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06040052 CITYOFCUPERTINO BUILDING DIVISION PERMIT O,NTI2AGTQR INF�?�tMATIQ�I�,I BU'LDINGADDRESS: A & H HEATING PERMIT I'D'06040052 7519 DUMAS DR OWNER'S NAME: PERMIT ISSUE DATE HOLB 770 CHESTNUT ST 04/11/2006 NE: SANITARY NO. CONTROL NO. (408) 279-0722 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j 0 o LICENSED CONTRACTOR'S DECLARATION Job DESCrIpIl00 I� i hamby affirm that I em licensed under previsions of Chapter 9(commencing Z� with Section 70(h77 of Division 3af W Buainw and ProfeWuns Code,and my licoue Is 'aOr adeff d"110 Z CHANGE OUT FURNACE; WA TRAL AC 220 CIRCUIT OZ_ Lic, Lm. as 1- Dam L -+ r^a CSDFCr L 3 q ARCHITECTS be used DELLA ATION �D I�$+ 1 understand my plans abed he used a public mends y p a w� Licensed Profcasional r� Q y� OWNER-BUILDER DECLARATION 1# I hamhy affirm that 1 am exempt from the Conmclo's License Law for the Yo p O following reason.(Sation 7031.5,Business ad Pm(easio s Cade:Any city or county S$ which mquites a permit to consmtsel ser.improve.demolish,or minor my sm cture $5000 prior w its issuance.aim requires dmapplicanl forsueh permit at file,signed sammenlnew < hat he s licensed purmamt to the Provisions of the COARMONs License LAW(Chap=9 Sq.Ft.Floor Area Valuation IFq (coma nctng with Section 7000)of Division 3af the Business,ad Proton ram Code)., RE$- that he is eacmpt themfmm ad me bub for the alleged assumption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant an•civil penalty of y U U —Occupancy Type not more Nm five hundred douses($300). Q I,as awmar of the property,Or my employees with wags as their tele compensation, will do the wark.and the srtmtum is rasamnGAaranamd total*(Sec.7044.Business Required Inspections and Pmfwions Code:The Commutes Licetue Law doe at apply m e an Owner of q P properly he buildsorImproves 0mreon,andwho doessuchwankhimself or damage his own crnployees.provided that Inch improvements as mainland a roRerdfchado.if. ' however,Ne imitator;or improvements is mid within me year of completion,the owner- builder will hoe the burden of proving that he did ml build or improve for purpose of ale.7. ❑1.as owner of tha property,am emlusively communing with licensed contrmlom o construct ma pmjen(Sec.7064.Business sad Pmfeasioas Coale)The Ccomacurs Ll- case Law doe at apply to in owner of property who build,a improves Thereon,red. who commas for such projects with a commmor(s)licensed pumunt to Ne Contractor, License Law. ❑1 mat aempt under See .B k P C for this mann Owrcr Data 40 WORKERS COMPENSATION DECLARATION 1 hereby alarm under penalty of perjury ane of the following dols Woe: I haw end will main d..Cenifrem of Consent as self-Inman for WaskeraCompm- saim,as provided for by Scouom 3700 of the Labor Code.far the perfamtanm of the wart far which this permit is mound. ❑1 have and will maintain Workm a Compensation insurance,Is required by Section 3700 of the Labor Cade,for me perfarm ace of the work for which this permit is rated. My Worker'sCCompen,eJoo Imran carrier and Policy numberarter : ,q Cartier. hz-neiS A7_4 Pollytm.-/ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (DM section reed cotbecamPkmd if tha permit In foam huadrt0 dollar(5100) or Int) 1 Unify that In Jre parpormaxa of the work for which Nin permit is intend,I Mall not employ mypermn in my marteres as to become subject to tht Workers'Compewdon Laws of California.Dam ApPliam NOTICE TO APPLICANT:If,after making this Ceni rate of Eumption,you should became subject be the Worker,Compensation provisions of Ne Later Code,you muse .J O forthwith comply with such provisions or Ns Ismail Nall be devoted raveled. Z 52, CONSTRUCTION LENDING AGENCY 1 hereby affirm this Dem is a construction lending agomy for tie performance of ? the work for which Ina permit Is issued(Sec.3097.Cis,C.) Gp Leader,Name n7. z Leader,Address V Q I certify that 1 have read this appllcuian and arm Nu dee above Information is F+ correct 1 agree to comply with all city ad county ordlrsm:o ad atate Isws relating to QO building conswction,and hereby authorise representatives of this city to motor upon dee above-mentioned pmpcny far inspection pugmeet W (We)agree to save,indemnify ad keep humorous the City or cupcninu against vt M liabilities,judgmenu,costs and expenses which may In my waya cram against said City U z in conregmnce of the grating of this permla, Y I •+ APPLIC UNDER P AN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —D SOURGVLATI S. n,%� n fl✓ � L/'{I- Re-roofs Sign ofArplicantContrachor HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will Ne mplinnl art forum building occupant sort orhandlt haaNaa material as Mond by tha Cupemmo Municipal Code.Chaps,9.12,ad the Health ad Safety Code,Sedan 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yat 0?It Will the applicat or form building acapant use mo pheme or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit baysrdous air contsminsnts u JcOncd by the Bay Amo Air Quality Management all new materials for inspection. District? QYa No Ihave mad the handou materials re emu underChapur 6.95 of the Califon. r ns Hot"Safety Cade,Sedan 255 533 25534.I undemand dm lithe building does not cu eptly have•ren nt thayl s my ponslitillly o cotify the occupant of the m uiM. which Ib net dorm' avec ofaCe eoi""fye�cu ry. R 'q f� �e p" Signature of Applicant Dale / Y��6 All roof coverings to be Class "B"or better mV Tomas arssd ml Dam Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 OCUPERTINO Building Department JOB ADDRESS: PERMrr #` OWNER'S NAME: MOM, K)I-R PHONE # ' ,'- GENERAL CONTRACTORH 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/ Walfpaper 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 . . . . . . . . : 35924046 . 00 DATE ISSUED. . . . . . . : 04/11/2006 RECEIPT # . . . . . . • • . : 33926 REFERENCE ID # . . . : 016040052 SITE ADDRESS . . . . . : 7519 DUMAS DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : HOLB ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4310 RECEIVED FROM . . . . : PERLHEFTER 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 5, 000 . 00 0 . 50 0 . 00 0 . 50 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 . 24 0 . 00 176 . 24 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 176 . 24 MASTERCARD TOTAL RECEIPT 176 . 24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS • CITY OF CUPERTINO o�oo'�� FURNACE/AC •1PEI�TIN0 PERMIT APPLICATION FORM APN # � ✓ � � � Date: L Building Address:7SR, J/LIMAS D12, Owner's Name: NOPhone #:143 Con tr to ( r Phone:.2r7n D7a. License #:EA- 3A Y 17D� Contact: Phone: ' Cupertino Business License#: D Naps 7 -0744,x Building Permit Info: �/ Bldg ❑ Elect JCf d Plumb Mech LT Job DeseripUtion i Residential Commercial ❑ For Residential Ins allations: Attic ❑ 151 floor M 2nd floor❑ dhere to min set back requirement Ter Commercial Installations: placement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Pr 'ect: Type of Construction: Occupay gro Strapped ❑ On Platform IN Bonded ® Sq.Ft. Floor Area: New Location Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm . 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 BUSLIC Business License BUILDING