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06080035
CITY OF CUPERTINO 1'K*'•exu.+v . * " "' � ``' �"'�' BUILDING DIVISION PERMITCC1)ITRACTOR INEOLtMA_TION u"�t, 'VZsu Ru1LDINGADDRESS: AIR QUALITY HEATING & AIRC 5WIT NO.06080035 1128 STAFFORD DR OW NER'S NAME: PERMIT ISSUE DATE Alk FERRIE JAMES D 714 NORTHRUP ST 08/07/2006 lip NE: SANITARY NO. CONTROL NO. (408) 293-7138 ARCHITEC MNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH opo LICENSED CONTRACTOR'S DECLARATION �=C I Mrtby""m teat I Am licensed under provitioru or Chapter 9(commencing Job Description <U with Section]IXMl)af Division Sar NC Busincv anE$pfpssiuns Codc,end mYliccvc is ?ate in full foto0 and L +PYI/Y-„ REPLACE 2 FURNACES AND ADDAIR CONDITIONERS �v�2 Li<enacC O Lic.N 3— Daw�Comncwr FE A. So CLARATION D m I tinders d my plans shell M mad ss Public tocnrsls / JyU /� goG tTm N Licensed professional lV'p 3 OWNER-BUILDER DECLARATION I hereby arm 1 am exempt from the Contractor'sLiccnx Law for do "l n O following mason.(Section 7031.5,Business and Professions Code:Any city or county V which mqui=a permit m construct Wer,improve,demolish.or repair any struelum --s $21800 _Z< prior at its issuance,also mqumes the applicant for such permit o rilea signed smemcm that he Is licensed pursuant to the provisions of the Comsxmr's license Law(Chapter 9 Sq.Ft.Floor Area Valuation YFG (commencing with Section 7MX))of Division 5 of the Business and Professions Code)or y that he is e¢mpt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant far a permit subjects the applicant to a civil penalty of er Occupancy Type eat mato than five hundred dollars(SSOOh ❑Lo he werof and bosomy,structure mY emmeYw with wagess Near sale compensation, win do Newmk.and NcheContractors ontra not intended oroffered foliate(Sec.at an Required Inspections ness and Prty who ns Cade:The ves the en.License law dem eat apply lf r t owner ver q P propertywhoboarsviimproves Norrie,and cons arearuincordhimselfor tiueughh. however. the Wiping or that sato improvements are not intended creficmilled ed far ale.R. builder,Ne Wilding or improvement u sold within one year of improve a for the owner. builder will nave cite burden of proving Nm Medici not build or improve for puryose of sale.). ❑1,As owner of the property am exclusively contracting with licensed coma ours to ..,met the project(Sec.Tan.Business and Professions Code:)The Conoamals U. cense Law does not apply to an owner of property who builds or improve,thetoan,and who contracts for such pmjew with a contr cter(s)licensed pursuant te the Conmacmis License Law. ❑I am cxempt umlhm 5 ,B R P C IM Nis toamn Owner Dau WORKER'S COMPENSATION OECLARATION I hereby Alford order porosity of perjury arc of the following aleclaratiarsc Ihartandwillmainuin.Ccr rB.mof Cancelwself-insureforW ftesCompen- sation,As provided for by Section 3700 of the labor Cade,for the perform..of the work for which this Permit is Wood. ❑1 have amd will mainuin Woriers Compensation Insurance,u mitered by Section 3700 of the labor Code,for Ne performance of the work for which Nis permit is issued. ' My Workcls Compensation lnwnntt cam and olicy numbcr"o Carrie r,,t ��. o, a: 3 CERTIFIG OTOFF"EFIPTIONMOMWORKERS' COMPENSATION INSURANCE (This section recd not be completed if the permit is Imonm hundred dollars(SIM) or less) I certify Nal in the performaecc of Ne work for which this permit is wood.I shall not employ any person in any manners,u In become subject to the Wmkees'Compenadon Lawa of California.Date Applicant NOTICE TO APPLICANT:If.after making Nu ceni0.te of Exemption,you Ahmed become subject w the Workcls CrMPCAAM m provisions of Ne labor Codee you most •J O forthwith comply with such provisions or this Permit shall M d.med revoked. 'Ey CONSTRUCTION LENDING AGENCY (•w 1 homey ARIrm Nat then 4.consuocdon lending agency for ft Performance of C.> ft work for which this permit u issued(See097 3 ,civ.C.) ih]Q Lender'sName z Lender's Address U O 1 certify Nat I have road this application And sate that the above information is D.f•' Centel.1 agree to Comply with all city and county ordinances and sue,laws totaling w OU building concoction.and hereby authofi¢representatives of this city to enter upon the C[l shove-mentioned pmPerty for inspection purposes H gy (We)agree to ave,indemnify And tamp harmless the City of Cupmrdno against IiabilidMjudgmenu,casaandexP.n hichmayinanywayamm agamstaid City U z in consequence of the granting of this permit. ,�• a•-' APPLICANT UND RSTANDS AND WILL COMPLY WITH AL ,NON-POINT Issued by: Date so U EREGU N5. s. n oto rr vph o.uacmr �i� Re-roofs Z AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building accupantswm or handle havrdou material u alarmed by th Cupenina Municipal Code.Chapter 9.12.and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. 41 0Yc If a roof is installed without first obtaining n inspection,I Will the Applicant or fuwm building attupam use equipment or devices which g aagree to remove P omit hrrardnus All conumimnts As&r,.d by the Bay Ama Air Quality Managerm.1 all new materials for inspection. Cnaarict7 ❑Yes aI Ihue mal Nehe.Seem25505.Z53snaucriala imments4.1 ChaPur6.95eftite Wilding �� riaHcalIh&safety CAM,Smions255U5,25533And255X.1mwersun0.95.f Calif., data not euemntiY hose A mnsnl that It 4.my m Ponsihilfy w notify cite oceupant of the toyu' menet ch retia be tvriarwsauan"ar ac cm team rracyQan G Signature of pplicant Date AgklcoA� wrctorau 1deadagtm f' Date. All roof coverings to be Class"B"or better CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36207013 . 00 DATE ISSUED. . . . . . . : 08/07/2006 RECEIPT # . . . . . . . . . : 35528 REFERENCE ID # . . . : 06080035 SITE ADDRESS . . . . . : 1128 STAFFORD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : FERRIE JAMES D ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : AIR QUALITY HEAT CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791 COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIRCON ADDRESS 714 NORTHRUP ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 293-7138 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - - - - - --- ------------- -- - ------- --- ------- ---------- ---------- ---------- BREMACOVER NO UNITS 2 . 00 35 . 64 0 . 00 35 . 64 0 . 00 BREMFURN NO UNIT 2 . 00 28 . 62 0 . 00 28 . 62 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 22, 000 . 00 2 . 20 0 . 00 2 . 20 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 216 .43 0 . 00 216 . 43 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 216 . 43 52507 TOTAL RECEIPT 216 . 43 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • Community Development ry 10300 Torre Avenue F ✓'- Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT # //a 6?��o C-0 o -js� OWNER'S NAME: Da ec,r' e PHONE # q68 -a5'7 ,9 7® GENERAL CONTRACTOR: ; FAX# I am not using any subcontractors: _A16 Q U.bS�nl b�Q 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 •�C Q� a I D to er/Contra for Signature Date CITY OF CUPERTINO © ' FURNACE/AC SUPEkTINO PERMIT APPLICATION FORM APN # 7 Date: 1/ / ' aia Building Address: Owner's Name: Phone#: �nn Fe r -e Contractor: Phone: License #: ra fR, � '408- aZ 34/38 Contact: Phone: Cupertino Business License#: m ,:;C r 1 or W9- 3 - '7/38 QQ 791 Building Permit Info: Bldg ❑ Elect P7 Plumb ❑ Mech Job Description: uiur�o�c- Q�J� cZ L ` Residential Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2nd floor❑ Adhere to min set back re uiremenTJ�r or Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cst of Project: Type of Construction: Occupancy group: i a i 8ot+, OL-) �. YZ-- � Strapped ❑ On Platform Er Bonded a' Sq.Ft. Floor Area: New Location Replacement Qty. if ApplicableFc5D Fee Description Fee Grou BENERGY Ener BUILDING 2 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 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