06050073 F
Y IAF CUPERTINO �+ y*�yt?ry,. vd �'BUILDING DIVISION PERMIT " OA,��.r-»,u'F,t ram^ING ADDRESS: AAA URNACE &,,AIR CONDITI N1"MO-06050073
9 LILY AV
'S NAME: PERMIT ISSUE DATE
QUANG TRANG 1712 STONE AVE 05/09/2006
SANITARY NO. CONTROL N0.
(408) 293-4717
ARCHTIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;op LICENSED CONTRACTORS DECLARATION - IOb Descrlp S®
i� 1 Wrcby AUItu Nat 1 am IIavM under provldons of CNptu 9(ptmmemint br
ulfarcean0ec'vimanJOfM1eBLLV eVwdRafaabmCadC.wdmylkenwY REPLACE FURNACE AND. DUCTS
�'z ue.mc C7u Lie.t
7Wd. w Wll
ARCHITECTS Nused OEC ds 111 2006U 1 unwnJ my PlII be d u public accords
BUILDING
ala Licemtd Professional
5 OWNER-BUILDER DECLARATION \l-/
1 hereby mexa .nim(Sea that I am exempt s An the Contraclemons ds :My c Law for county
cc following mann. credit ?OSIS,Business and relearn.
4.um Cade: 0 airy of county
3$ which requires•permit w eonoWct,plus.improve,hpmotrh,ore a sig ed mm.ure : 7 S O O
prkrwits iensedpalso
moul Uson lolishecanf for sechpeter mRhen Law
< (dout cons. lamedpu.d.700 )afDiskiu 3afftnusinmm afcsdo Cb )per Sq.Ft.Floor Area Valuation
¢r, B (enmmend omenth Sm9an7 and of basis for
alleged
Flnepton,Myavi Code)per
Nu Section
u esemPr,any sip li and or aper it the allot a exemption Any vkiaum of
a.,m Ions by any sant s a OO). rvbjecu the applicant w a civil pan.uy of r Occupancy Type
not mad Nan Eva hundred dollars(S300L
❑L At owner of the property,.my employm with wage u Net,wk compevNan.
will do the work and Ne suunum is trot intended.olfered for Ask(San.IOM.Busineu Required Inspections
and Professions Code:The ContrAutm's License law dour Out not apply m an own.of q p
properly who build,Or Improves thrswn,and who doessuch wart hmmedf.through his
own emptaycaa,provided that each improvements am notimmded oroQerod I.sala If.
however.the bufldintor hoped.,Is sold wiWn one leu afcmmkuao,the awms-
builder will haw the burdrn of proving that M did not build.Improve for purpm of
Ask.1
❑1.As owner of the property,am exclusively comneving with licensed conuacmrs to
canpwoa the project(s«.7044.Business and Profession,Code:)The Cmua.M U.
cave Law does not apply in an owner of property who builds or Improve,the pan,and,
.he contracts far such Project w06 amuncear(s)Iicepeed perrvam in the Comwmh ,
License Law.
❑I Ann exempt under See .B k P C f.this acuon
73EMM
ner Data
WORKERS COMPENSATION DECLARATION
I Wroby al rine under penalty of perjury arm of the following declamiom:
I ham and will raromi..CeNOmm of Caventw Aulf-imuml.WorWeSCompen-
n.u provided fm by Section 3700 of Ne Labor Code,for the perfomuce of the
k for which Nr permit is Issued.
1 have and will msinmin Warkaes Compensation Insurance,u required by Section
of the labor Cada,far the performance of Ne work forwhich this permit r luted.
Worked,Coo)mpenwion In/s�emrce arrier and Policy number w:
ier: v�'-I'+7f i /� ..,.lf PoIIry Nn:
ER Fl TE F EMMONh7IOM ORKEft5
COMPENSATION INSURANCE ,
mals Auction need not N completed I(Ne pemlt r farm Weekend!dollars($100)
or tai)
I certify that in the parfarmumo of Ne work f.which Ni,permit is Wood.l dull ret
employ anyperson in any munerso u be become subject w the Worked Compensation
Laws of California.Disc
Appll=l
NOTICE TO APPLICANT.If.Met making N4 ConOaam of Exemption,you Wuld
become subject to Ne Weaker,CompenMdon provisions of Nn Labm Code.you mum
.JO forthwith comply with such provisions,or this Permit bill W enteredmveked.
'Zy CONSTRUCTION LENDING AGENCY
[-. I hereby IMM than than is a com ucoan knding all for to performance of
a Oe work for which Ni,permit Is issued(Sec.3097,Civ.C.)
fit Q Lunettes None
7 z Iundces Address .
U Q I certify that I have mad this Application and sum met the above Infatuation r
If,f-' comet.1 agree in comply with all city and county ordinances And dam laws totaling to
�(J Wilding Construction.and hemby auNarian reprawnmiwa of Nis city w enmr upon Np
W +hove-mentioned property for inspection purposes.
F (We)agree to ave,indemnify and loop,harmku the City of Cupertino against
vert rn liabilities,judgments.costs and expense which may in soy way acme against said City
U in consequence of the grand.1 of this permit.
�--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —
SOUR EREGULATIONS.
tea.+..— 'gay.ed� Re-roofs
sigr(awre of AppliaaLlConuacwr Dara
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win the pp,fant an future building o.upentsma,or handle hauNous material
A,defend by than Cupenko Municipal Code.Chapter 9.11.and the Health and Safety
Cmk,Section 25532(+)? All roofs shall be inspected prior to any roofing material being installed.
❑Y. 0
Will the aPnlicant or f/usum Wilding occupant pew equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
mit hevardnus ala conumimms u dt0m-d by the Bay Ada Air Quality Management all new materials for inspection.
. .District?
❑Yes �Nu
I have meal the hmardmu malddabmqulrcnmts underC'hapterQ93 oflM Califar-
nklkalNASA(myCmk,Sttvms2550.3.25537md257N.lu.kmandthdifNe building
does act currently how a tenant.dist It r my responsibility in m ll'y the occupant of the
require AL3 whiaamost mmetpdorwinuataaf.CetdRamofaaPrmy. Signature of Applicant Date
IA 414't l 4 r < All roof coverings to be Class'B"or better
Ow .am
eshorbed agent Dam
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903009 . 00
DATE ISSUED. . . . . . . : 05/09/2006
RECEIPT # . . . . . . . . . : 34315
REFERENCE ID # . . . : 06050073
SITE ADDRESS . . . . . : 839 LILY AV
SUBDIVISION . . . . .
CITY . . . . . . . . . . . . . : ' CUPERTINO
IMPACT AREA . . . . . . :
OWNER .. . . . . . . . . . . . : QUANG TRANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BARBARA MANGAN
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
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- =------- ------------- ---------- ---------- ---------- ---------- ----------
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 7, 500 . 00 0 . 80 0 . 00 0 . 80 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 165 . 08 0 . 00 165 . 08 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
4
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building De cutment
JOB ADDRESS: PERMIT #
"F.5c L% /k vc Q60s'a a 73
OWNER'S NAME: ? , PHONE # Z - 6•,2 3 7
GENERAL CONTRACTOR! FAX #
I am not using any subcontractors: 4, AJ2G a�D o 6
Signature Date
PIease 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 ddzha C Nc
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 OQ050613
FURNACE/AC
OUPEkTINO PERMIT APPLICATION FORM
APN# � _ 3— /�/`�{ Date:_
Building Address:
e' ; '{ u
Owner's Name: Phone#:
f„Z—,6 Z 3
Contractor: / Phone: License#:
Contact Phone: Cupertino Business License#:
7�
Building Pdrmft Info:
Bldg ❑ Elect ®" Plumb Mech
Job Description:
2 G v •a er u --7F
Residential ❑ Commercial ❑
For Residential Inst ations:
Attic ❑ 1" floor 2nd floor❑
Adhere to min set back requirement K'
or Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required EJ
Cost of Project: Type ofConstruction: Occup cy group:
Strapped LJ On Platform 0 Bonded C1 Sq.Ft. Floor Area:
New Location Replacement
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 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG.
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ I MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS I Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING