09010039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � QR
BUILDING ADDRESS: PERMIT NO.
11300 CANYON VIEW CL AAA FURNACE & -AIE-- 09010039
OWNER'S NAME: CONDITIONING PERMIT ISSUE DATE
SAN CONTROL NO.
14.10 :
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
REPLACE 80, 000 BTU FURNACE BD ELECT PLUMB ECH M�
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z . with Section 7000)of Division 3 of the Business and Professions Code,and my license is
n=H in full force and 7
i.
Z License Class LN 2 04
n M a Dale gg.2,- - ntractor '
A CHI'r- CoS DECLARATION
I understand my plans shall be used as public retards
X96
4 H Licensed Professional
rn� OWNER-BUILDER DECLARATION
qy 1 hereby affirm that I am exempt from the Contractor's License Law for the
L p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K io which requires a permit to construct,alter,improve,demolish,or repair any structure
yZ y prior to is issuance,also requires the applicant for such permit to file a signed statement
F=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yF- (commenting with Section 70D0)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 any 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 Conuactoes License Law dors 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.).
❑1,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 contractors)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sea .B&P C for this reason
r)wner 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-insue for Worker's Compen-
sation,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
6'/Op of the labor Code,for the performance of the work for which this permit is issued.
My Worker's ore ensanon Insurance carrier and Policy number are:
Grtier Policy No., 1 v
C91tTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one 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 in any manner so as to become subject to the Worltcrs'Compensation
Laws of California.Date
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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[~-r►�- 1 hereby affirm that there is a construction lending agency for the performance of
ai the work for which this permit is issued(Sec.3097,Civ,C.)
W Q Lender's Name
Lender's Address
C.)0 1 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
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
LL
(We)agree to save,indemnify and keep harmless the City of Cupertino against 1
liabilities,judgments,toss and expenses which may in any way accrue against said City I
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SVc�RRCE REGULATION .
r'1.._ ,/- 4/IN,1 Re-roofs —
gnatum of Applican onuactor Date Type Of Roof
HAZARDOUS MATERIALS DISCLOSU
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)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes []�No
I have read the hvardous material requirements under Chapter ti.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if due building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prier to issuance of a Certificate of Occupancy. Signature of Applicant Date
` All roof coverings to be Class" ``or better
ner or authorized agent ate
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: Sy1ViaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35627018 . 00
DATE ISSUED. . . . . . . : 01/09/2009
RECEIPT # . . . . . . . . . . BS000006942
REFERENCE ID # 09010039
SITE ADDRESS 11300 CANYON VIEW CL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER ALLEN JAE L AND BARBARA A TRUS
ADDRESS 11300 CANYON VIEW CL
CITY/STATE/ZIP CUPERTINO, CA 95014-4838
RECEIVED FROM JIM RANDO
CONTRACTOR R.ANDO, 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, 912 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 912 . 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 ---- -
------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
Community Development
10300 Torre Avenue
. 0 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
_ 0
OWNER'S NAME: 6,44,6 44 € PHONE # -
GENERAL CONTRACTOR: k FAX #
I am not using any subcontractors:
tSiTture Date
Please check applicable subcontractors and complete 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
CUPEkTINO PERMIT APPLICATION FORM
0901 W3
APN# Date:
,35 cv 21 01 8' 01)
Building Address:
4W eN&V-afJ
Owner's Name: Phone #:
Z,?F ��- d 0/cF'
Contractor: Phone#:yp6e 7l J
4,&De2 Fax #:
Contractor License #: Cupertino Business License#:
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Contact: Phone #:v;:�2aoc
C$X X ,� Z �/�- Fax M
Building Permit Info:
Elect y Plumb Mech
Residential kJ Commercial
Job Description:
t✓ 0 Zf C D G
For R sidential Install tions:
Attic El 1St floor �`� 2"d 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: I, Type of Construction (Usage Class):
Strapped On Platform El Bonded El New Location Replacement
Project Size: Expr s Standard ❑ Large ❑ 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. Z5--
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/AC
CUPEkTiNO FEE SCHEDULE
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
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
r 1 EPERMITFEE Electric Permit Fee E
IMPERMITFEE Mechanical Permit Fee M
r
1 PPERMITFEE Plumbing Permit P
M9�
/ 1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
Quantiq Fee Description Fee Permit Type
INPUT Resources Energy A!
. n oor Atr ua rty and imshes
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:allExposed Raftleboard or MOF 4 IAQ/Health pts y=yes 0
8.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=yes 0
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
1 1 1
Total Points Availablel1 1401 1301 57
Total Points Project Received: 01 0 0
I,01
G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xis