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08100072 CITY OF CUPERTINO zee b-=a.=„,«,�c� f'd�•tip ';fir gip' �� •H" ' ' BUILDING DIVISION PERMIT BUII�I1N ADDRESS: PERMITNO. G8091 NORTHWOOD DR AIR QUALITY HEATING & AIR 08100072 OWNER'S NAME: PERMIT ISSUE DATE MI. FUKUMA HAROLD E 720 NORTHRUP ST 10/14/2008 NE: (408) 293-7138 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER; - BUILDING PERMTTINFO BLDG ELECT PLUMB MECH o o LICENSED CONTRACTOR'S DECLARATION Ib Description m I horeby a1Bam that l am licnxd under p (commencingOOSCOpsloof Chapter 9(commencing with Section]pgB of Division 3ofthc Bullpen and Profs ions CoM.o�pylicenuu REPLACE FAN n full forte end eH (f(7 j,-,_ Lieeve Clessit p Dab Contrxsm CHITECI'S DECLARA f . I unticwnJ my pun shall W used an Public recorm to LLa to Licensed Professional 5 OWNER-BUILDER m CLARATION 1heresy ape.NatI 1. aemptfrom tWCanr.Co :A.,claw for tW Q O following moon.(gallon](D 13,Business im ,mfenians Code:Any city or county �i which requires issuance.pmma b e fires th l aper impmw,h Per it i or repair spy ainecre Z y ppm b ire ensedthan to the thovisio ons for sucsump ter to fm am La ed nakmunl FFss� thouthenicmucd Pu ntbtheofMve nso(me Buie ldcfl (Ch-loon 9 oOc)or Sq.Ft. Floor Area Valuation yF$ Loathe eco. imSauoardandusDasisfu3ofealeueiiexampton.MionsCode)or $2200 Loathe u exempt dserefrom and the beau fm the tea due aempu..Any violation of nation than by any red dont rora pe.il abjau the applicant k.dvil penapY of ANY Number � Occupancy e .t mare man fiw hundred.alien(SSoO). � 31636042 17 U' p y�'p I,esaw.r of the psvperty,mmy moPloyw with wagesu Meir eek compenad., will do the work,and the met..u notinterWed or offered formal.(Sec.7044,Business and Pmfesoaru Cedm The Canuanola License law dors rot adame,ply b an owr of Required Inspections pmpenywM bailee or impsows memo.ad«W tloesson wort n;,,,..11m through hu ownemploym,ProMded mat soh improwmena art not ionated oroRered lunatic If. however,the Wilding or improvement is sold within one year of complelian,the ow.r- Wilder will have the bodes or proving that he did mi build or improve for purpose of sale.). ❑1.u owns of the property am exclusively contracting with licensed contraebrs to construct the project(Sec.7044,Business and Profession Cade:)The Comeacmrs U. cense law docs not apply in an owner of pmpeny who Wilds or improve thereon,and. who erects for such projects with aconuaclm(s)licensed passant m the Conua:lons License Law. ❑I am exempt under See .B&P C for this mason Owner Dam WORKERS COMPENSATION DECLARATION I hereby afford under penalty of perjury one of the following declandmic 1hswandwillmainuln aCe rramof Cementbself-inumfmWorWsComWn- sd..u Providd fee by=a.PIIU of the labor Code,fm the peRmmance of the work for which this Permit is limed. ❑I haw and will maintain Workers Compensation Insurance,as required by Section 3700 of the LaWr Code.for the Pantomime of the work for which this permit is issued. My Workda Compensation l orris and Policy number are: Carrier.t0 Polity No.:ARK S Z CERTIFl TEOF EMPP ll PROM ORKERW COMPENSATION INSURANCE (flus seen.need rot W camplckJ ifine permit k for one hunmddoBan(SIm) or leu) 1 cenify that in the perfo.ame of the work fm which this permit is Wood.I shall.t employ any Person in any manmrse in b become abjeeL in theWorkers'Compensation Laws of California Daus Applicant . NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subjat in the Workers Cmnpensm..provisions of On IaWr Cde.you mute �O foMwith amply with soh Proviuon or this pemil"I W dcemcd rewkcd. z'73CONSTRUCTION LENDING AGENCY I—m I Wreby*Mm mat Bert is a conslruccom lending agency far the performance of (La the work for which this Permit k resod(Sec 3097.Civ.C.) Q Lenders Name .7 z Lenders Add. C)0 1 certify mat I law read this.,licalion and shote that the mo.information is "mace”agree b comply with all city and county ordinances and auk laws relating b O Wilding construction,and hereby anmodic mtancenudhes of this city to enterupon the 0. hove-mendmcd Property fee inspection purpts¢s a (We) S.to aw,indemnify it keep harmless the City of Cupertino agent rn Iiabilitin.Judgmenu,coN and expema which may in any way accrue egainsl aid city t,)2in consequence of the grunting of this Permit APPLICANT U �DERSTANDS AND WILL COMPLY WITH ALL No'. Issued by: Date t7 &&- SOUR /5 U ONQ'1 S. _ / (%�— ' 0 Re-roofs Sig fA ioHAZARxror b HAZARDOUS or building DISCLOSURE Type of Roof Will y ft C Pent or future Wlldi ode.occupant Rmc or hanand the beauteousmaterialSafr u deBncd by the Cupertino Muniripel Code.Chapter 9.13.end the NW th and Safety Code.Seenon25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑YnsNo Will rhes applicant o future building occupant use equipment or devim which If a roof is installed without first obtaining an inspection,I agree to remove n haemous air cone nimn s as dcMcd by the Bay Am.Air Quality Management all new materials for inspection. District? 1 / ❑Yes ` . Thaw x read the bamaterials requimmenu under Chapter 6.95 of the Califor. his Health&Safety Code,Section 25505.25533 and 25534.1 understand mat if use Wilding does rot cwrtndy W •=ML thm it b my res MMiimy b ratify de occupat 1`01C rcyviremeno 'h met 'ormusuanceof.Cadfcm.1'0 op Signature of Applicant Date Owmr ora team g=nl , ) All roof coverings to be Class'%W'or better CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31636042 . 00 DATE ISSUED. . . . . . . : 10/14/2008 RECEIPT # . . . . . . . . . : BS000006338 REFERENCE ID # . . . : 08100072 SITE ADDRESS . . . . . : 20091 NORTHWOOD DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . OWNER . . . . . . . . . . . . : FUKUMA HAROLD E ADDRESS . . . . . . . . . . : 20091 NORTHWOOD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0554 RECEIVED FROM . . . . : MATTHEW T FARBER CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791 COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIR ADDRESS 720 NORTHRUP ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 293-7138 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- -------- ------- 1BSEISMICR VALUATION 2, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1MPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00 1MRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 ---------- ---------- --------- ----- TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER --------------- -------------- ----------- CREDIT CARD 224 . 85 MC --------------- TOTAL RECEIPT 224. 85 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- ------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • .,. Community Development 10300 Torre Avenue 5'" l Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 OUPEkTINO Building Department JOB ADDRESS: �D � /� PERMIT / v OWNER'S NAME: %'/ice/ PHONE # L — P GENERAL CONTRACTOR: FAX # " X65 I am not using any subcontractors: gnature Dale Please check applicable subcontractors and co Tete 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 FURNACE/AC On OF CUPEkTINO PERMIT APPLICATION FORM APN# 3 i�3 0 ya: v Date: / U Building Address: — Owner's N � Phone#: Contractor: Phone #: Fax #: 79� 09fF> Contractor License#: Cupertino Business License#: Contact: Phone#: S Fax #: Building Permit Info: Elect Plumb Mech Residential Commercial Job Description: ��J^ For Residential Installations: Attic ❑ I" floor 2nd 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: 90-1 Type of Construction (Usage Class): 47,MO L,/f3 Strapped L On Platform BondedEl New Location Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Valuation: 7;-Z�O0 4�— 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. Z!o-- Revised 6/16/08 CITY OF CUPERTINO FURNACE/AC CI of CUPEI�TINO FEE SCHEDULE • Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or • floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets IBPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. IBSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the install/relocate/or M • replacement of ea appliance vent install & not incl in an appl permit. Quantity Fee ID Fee Description Fee Permit Type r n