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09010084 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 1120 S STRILING ED AAA FURNACE OWNER'S NAME: CONDITIONING PERMIT ISSUE DATE S A 0 CONTROL NO. ' (408) 293-4717 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION Job Description Cmi I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full fora and riled REPLC FURNACE 60, 000 BTU & A/C 2 1/2 TON z License Class " L:2C Lie.M 7 '?/ a Dale_ i^ZU—c+�� Contractor n k- ARCHITECTS DECLARATION 1 understand my plans shall be used as public records �dU 4 O y Licensed Professional y 3 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p O following mason.(Section 7031.5,Business and Professions Code:Any city or county .429 which requires a permit to construct,alter,improve,demolish,or repair any structure 4;- prior to its issuance,also requires the applicant for such permit to file a signed statement E x that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation %$-a $-a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6430 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 mon;than five hundred dollars(S500). 36226008 . 00 ❑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.70",Business Required Inspections and Professions Code:lite Contractors License Law docs not apply to an owner of Q p 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 Contractors License Law. ❑I am exempt under Sec. B&P C for this reason Owner Dale 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 Compen- .&don,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 8-1 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 Workers Com on insurance carrier and Policynumber are: Cartier.sir T'r tCV Policy No.; y1_35& f L-—6 L CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mis section meed not be completed if the permit is for one hundred dollars($100) or leu) 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 Oforthwith comply with such provisions or this permit shall be deemed r:vokcd. Z'"' CONSTRUCTION LENDING AGENCY [~i►�-� 1 hereby affirm that there is a construction lending agency for the performance of tY, the work for which this permit is issued(Sec.3097,Civ.C.) W A Undoes Name 04 a z Lcnders Address U 0 1 certify that I have read this application and state that the above information is V ►*. cored.1 agree to comply with all city and county ordinances and state laws relating to 8> building construction,and hereby authorize representatives of this city to enter upon the >.W above-mentioned property for inspection purposes. CL (We)ages to save.indemnify p harmless the City of Cupertino against Hliabilities,judgments.cossand ex which may in any way accrue against said City (,)Z in consequence of the gNin rmit. Date ►-d APPLICANT UNDERSTA(D ND WILL COMPLY WITH ALL NON-POINT Issued by: aREIGULATIONS. Re-roofspplican for Date 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 Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes FINo 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 nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. listed? ❑Yes 9No / 1 have read the hazandtws requirements under Chapter 6.95 of the Califor- nia Health k Safety Code. ,25533 and 25534.1 understand that if the building cur cly hays a it is my responsibility to notify the occupant of the reqs' nta which must a 'or to issuance of a Certificate of qccupancy. Signature of Applicant Date 6�w r 2` `�'1 All roof coverings to be Class'Jor better CJZVnclor authorized agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36226008 . 00 DATE ISSUED. . . . . . . : 01/20/2009 RECEIPT # . . . . . . • • • : BS000006999 REFERENCE ID # 09010084 SITE ADDRESS . . . . . : 1120 S STELLING RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : OPAL LEMMER ADDRESS 1120 S STELLING RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 6,430 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6,430 . 00 0 .70 0 . 00 0 .70 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 2 . 00 122 .38 0 .00 122 .38 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 287 .24 0 . 00 287 .24 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------- CREDIT CARD 287 .24 VISA --------------- TOTAL RECEIPT 287 .24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ----- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL cqe� oc44 CITY OF CUPERTINO FURNACE/AC CUP ERJJIN0 PERMIT APPLICATION FORM APN # Date: .-3 A; ( 00k - Uv O/ Z o Building Address: Owner's Name: Phone #: Contractor: Phone#: L/ Fax #: Contractor License#: Cupertino Business License#: Contact: Phone #: �� Fax #: Building Permit Info: Elect Plumb ❑ Mech Resid ntial Commercial Job Description: For Residential Installations: Attic ❑ 1" 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.Re uired ❑ Cost of Project: y3 z9,� Type of Construction (Usage Class): t/ l� Strapped On Platform Bonded New Location Replacement Project Size: Express B'" Standard ❑ Large ❑ Major❑ Valuation: X30,4210 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 10FURNACE/AC CUPEkTiNO FEE SCHEDULE Group FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS 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 IEPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P ` 1TRAVD0C Travel Documentation B I 1BUSLIC Business License B Quantity Fee ID Fee Description Fee Permit Type INPUT Resources Energy IAQ/Health 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/Heaith pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes T.Seal all Exposed Particleboard or MDF 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 Id 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 M . 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 G:data/propstgreenbuildingguidelinWremodelers/gmenpointsfinal2.12.04pmtected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPERTINO Building Department JOB ADDRESS: /y PERMIT # 2D 5;oO441 OWNER'S NAME: Q PA L L a rr»m P/L PHONE # ` —-7 2- GENERAL GENERAL CONTRACTOR: FAX # I am not using any subcontractors-;q9 Signature Date Please check applicable subcontractors and complete the following information: Ad 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