06120011 CITY-OFCUPERTINO
BUILDING DIVISION PERMIT .,CON::TRAG�T.p ANF,ORMATIOIV, �-
BUILDING ADDRESS: AAA FURNACE & AIR CONDITI RI:R"f6rU006120011
1047 TUSCANY PL
OWNER'S NAME: PERMIT ISSUE DATE
ALAN ZAPALA 1712 STONE AVE 12/04/2006
NE:
SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHI ER/ENGINEER: BUILDING PERMITINEO
BLDG ELECT PLUMB MECH
0 0 0 0
ipp LICENSED CONTRACTOR'S DECLARATION lob Description
I w FF 1 hereby A R.that 1 am licum a t unlet provisions of Chapter 9(commencing
�ZW with Section 70M)ofDrvismn 3ofthc Business and Profccsium Code,and my Ike=is
>>„ kfa0rort adfIT r, v REPLACE FURNACE AND A/C
aq3 License Cl LM# t
t t•p Dale� — Comracmr/tdA
ARCHITECTS Dp2LA N
i 1 undersuml my Pla^s shall k used As public accords
)yU
o(' Licensed Professional
OWNER-BUILDER DECLARATION
� I hereby affirm Nal I am exempt Tom the Contractor's License Law for We
:00 following mason.(Section 103 1.5,Business and Polessfom Code:Any city or Countym E which acquires a permit m construct,atter.enp rvc,demol'mh,nr repair any Muc u a $10000
-iy prior At its issuance.also requires the applicant for such permit o file a signed summcm
< that he Is licensed Pursuant tm We pmvisimsof the Comrrtor's Ions Law(Chapter 9 Sq.Ft.Floor Area Valuation
�Fp (commencing with Section 7W0)or Division 3 of the Business and Professions Code)or
a $ that he Is exempt dterefmm and We basis for Ne allogcd exempdon.Any violation of
Sedan 7031.5 by arty applicant for a permit mbjecu the APPI¢ant m a civil penalty of MrflKer Occupancy Type
not more Nan rive hundred dollars(5500).
❑1,As owner of We propmy,or my employees with wagon as char sok compemad. ,
will do the wart,and We structure is not intended or offered for sale(Sec.7014.Business - Required Inspections
trotPmressiau Cade:The Contractors License law dam act apply m an awns of � q P
property who bui Ids or im proves theme,and who docs such work himself or through his
awn employees.provided Nat such improvements azo not intended moRered forsake if,
however,the building or impovenunt u sold within one year of comPktian.the owrcr-
Wildcr will have the burden of proving Nal he did nal Wild or improve for puryose of
sale.).
❑1,as owner of the property,am mothnivoty conoac u,with licensed rontracears to
construct the pojea(Sec.7014.Business and Professions Code:)The Contractor's Li-
M=law dao not appty to an owner of Property who Wilds or imposes Woman,and
who contracts for such pmjccu with a contractors)licensed pursuant As the Contractors
License Law.
❑ m 1 reaempr under Sec ,B d P C for this acuaa
Owner Data
WORKER'S COMPENSATION DECLARATION
40 1 hereby am.under penalty of perjury one of the fallowing drslarvime:
radon.I have and will maintain s Cedfi700 of Chem Cost
sure far Wwkera nt,of We
workr provided for mi Section 3700 of the labor Cade,for the performano of Vac
work for which this permit is issued.
❑I have and will maintain Worker's Compertsman Insunna,as acquired by Senion
3700 of the labor Code,for not pedocars.of du wart far which Nis permit is issued.
My Workers Compensation Insurance Cartier and Policy numkr are: c
Cartier.�r�fQ fJK/.4 11Policy No.:-I/
l.hl(I IkICA F %EMPIIONER, ERS'
COMPENSATION INSURANCENCE '
(Thu acnimm need not he completed if the permit is Intone hundred dollars(SIM)
M,It..)
I Comfy Nat in the Performance of the work for which this Permit is issued.l shall not
employ any person in any manner so as he become subject to the Workers'Compuunlon
laws of Cakfamia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccniriam of Esemption.you should
become subject an tic Wa icael Compensation previsions of out Labor Cedc,you must
.JO forthwith comply with such provisions or this permit shall k deemed revoked.
z� CONSTRUCTION LENDING AGENCY
[—� I hcrchyaRrm than Were A.cansuucuon lendingagcrny for the pniermarwcul
FL
not work for which this permit is issued(Sec.3097.Civ C.)
1 Q Lender's Name
=z Lenders Address
U O 1 certify that i have mad this application and sum than We above information is
UU. canes I agree to comply with all city and county mdu ares and ren¢laws totaling to
pbuilding Connwnion,and hemhy authorise represematives of We city to enorupon the ( /tay7(�/ ////�/7��
above-mpacree o property for ofthislre purposes. ` !J�agJs/
a (We)agMe to save,indemnify and keep haamtess the City of Cupertino against
f We Scandal
� liabilities,judgmcnts.casco and expenses which mey in any way accrue againansaid City
h.
U Z APPLICANTeUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ^d
SOURCE RE ULATIONS.
n) a Re-roofs
Si amacof yPliCmV onuanar Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuwre building accuPamstorc or handk hayaNaw material
as&need by tic Cupertino Municipal Code.Chapter 9.13,and the Health and Safety '
cam, en 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
res
Will the Apple."or more building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .
emit haomdous air contaminants as defined by the Bay Area Air Gaily Management all new materials for inspection.
District P
Yes
Ihaveoadthehaard mmcriakmquimmenuunmr Clmpor6.95ofNeCali(or-
ni,HcalthkSafcty Coda Sedom25505,35533m 25534.1um Rrsu ifthc Wilding
dnes oat Currently have a tenant Nat it u my responsibility an mufy no occupant of the
ac aucmens which must W met pilar m issuamn of a Certificate oracupamry. Signature of Applicant Date
t
owns r salt ,gent " �aD�' All roof coverings to be Class "B"or better
t
:,,,:,� Community Development
Its
� 10300 Torre Avenue
Nf, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPERTINO
Building De artment
JOB ADDRESS: PERMIT#
OWNER'S NAME: Z4 ,44,-, ,4 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
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/4tontractor Signature Date
CITY OF CUPERTINO
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35929032 . 00
DATE ISSUED. . . . . . .: 12/04/2006
RECEIPT # . . . . . . . . . : 36947
REFERENCE ID # . . . : 06120011
SITE ADDRESS . . . . . : 1047 TUSCANY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALAN ZAPALA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
. CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
•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 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
PPERMITFEE FLAP 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 . 54 0 . 00 175 . 54 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------- - --- ----- ------------ ------------------
OTHER 175 . 54 VISA
TOTAL RECEIPT 175 . 54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
a
C1012 001 �
a�ag-Twb CITY OF CUPERTINO
FURNACE/AC
�UPEkTINO PERMIT APPLICATION FORM
APN # r Date:
Building Address:
,Ove /vSCptir �c�
Owner's Name: Phone#:
Contractor: Phone: License#: /
Q`-d 3- G= 7/
Contact: Phone: Cupertino Business License#:
C lu 2- ;�e /71 p o
Building Permit Info:
Bldg ❑ Elect Oic Plumb ❑ Mech
Job Description:
c -14- -wina c /� O -,
Residential Commercial ❑
For Residential Int ations:
Attic ❑ 1" floor 2"d floor❑
Adhere to min set back requirement
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 oft ction: Occupant group:
D W.
Strapped ❑ On Platform L111
Bonded ❑ Sq.Ft. Floor Area:
New Location Replacement u
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