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09010041 CITY OF CUPERTINOW � ; BUILCING DIVISION PERMIT s: PERMIT NO. BUILDING ADDRESS: 6658 C1, AA RNA PERMIT LSSUE DATE OWNER'S NAME: CONDITIONING SA 0 9 CONTROL NO. etlo BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH REMOVE FURNACE INSTALL CJ O C7 D uca LICENSEDCON7RAC1'OR'SDECLARATION CENTRAL SYSTEM IN THHnb Description UI hereby affirm that I am licensed under provisions of Chapter 9(commencing ^T ^^ m T t . with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and License Class ` l' Date Contactor =F ARCHITECTS DECLARATION 1 understand my plans shall be used as public records D-U O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county y= which requires a permit to construct,alter.improve.demolLth,or repair any structure h permit ro file a signed statement Valuation prior o its issuance,also requires the applicant for sucstatementS Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis[a the alleged exemption Any violation of APN Number Occupancy Type Section 703 L5 by airy applicant for a permit subjects the an to a civil penalty of not more than five hundred dollars(SM. ❑I,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.7(M4.Business Required Inspections and Professions Code:The Contractor's License Law does 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.U. 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 constrict the project(Sec.7044.Business and Professions Code:)The Contractoes 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 Contractors License LAW' ❑1 am exempt under SeB&P C for this reason See. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure 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 Insttrana,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. y Worker's Compensation Insurance carrier and Policy number are: Cartier. �� �! Polity No. -C C RTIFI F EXEMPTION FROM WO E S' COMPENSATION INSURANCE ('cads section reed 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 Workers'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 0 CONSTRUCTION LENDING AGENCY H 04 1 hereby affirm that there is a construction lending agency for the performance of Pd> the work for which this permit is issued(Sec.3097,Civ.Q W Q Lender's Name Lcndefs Address Z U 0 1 certify that 1 have read this application and state thatinformation is the above cormct.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 above-mentioned property for inspection purposes i7W (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City �� e_e� U Z in consequence of the granting of this permit. DateZ / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO CE REGULATIONS. Re-roofs — ignuure of Appl rant/Conuac De1c T of Roof HAZARDOUS MATERIALS DISCLOSURE Type / 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 1 have road the harardaus 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 currently have a tenant.that it is my responsibility to notify the occupant of the Date req;( cnts which must be met prior to issuance of a Certificate of Occupancy. Signature Of Applicant p / ' - All roof coverings to be Class'n"or better Owner or authorized agent Dae CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36924054 . 00 DATE ISSUED. . . . . . . : 01/09/2009 RECEIPT #. . . . . . . . . . BS000006944 REFERENCE ID # . . . : 09010041 SITE ADDRESS 6658 CLIFFORD CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MARK MUEGGE ADDRESS 6658 CLIFFORD CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2347 RECEIVED FROM . . . . : JIM RANDO 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 4, 960 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 4, 960 . 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 si � Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEf�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: , e C - PHONE # D/ GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ,� �-. - ll G Z •off Signature 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 0 9 61 COL4 APN# Date: 2A 05q. Z)o Buildin Address: l0� vD ��i � D/a✓ v1 #: Owner's Name: Phone vet - Contractor: Phone#: ,7_ Contractor: Fax M Contractor License#: Cupertino Business License M li�Zg 2Z F-D X-.0 Contact: Phone#1<4 A w Z�,� Fax #: Building Permit Info: Elect ( Plumb rq-- Mech Residential Commer ial Job Description. I"\ For Residential Installations: Attic ❑ 1St floor [ 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Additional weight (structural calcs) E]Replacement same weight 1-1 Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of Conpn (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Ex ress [q"'Standard ❑ Large ❑ Major❑ Valuation: y9G6,� 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 6/16/08 CITY OF CUPERTINO aOF' FURNACE/AC CUPERINO FEE SCHEDULE Group FURNACE FURN/AC 1 PGASRES 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/burner, 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 1 EPERMITFEE Electric Permit Fee E r 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B ( 1BUSLIC Business License B Quantity Fee ID Fee Descri tion Fee Permit T e INPUT Resources Energy IAQIHLalth n oor tr ua rty and mtshes 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 t 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.Sealidl Exposed Pai icleboard_or MCF 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 k777d 1 i 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 Available] 1 1401 1301 57 Total Points Project Received: 01 0� G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis