06060022 CITY OF CUPERTINO � }tm sns zy
. UILDIN'U,,DIVISION PERMIT ,-Cp�fRACTORINFORm'Adf,
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Bu1LOINGADDREss: STANFORD PLUMBING HEATING &AffVO-06060O22
22034 BAXLEY CT
OWNER'S NAME: PFRMrf ISUE DATE
t
CRAIG CUMMINGS 1965 KYLE PARK 006
SANITARY NO. CONTROL N0.
(408) 286-8931
ARCH1TECf/ENr'INEER RUILDING PERMRINFO
w BLDG F1RCr PLUMB NECH
lob LICENSED CONTRACTOR'S DECLARATION Job Description
". �iF I hereby arBrm ihu 1 w 0moam under pr.umt.a Chapo 9(matmowin{
" NmSeedon]01101 P 3a(tha Butimst.rtd Profv Codc-aNrrt' it
W CO]=.7=
ra e W R & R 2 EACH FURNACE Affi 0Ar
1qz Ixcue Co.a A�P\aR7®!
F (hlc Contrsmr r
ARCHRECTS DECIaR TT N
i I uMovaod my 0
rlw Wall Ix=d u public rtcnn6
IicaucdPmfoolooal JUN Zg 2006
0`NNEm tote DER DECLARATION CrroTION
<S I h"ohytoam .(S than 11.,13 from ft Cotiom oo :J y Law for tk
.o o wt h Nor mama.(Scrim]0313, alw. .nd PmrcuiaM cam:Ray clry a caa.y 8 0 0 0
�i whkh b,, apabo,w conar:ho ptu.®pmts,.toadW.ampmcnyvrvna.
-z� pylar to ns um,mm..Iw m4uirtathc aPplL:a°t(apwh pamitw fik.tlLrcd asmmt
< daukitlucrumptuvuMtotboP ivaoaftbcConlrawar',Lko.L..law.9 Sq. FL Floor Area n
j � 5 (emnownang.th Sad.7000)of Division 3 of the 111 WP.faiom Code).
. .. thn be h eaaopa thaefraa and the It.fa the.1•�^"uam W m Am vblatian of
Seal.703"by arty apptiona for.p ft mbjeeu Ne-11 ant w a d 11 Rrutp or i Occupancy Type
era mac duo A.btmdmd dolun(IM
❑1,u ower'of th PtoPcrtl,a COY wplvYea viwh w.Qa u thu mW caopeovrhm.
*..dawn,Land°em„a°mhn in ndcd« aendr°rule(see.]D".B°°""' Required Inspections
mrd Pmfe.d,,..Code:Too CvouetWt L.ftats lar(om'at apply n an o of q
propvty saber buBda a imp.'et tivewa,W vhodau rah vmt hiT..tr athmuLh hu
ow empkyrra,prwlded thu mch uoprmwntoda w opintodrd wafered ra'a�If,
ho•ae'er,the boWio{oronprora is"d Wthin ane)earam Wp bo,me--
builder v haw Lho Godes of provut t1b t In dW aaa WW or impure for puryos a
pIL}
1.u ower of t4 pmpmy.w ombor.ly caau .S NW Baaacd mmrxrat n
can�oum ore p,*m(Sec]Md.Boilnev am Rafedau Cade:)'Ibe Cmaanar.li
cove Lav daa not pplry w mo a of popery vita build or impotea therms,and.
who comraaa roar mch pojem vrith m emtrameap)11,d Paattw m Ali Cootraw ' .
IJcena law.
❑Iwawp. •. yes .BdPCfa thu woo
Ovrc Dm,
W ORXERS COMPENSATION DEII.SRATION
1 bereby affl..ceder P® y of pajtoy me of tha W Wo{dedarab—
I baw and"I ttuinuio a Cod6mm of Cavum to s f-Iron fawartda Caopem
aaliortAs pmrlded fa by Seth..37410 of the labor Cade,for me perf..of the
farrhkh thir prmh u ivaetl.
I and w l..Crum Workzet Umpouulm btmr.Me,u occi a by Sdm .
a ft Lata Code.fa rhe perfowane of ds�tr.�v/hkltmuPQorftRi,I.—
UyW
rrier O_4 If n� ftotN L K d/2
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rrhli swim ood asbe uavpkmd if tb�Ier.lt I.I..httomcddoeaa(3100)
a lual '
I¢rdfv Net to the prrfmoase a the w for Mhwh Nu permit u i I Nall twr
=ploy mypermn un my m 0u Wbc =object to tho WohoY Cotop�
ICO a California Doc
NOOIICE TO APPLICANT:R,atter.akin{tbV CcoiBra,o a Faonptlon,yam N W
become tuition w the Worc&t;Canro.w.pmHdau a the lab.Cmc,yott otm
,J O ranbwth eornply wM met pmvb600s a Nu po.it N.I1 be deemed motel
Z� CONSTRUCTION LENDING AGENCY
[-tr I bemby art .Nat otn 4. auuaim kndl "Fny fa the Marfa or
pf.> dtc t fa.hkh dm permit u imrto (Sat 3097,Civ.C) '
iC] Lcmeh Nude
= Z Isodera Amw
U0 1 a tify that 1 Mu Cud thu mptliotiaa and vam mat Ne.bow Iafomtaum u
(L cotta,,I a{rte toamply with all chy W county mRturaa W.um I.,.a won{w
�U buildiv{caWrartion,WhoriY bon pwWw cnuti.rsor Nu city to emu uptn tK
C31 above-mcndored popcny for impcctian lot psa
(WC) rte w aaw.inmmni(y and trop hornless the Cry or Cttperfitw a{aiw
raj) liabilitkt,J L tw,eoau and eapcmca which may Want wyacaue.Laloat Laid Ory
U z APPM'CN '16RI�n{ AND WILL COMPLY WITH ALL NON-POINT Issued by. Date
Re-roofs
St HAZARDWS MA DISCLOSURE o.w Type Of Roof .
WIB
ftp,].or
fwurt hulldia{oreupa^t qac a hawk hrurdoua weriil
u mllrad by Nc Cupenloo Code.C otpter 9.12.W ft Ha1N W Way
Cam.Scm.2553](UI All roofs shall be inspected prior to any roofing material being installed.
❑YuNo
ftMno WMn{a ox=otlulpmeotor c a 1, If a roof is installed without firs[obtaining an inspection,I agree to remove
Will ft appl��Z
.nll lunrdotu alr contwimnu n mrmm by Nc Bay A Air QWItY M.naLrmmt all new materials for inspection.
Dlmia7
O Y�
I mad Ne rrwimtanuwderChapwR91adcCah(o,-
td, WNY 25583.25533 W 25534.I.lour.N V ft Gdldin{
dw c MI Na it u my 'hility w.dry dte omgmt or Ne
m9 ptiawt a'crn;rta'e .v Signature of Applicant Date
o.•naam .peat D,w. All roof coverings to be Class "B"or better
i
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35606031 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . : 34673
REFERENCE ID # . . . : 06060022
SITE ADDRESS . . . . . : 22034 BAXLEY CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CRAIG CUMMINGS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ATLAS HEAT & AIR
CONTRACTOR . . . . . . . : TRILLO, STEVE LIC # 4269
COMPANY . . . . . . . . . . : STANFORD PLUMBING HEATING &AIR
ADDRESS . . . . . . . . . . : 1965 KYLE PARK COURT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 286-8931
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- ------------- ---------- ---------- ---------- -- -------- ----------
BREMAIRHAN NO.UNITS 2 . 00 20 . 52 0 . 00 20 . 52 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
MPERMITFEE 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
---------- ---------- ---------- ----------
TOTAL PERMIT 132 . 92 0 . 00 132 . 92 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --------- ---------
CHECK 132 . 92 7719
TOTAL RECEIPT 132 . 92
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO U-0 b(o 00
SO FURNACE /AC
CITY OF
' CUPER1INO PERMIT APPLICATION FORM
APN# Date:
6-D 6 -031 � � oro
Building Add
May
Ow er's Name: Phone #:
� IRS (D
Con act r:t r License#:88
d
Contact: Phone#:
r
Applic nt/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Descriptio p� /� 2 eo.-
Residential: T + R 2 ea-&(O/ q Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/En gineer: Valuation:
' Type of Construction: dWJ
Occupancy Group:
I �
Qty. if
A licable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
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 BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG