06090217 I
CITY OF CUPERTNO (� i �a ♦
BUILDING DIVISION PERMIT <C�NTRACT(1R INaOTtM�kTION
BUILDING ADDRESS: AAA FURNACE & AIR CONDITI� 4QUO06090217
19358 SAKURA WY 07
OWNER'S NAME: PERMIT ISSUE DATE
MIYAKO HENRY 1712 STONE AVE 09/22/2006
NE: SANITARY NO. CONTROL NO.
(408) 293-4717
ARCHITECTrENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
CC'z LICENSED CONTRACTOR'S DECLARATION - Job Description
m 1 hereby affirm that 1 sm liecnmd umkr provisions of Chapter 9(commencing
with Section 70000 of Division 3 of the Business and Professions Cad,and my license is
N infullforeca+ fes ^ L e REPLACE FURNACE AND ,REPLACE A/C 3 TON
a Z Licc a=Clan
F Date Canuusor G
AR NfTECfS DEC A N
i < 1 understand my plans shall he used as public mcmds
ayU
G Licensed Professional
7 OWNER BUILDER DECLARATION
2 C C I hereby e(Sect that I on exempt from Be Gnnmas Cc :Any c law far the
p O following mason.(Saint](131.3,Business and ew,aceoes Codes:Any city or county $[�
e m�+ which rtquims a Perrone to cnnswcl,a@q impmw,dcmallsh,or repair any structure y 7
a�H prior to its issuasmc.auu rquime dm applicant forsuch permilto Bk asignedsummcnl
that ere u licensed pursuant to die provisions of Ota Comsscrui Licerm Law(Chapter 9 Sq.Ft.Floor Area u ion
u�s (commencing with Section]Go0)of Divis
ion 3 of the Business and Professions Crum)or /
thin he is eumpt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of AfN W6MT DCCupanc e�
not more Nan five hundred dollars($N)0).
❑I,mownero(utegopmrt ormyemployerawi0mMuumirmlecompensadon,
will do the wads,and Ne structure is natimmunded or offered forsale(Sec.8114,Business
and Profession" er
Cade:The Cantrai Lieue es Law donot apply to an owner of Required Inspections
property who builcisarimproves Neaten,and whodaessach work himselforthmugh his
own employee,Wovided thmsueh improvements am.1 amended oroffems!for sale.If.
howewn the building or improvement is said within ane year of completion,the owner.
builder will have the burden of proving that he did not Wim or improve for purpose of
sale.).
❑1,as owner of the property am exclusively contracting with 11—me convenors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cenm law does not apply in an owner of property who Wilds or improvra themon,and
who contracts fm such projects with a eonlractor(s)licensed pursuant to the Conmi
License law.
❑Iamacnytundes See .B&PCfmidausramn
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declareuam:
1 have and will maintain a Certificate of Convent to aelRinsure for WorkcesCompen-
aation,as provided for by Saturn 3/00 of the Leber Cade,for the performance of the
wort for which his permit is issued.
ri have and will maintain Worker's Compensation Insurance,As acquired by Section
y
,lf1�pWof the tabor Code,for the peRencrun a of the work far which this para t is issued.
orker'sC mpensationn unceaNicr end Policy number. art:
Cartier.
CEMFICAit Op E6EMPnON FROM OR ERW K
COMPENSATION INSURANCE
(Thu section need not be completed if be permit is Forane hundred dollars($100)
or less.)
1 cnify tam in We performance of the work for which this permit is issued.I shall not
employ any Parma in any mannerso ar to became subject in NC Workers'Compensation
Laws of Caliromia.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Ceniflcate of Exannnian,you should
become Subject he the Wad s Compensation provinces alone labor Code.you must
,J z forthwith comply,with such pram ns or this permiuhall he dccmcd mwked.
'ZO CONSTRUCTION LENDING AGENCY
[� Ihereby affm reel them is a construction lending agency for the performance of
!Yi the work far which this permit is issued(Sec.3197,Civ.C.)
1 A Lender's Name
7 z lender's Address
V O 1 certify Nat 1 have rid this application and sum WI the above information is
f'^ correct.l agree to comply with all city and county ordinances and sum laws relating to
V building construction,and hereby authorise repreienctows of this city to enter upon the
above.mentioned property for capmrson purpowhich Ms.
H y (we)agree to saw,indemnify and kmp harmless thc City of Cupcmno against s
Z incoitialuencmrnhe gravits,costs ng upertses which may in anyway ammo against said City
t..3 z s permit.
APPLICANTCof UNDERSTANDS Aof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date
5 RCE REGULATIONS.
P!fLL o/o Re-roofs
Signature or Applian AZARDOUto'S MATERIALS DISCLOSURE Dam Type of Roof
Will the opplicnl or future Wilding occupant smme or handle hamdous material
as cieOned by um Caparison Municipal Code.Chapter 9.11.and Nes Health and Safely
Critic.stetson zss32(a)7 All roofs shall be inspected nor to an roofing material beim
❑res �a P P � Y g g installed.
Will thea OaantOr future building Occupant am<a If a roof is installed without first obtainingan inspection,I agree to remove
pP 6 p equipment art devices which P g
emit hmudoes air canumirunts a defined by the Bay Area Air Quality Managcmcot all new materials for inspection.
DiaVlcll
❑Ye Nu
I have mad the ara morin rrials requirements under CluPter6.95 of the Gli(no
nu Hclth&SafctyCade,Secv=c M5.25533and25534.1understandthuifdm building
docs not currently have a mnam,that it u my responsibility m notify Ne wxupanl of the
rcgtcments which most be met prior to issuance of a cearwate of mnmaar. Signature of Applicant Date
r eed ager All roof coverings to be Class"B"or better
Al Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
S1v.e
OWNER'S NAME: - Al Y 44 Y,4,ea PHONE # p - 6_ ;�14
GENERAL CONTRACTOR: q c FAX #
I am not using any subcontractors:
Si ture 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
!m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37503019 . 00
DATE ISSUED. . . . . . . : 09/22/2006
RECEIPT # . . . . . . . . . : 36167
REFERENCE ID # . . . : 06090217
SITE ADDRESS . . . . . : 19358 SAKURA WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER MIYAKO HENRY
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 7, 800 . 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 175 . 34 0 . 00 175 . 34 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Ol.��g0217
CITY OF CUPERTINO
f I FURNACE/AC
• CUPERTINO PERMIT APPLICATION FORM
APN #
Building Address:
d—,4e1,.Cv Ze l
ov
Owner's Name: Phone #:
cti 1 xD W- fx6 ;76 Y,3
Contractor: License #:
aC 4I
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
u « Ya A '
Residential V Commercial ❑
For Residential Insta ations:
Attic ❑ 1" floor 2nd floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Ap2roval Required ❑
Cost of Project: Type of Construction: Occupancy group:
7 v 3
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
I 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 1 BUILDING
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