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11110137 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10550 CASTINE AVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11110137 CONDITIONING OWNER'S NAME: NELSON RICHARD 1 AND MARY S 1712 STONE AVE DATE ISSUED: 11/23/2011 NER'S PHONE: 4087371480 SAN JOSE,CA 95125 PHONE NO:(408)2934717' t LICENSED CONTRACTOR'S LARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �O! DEC License Class C-20" Liic.# 7 CDl-yl REPLACE EXISTING DUCT WORK W/NEW ContmctorM4 !',irvyAtl— Date___rc-��- I hereby affirm that 1 am licensed under the provisions of Chapter 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:54247 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 for which this APN Number:32644041.00 Occupancy Type: permit is issued. i 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.1 agree to complywith all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Z Date: with all non-point source regulations per the Cupertino Municipal Code,Section + 9.18. ll 2 V_// RE-ROOFS: IS rt- Date / 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 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I,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 complianee 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 wbichthis 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 Cade,Secti 25505,25533 and 25534. Section 3700 of the Labor Code,for 0hc performance of the work for which this - /Z v' Owner or authorized egentl Date" ;g/ /— is issued. ` _-__ _ -.-_ Ir I certify,that in the performance of the work for which this permit is issued,l shall not employ any person in my 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 for 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 n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION nnify and keep harmless the City of Cupertino against liabil ities,judgments, s,and expenses which may accme against said City in consequence of the I understand my plans shall be used as public records. granting 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 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32644041. 00 DATE ISSUED. . . . . . . : 11/23/2011 RECEIPT #. . . . . . . . . : BS000015395 REFERENCE ID # . . . : 11110137 SITE ADDRESS . . . . . : 10550 CASTINE AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NELSON RICHARD J AND MARY S ADDRESS . . . . . . . . . . : 10550 CASTINE AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1311 RECEIVED FROM . . . . : AAA FURNACE 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41.00 0.00 41.00 0. 00 - 1BCBSC VALUATION 4,247.00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 4,247.00 0. 50 0. 00 0.50 0. 00 1MPERMITFE FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 1MRRAA UNITS 1.00 65. 00 0. 00 65.00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0.00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 195.50 0.00 195.50 0. 00 METHOD OF PAYMENT AMOUNTREFERENCE NUMBER ----------------- --------------- -------------------- CHECK 195. 50 CHK --------------- TOTAL RECEIPT 195.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO • FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10550 castine ave. DATE: 11/23/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: $4,247 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK a lace existing duct work with new. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Heating System 1MRRAA 1 # $65 TOTALS: 1 $65.00 Mech.Plan Check 0.0 hrs $0.00 Plmnb. Plan Check Flee,Mall Ckech- Meeh.Permit Fee: IMPERMIT Plun ., Permit Etre: F/lc Penni:F::•e: • Other Mech. Insp. 0.0 hrs $44.00 rhlrer P7enilr hasp, Ocher(thee. hrsp. ELI 11"ch Invp Fee: P(uurb, In't"1'er: Ele,InVp. Pee NOTE:This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelinin In ormalion ava!lable and are on!v an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Pl,m Cheek Foe: Snppr/. 11C Fee PME Plan Check: $0.00 Pcn•mir F'ce' Suppl. Insp ite PME Unit Fee: $65.00 PME Permit Fee: $44.00 Cellistruction 7bc Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes (D No $0.00 A,lvanC,ed Planning Fees: Travel Documentation Fee: ITRAVDOC $44.00 • Styrone Motion Pee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: iBCBSC $1.00 SUBTOTALS: $195.50 $0.00 TOTAL FEE: $195.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 «U PE RTI N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 4 rj PERMIT# Cj13 OWNER'S NAME: MA P (3/1 PHONE# 0 GENERALCONTRACTOR: A44 -puelw4cc I BUSINESS LICENSE# TI ADDRESS: Z S I /2 CITY/ZIPCODE: OS'e *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL UBCONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signat)rfe Date Please check applicable subcontr tors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date GENERAL PERMIT APPLICATION � P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-32288�- FFAX(408)777-3333•buildingecupertino oraKA I ❑PLUMBING [gnECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS Paorecr AnpaEss p �n _ 5 t AFN w O OWNER NAME l 23 7 e MAI u STREET ADDRESS pypyi � A CONTACT NAME _ STREET ADDRESS /d S )V a _ .0� ATs ' nQ Q T/L p.� ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT DCONTRACTOR ❑CONTRACTOR ACEN7 ❑ ARCHH ECT ❑ ffNONEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME � ER L! gTYP BUS.LICM COMPANYNAME /�� (pe E MAI / ) � ^ — /''df / s4d�� FAX - A14-1 /'T/c- �T P r y��F' 'L//3—!o;P y STREET ADDRESS / �vCY C .STATE, �lJc 9 TjZf P ARCN TECTAENCINEER NAME LICENSE NUMBER BUS.LIC M COMPANYNAME E-MAI FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 17SFD Or DUpleX ❑ Multi-Family PROTECT IN WLDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NoFLOOD ZONE ClYes ❑ No DESCRIPTION OF WORK I ' C� / i✓I t NPG<.J TOTAL VALUATION: 4-7. O.V/ �'•-;.ei' ,+ .." �.' i_, ;s ya _ CEmuFapB�aT-f'� ' ..' 'ss des�'t-.y'aiCk By my signature below,I certify to each the fol n I am the property owner or authorized agent to act on the property owner's behalf, I have read this application and the infortnati ve p vide cc I have read the Description of Work and verify it is accurate. I agree to comply with ell applicable local ordinances and state laws relati g to ui in Orion. [authorize representatives oFCupertino menter the above-identified property for inspection purposes. Signature ofApplicandAgent Date: ENIENTAL 11YF0 ON REQUaED -'^'-�,or, -ss -- .--, d �pii- ��SrGNL�IIffwwr-g.lt; y��y P I. MEPMLscA,oO 201 Ldoc revised 03/16/11