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08010033 (2) CITY OF CUPERTINO �s,�� +h��ry�F�` �'� ga• [y 1�i'g�'��•j1�[ R�(�-y ' BUILDING'DIVI SION' PERMIT T`"C�yS:�J..�Cf1 .1,� .;�il•F'��"-"� '4 W1`I* ' PERMIT NO. BuaDliu��pREssETEOR PL AAA FURNACE & AIR 08010033 OWNER'S NAME; - - PERMIT ISSUE DAIS ANNETTE GROT - 1712 STONE AVE 01/07/2008' DE: - SANITARY NO. CONTROL NO. ARCHITECDENGINEER: 6UILOIN13 PERMIT INFO REPLACE FURNACE 100, 000 BTU BO ELECT O PLO O fop LICENSED CONTRACTOR'S DECLARATION - Job DOSCTIptIOn 1 m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing aE with Section 7")of Division 3 of the Business And Professiuv Cade,and my license 6 In full fume a sf i Licenec CIA ' Lia.. Comment, F o Dam TS p ARCHITECTS DELL DECLAR TO i p� I underamnd my plain shall he used u public rtenNs ayV :,,t; LiccmcJ Professional g OWNER-BUILDER DECLARATION no I hcrehy.(B�n that I L exempt from Ne Contractor's License Law for the p O following reason.Permit t 703 mm Business and ave,de Professions Code:Any city or counre 5$ which inquires enhance,permit reconstruct,alsee i t for su demolish,ore a sig any nmcmm prior m its arned .. eq.the lwvision of for Cmdrach nor's Lana. a c.signed swemcnt e (emhciad.,sedpunuanuomcpmvivionsofthe eflual agatucenselaW(PLapsef9 Sq.Ft. Floor Area Valuation p�$ (cat he is ixemwith Secdan 7000)the basis f r the she alleged exsnnd ma.An,id Code)of that he a exempt thmc(rom wtd she baze far the alleged eumptioa Any violadan of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type net more than five hundred dollars(5500).do ok.she the."C,wmY employees w.ffanenazsh[.(See compmumical will da the and Ne awctumeno,s Licenslmded e Lwe ofoual Apply 70aA.dame,Of Required Inspections pamand emfeulons Code:The ves daemon. Liana Law don not apply lf an ower is q P own ery who lou ipro or ire prates shereon,and who does such wink himuif ed Ihmugb his own employees,provided that welt improvements are not ear dedof or Completion. foe sok IL builder,the building orden of pmenniasoldwithinon year of hapavotioo,sheosto of builder will have the burden of proving that M did sot build m improv far WTose of sale.). ❑1,as owner of the Properly am exclusively contracting wish licensed conusemn in constraint the project(Sec.7004.Businw and Profeasioaz Cade)The CanuanaYs U. cone Law don not apply an an owner of properly who builds or ina men thereon,and who convects for ouch projects with a conmctar(s)licensed purmant in the Cammemes License Law. ❑I ore Hemp,under See ,B&P C far the reason OwnerDam WORKER'S COMPENSATION DECLARATION - I hereby aRimt under penalty of perjury oro of the following deGantione am and will maintain a Cutifimm of Conuntmulf-invert far WorkcYsCurepcn- n,az provided for by Section 3700 of the labor Code.for the perfor mare of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insunnes,az required by Section 3700 of the Labor Cade.for the performance of the wink fafwhich this permit a issued. ' My Wmkae.CCcanp...due linamncc carrier and Policy number am: Carrier. ar'�Af[ Y,it/10/ Policy N..:L�/�/1 /a g�1� ��1 �p CERTI5 TE F E^XE PP ION FROM WORKERS' s COMPENSATION INSURANCE (The section need not he completed if the permit is forone,hundred cle lars(SIW) or less.) 1 certify the,in the pmIummnce of the work for which this Permit is issued.l shall not employ any person in any manner ac,az In become subject an the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenificate of Exemption.you should became subject to the Worker's Compcusadon previsions of she labor Coda,you most .,- O forthwith comply with Such pmvisinn or Nis permR Shall be deemed revoked. ' z CONSTRUCTION LENDING AGENCY I hereby MMM that them is a Construction lending agency for the performance of _ Cl the work for which this permit is issued(Su.3097,Civ.C.) QLender's Nam. D z Lender's Address U 0 1 certify that 1 have read Nis.,uh inion and sum shat me above information is UL F cored.I agree to comply with all city and county ordinances and sum laws missing m O U building coaswction,and hereby authorize mpmsenmtives of this city to enter upon the r W shove-memwncd pro,ay lar inapcceun purposes. gy (We)agree to save,indemnify and keep harmless are City of Cupertino against rF-t It) liabilities,judgments,casts and expenses which may in any way aceruc against mid City C.)z APPLICANT UNDERSTANDS AmND WILL COMPLY WITH ALL NON-POINT Issued by: Date ;19'eir SOUYcE REGULATI NS. - - -- k7 zsv ///o7-k` Re-roofs Signmurc of App sAWCamm o� Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applinum or fume building accupantsmre or handle hvardous trimmed as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety C.de.Section 15531(.)+ All roofs shall be inspected prior to any roofing material being installed. El Y. Na Will the applicant r fmae wilding asnpam use equipment or devices womb -If a roof is installed without first obtaining an inspection,I agree to remove hanrdnus sit contaminants as defined by the Bay Am.Air Quality Management all new materials for inspection. ❑Yes 0111�u I have orad Ne havandouusmaterials requirmants under Chapmr6.95 of de Califar- ria Hcaldb&Safc,yCode.Scc una2 505,15533 an,115534.I undconand thmifthe building does not currently have a enaml.Nm it is my rnpomibility to notify the occupant of the regailt Lw hich�must xSmet pdoto inn aanc.. C.ndwate o(Occupancy. Signature of Applicant Date O�v/n° �rixm' ;t +r — q-o --Epjs� All roof coverings to be Class"B"or better CITY OF CUPERTINO ® 6 ITEMS OF 22 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32644009 . 00 DATE ISSUED. . . . . . . : 01/07/2008 RECEIPT #. . . . . . . . . : BS000003633 REFERENCE ID # . . . : 08010033 SITE ADDRESS . . . . . : 10535 METEOR PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : ANNETTE GROT ADDRESS . . . . . . . . . . : 10535 METEOR PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1326 RECEIVED FROM . . . . : JIIM 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 3 , 962 . 00 0.50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40 .79 0. 00 1MPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0 . 00 1MRRAA UNITS 1. 00 61 .19 0. 00 61.19 0. 00 IPPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 TOTAL PERMIT 224 .85 0. 00 224 . 85 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 879 . 01 VISA --------------- TOTAL RECEIPT 879 . 01 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ------------------------ -------- ---------------------------- 113 SLAB 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL ( 40 i 0033 CITY OF CUPERTINO FURNACE/AC 0CUPEkTINO PERMIT APPLICATION FORM APN # I 0 O e Date: Building Address: /05 Owner's Name: Phone#: titin=rTc o� 06 Contractor: Phone fM X(XC QVC Fax #: f Contractor License#: Cupertino Business License#: P�,ry Contact: Phone #: ypdc _a 93- V 212 G,f,c 7x1v Fax #: Building Permit Info: Elect Plumb Mech Job Description: �ui�aco 1bv,x'-Pv 47t) Residential Commercial For Residential Installations: Attic ❑ I" floor i7f 2"d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of C�trJaction (Usage Class): 3 fGJ, W �1�� Strapped On Platform Bonded New Location 0 Replacement Valuation: 3161, E Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO a4 FURNACE/AC CUPEkTiNO FEE SCHEDULE FURNACE: Qty. if Applicable Fee ID Fee Description Fee Group Permit Type MCRAA Furnace M FURN/AC MCREPALT Commercial Mech Repair/alt/add M MCSUSHTR Commercial Suspend Wall/floor M Heater PGASCOM New Gas Piping System 1-4 Outlets P Commercial BSEISMICO Seismic Commercial B MRRAA Residential Mech Repair/alt/add M MRSUSHTR Residential Suspend Wall/floor M Heater BSEISMICRE Seismic Residential B MFLRFURN Install/relocate Floor Furnace M MECPLNCK Mechanical Plan Check M MFR=<100 Furnace Syst<100k BTU M MFRN>100 Furnace Syst> 100k BTU M MRAIRHAN Comm/Res < I00 BTU M EPERMITFEE Electric Permit Fee E MPERMITFEE Mechanical Permit Fee M BREMRECEPT Electric Receptacles E PGASRES New Gas Piping System 1-4 Outlets P Residential BPGAS Gas Piping System 5+Per Outlet P r TRAVDOC Travel Documentation B BUSLIC Business License B CITY OF CUPERTINO G . FURNACE/AC ®CUPEkTiNO FEE SCHEDULE AIR CONDITIONER: Qty. if Applicable Fee ID Fee Description Fee Group Permit Type BCAIRHAN Commercial A/C Units <= l Ok CFM B FURN/AC MCRAA Commercial Meeh Repair/alt/add M SEISMICOM Seismic Commercial B BREMAIRHAN Residential A/C units<= l Ok CFM B MRRAA Residential Mech Repair/alt/add M BSEISMICRE Seismic Residential B lei EPERMITFEE Electric Permit E MPERMITFEE Mechanical Permit M / PPERMITFEE Plumbing Permit P BREMRECEPT Electric Receptacles E PGASCOM New Gas Piping System Commercial P 1-4 Outlets PGASRES New Gas Piping System Residential P 1-4 Outlets BPGAS Gas Piping System 5+ Per Outlet P TRAVDOC Travel Documentation B BUSLIC Business License B • Community Development 10300 Torre Avenue S Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 JUPEkTINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # 60 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: -o -2-e,% 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