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09010116 7 77 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � �� ' ... ........... BUILDING ADDRESS: PERMIT NO. 10822 S BLANEY AVE KESTER HEATINLE_ n9nin1i6 OWNER'S NAME. CONDITIONING EMIT ISSUEDATE 4351 GL SA CONTROL NO. r0 BUILDING PERMIT INFO ARCHITECI7ENGINEER: BLDG ELECT PLUMB MECH RPLC EXTNG FORCD AIR FURNACE Q D D D q p p LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 70(10)of Division 3 of the Business and Professions Code,an. d my license is o<a in full force and effect Da Z License Class ZZ2 .Lic.#t L K-0 Date Contractor 1 ARCHTIECTS DECLARATI I understand my plans shall be used as public records Dgu 1:u.y Licensed Professional n OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county o w,� which requires a permit to construct,alter,improve,demolish,or repair any structure Z; prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation E_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq X t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑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 Required Inspections and Professions Code:The Contractor's License Law dots not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- _don,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not tic completed if the permit is far anc hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person n any manner so as Io^bee subject to the Workers'Compensation Laws o(�aliforoia a� �Z-1 �M Applicant - NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY [~i t�-t I hereby affirm that there is a construction lending agency for the performance of .7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address (�0 I certify that 1 have read this application and state that the above information is [7r" correct I agree to comply with all city and county ordinances and state laws relating to 0Vbuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. >4 W0. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hrn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z inconsequence of the ranting of this permit Date APPLICANT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR ULA NS. ` — v`l 1 Re-roofs Signature of Applicant/Con tar Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? J�/� All roofs shall be inspected prior to any roofing material being installed. ❑Yes C7 no Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .aict? ❑Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not current have a tenant that it is my responsibility to notify the occupant of the mens w It must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class" "or better Owner or autharized agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36923050 . 00 DATE ISSUED. . . . . . . : 01/27/2009 RECEIPT # . . . . . . . . . BS000007048 REFERENCE ID # 09010116 SITE ADDRESS . . . . . : 10822 S BLANEY AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DAVID M KESTER ADDRESS . 10822 BLANEY AVE CITY/STATE/ZIP CUPERTINO CA, 95014-4544 RECEIVED FROM . . . . : DAVID KESTER CONTRACTOR KESTER, DAVID M LIC # 22101 COMPANY KESTER HEATING AND AIR CONDITI ADDRESS . 4351 GLENPARK DR CITY/STATE/ZIP SAN JOSE, CA 95136 TELEPHONE (408) 265-1103 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 700 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 700 . 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 225 . 85 0 . 00 225 . 85 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 225 . 85 VISA --------------- TOTAL RECEIPT 225 . 85 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------- _ -------- ------------------- _ _ -- ----------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO ............a., FURNACE/AC CUPS TiNO PERMIT APPLICATION FORM APN # t Date: Building Address: Owner's Name: Phone#: Contractor: Phone#: C' C�^��,.� Fax#: 5 Contractor License#: Cupertino Business License#: �75 Lf kc:> ZZ t -7- Contact: Phone#: Fax#: Building Permit Info: Elect❑ Plumb ❑ Mech ❑ Residential Commercial ❑ Job Description: , 1��r t'_ i �G('�� rJ a� � f ,.� J�?i e�'' `� ► –�_ For Residential Installations: 2nd floor ❑ Attic ❑ 1St 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: Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express aridard ❑ Lar e ❑ Major❑ _ Valuation: 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 CITY OF CUPERTINO '.._51 � FURNACE/AC CITY OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1 MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not incl in an a pl permit. FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1EPERMITFEE Electric Permit Fee E 1MPERIVIITFEE Mechanical Permit Fee M / P t 1PPERMITFEE Plumbing Permit MNJ�Q,A- N_ — 1TRAVDOC Travel Documentation B 1BUSLIC Business License B INPUT ResLu-,res Energy A01Health M.Indoor Air Quality and Finishes 1,Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y--yes0 5.Use Exposed Concrete as Finished Floor 4 Resource pts Y--yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 i Total Points Available: 140 130 57 Total Points Project Received: 01 01 0 G:datalprvgs/greenbuildmgguidelines/remodelerstgreenpointsfinai212.D4protectedxls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # I D,2�ZZ 0: 'Ti)LAtz' >vf-. OWNER'S NAME: - * o o:.�• p 5`► PHONE # _ �; -t�. 35 GENERAL CONTRACTOR: FAX #4*,' 12" 26 _k:— I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: 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 Date Owner/Contracto Signature