n01110
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
3�•2-'4'I -Olq
Building Address:
/6
9 4 7
Owner's Name: Phone#:
Contractor: Phone: License #:
V �1n S 4v, + (fV - 40�f-6S -/&b62 � 0
Contact: Phone: Cupertino Business License#:
3i µ-t v .ef 51Dr- I�V55-, ay
Building Permit Info:
Bldg ❑ Elect C'-3' Plumb Il Mech �-
Job Description-
Residential Commercial ❑
For Residential Installations:
Attic ❑ Is` floor ❑ 2nd floor❑
Adhere to min set back requirement In"'"_..
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Constructa'on: Occupancy ou
Strapped ❑ On Platform Bonded H' Sq.Ft. Floor Area:
New Location ❑ Replacement l5"
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 cfrn 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 System Fee PLUMBING
BUSLIC Business License BUILDING