11020003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1606 PRIMROSE WAY CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11020003
CONDITIONING
OWNER'S NAME: WENDY YANG 1712 STONE AVE DATE ISSUED:02/01/2011
NER'S PHONE: 4087258224 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
3 RELOCATE FURNACE FROM CLOSET TO ATTIC EXTEND
License Class C� Lic.#
n GAS
Contractor / Awf N�C a Date O( I LINE&ADD ATTIC LIGHT
I hereby affirm that I am licensed under the provisions of Cliapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2633
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work forI`a �I
APN Number:36615009.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITH YS O�IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LLED INSPETI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1
granting of this permit. Additionally,the applicant understands and will comply Issued by: ate:
with all non: . t source re ulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
SignatureDate v � ' All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections`2550 2 5 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater K
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's fog which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
iridemnify and keep harmless the City of Cupertino against liabilities,judgments,
ats,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
,ranting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36615009. 00
DATE ISSUED. . . . . . . : 02/01/2011
RECEIPT #. . . . . . . . . BS000012622
REFERENCE ID # . . . : 11020003
SITE ADDRESS . . . . . : 1606 PRIMROSE WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER WENDY YANG
ADDRESS 1606 PRIMROSE WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AAA
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 633 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 633 .00 0.50 0 . 00 0 . 50 0. 00
1MFR=<100 UNITS 1 . 00 126 . 00 0 . 00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0. 00
- ---------- ---------- ---------- ----------
TOTAL PERMIT 211. 50 0 . 00 211 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 211. 50 chk
---------------
TOTAL RECEIPT 211 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ELI ADDRESS: 1606 primrose way DATE: 02/01/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$2,633
4:PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK relocate furnace at existing attic location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air J 1MFR=<100 1 # $126
TOTALS: $126.00
Mech.Plan Check Fo.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00 }... ; ,r,, ;=3 Of"
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEtMS (Fee Resolution 09-051 Eff. /1:70) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $126.00
PME Permit Fee: $42.00
��E't,td�ilc�ctl /ie'1'fr , t'l'c':
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50
Revised: 01/15/2011
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
)/0 zbo0 3
APN # Date:
3Low 15 cool- 0 0 1 - oi — 1 )
Building Address:
to0lo r i ro
Owner's Name: Phone#:
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Contractor. r� AX Phone #:elo -t;L-9 3 _y �,
Fax #: -d-9 3 - (o -7 -7 /
Contractor License#: -7 lo$& Cupertino Business License#:
Contact: nQ Phone #:qa,_019 3 -Ll 7) -)p
Fax #:
Building Permit Info:
Elect Plumb Mech EIX
Residential a Commercial LJ
Job Description: ' e OCG.+i n5 r u r N 4CC j= r u C�oSe --e) CUM-7 r-
For Residential Installations:
Attic a 1St floor ❑ 2' floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: 3� UU Type of Construction (Usage Class):
Strapped On Platform Bonded New Location Replacement
Project Size: Express Standard Large Major
Valuation: 7-(0 331 ev
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09