09020015 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
7594 WATERFORD DR AAA FUFNACE & AIR
OWNER'S NAME: C OND I T I ON I NG PERMIT ISSUE DATE
C909T TDJ 1 :732 53
^HONE: A O. CONTROL NO.
(408) 253-4717
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
90Z LICENSED CONTRACTOR'S DECLARATION Job Description
w1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Q with Section 7000)of Division 3 of the Business and Professions Code,and my license is R P LC FL(RNC & A C
e y in full fore and efhc '7b �-k-7
License Gass C► C Lic.if
f,O Date�-3"a9 Contractor 44A l'ye
ARCHITECTS DECLARATION
1 g a 1 understand my plans shall be used as public records
�yU
L Cy Licensed Professional
ti OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
-<2 which requires a permit to construct.alter,improve,demolish,or repair any structure
prior W its issuance.also requires the applicant for such permit to file a signed statement Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Caw(Chapter 9 Sq.Ft.Floor Area
xI-- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $10056
y that he is exempt therefrom and the basis for the alleged exemption Any violation o[
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). 36616003 . 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.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of 9 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 U.
cense Law docs 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.
❑I 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:
J I have and will maintain a Certificate of Conscnt to self-insure for Worker's Compcn-
ation,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 (O Worrkees)C�`ompensation insurance carrier and Policy number are: /
Carrier: 7 e�i 1E Policy No..7t-JS E Z—
CERTIFICATE 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 Workcrs'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 revoked.
Z"' CONSTRUCTION LENDING AGENCY
F~-r 1 hereby affirm that them is a construction lending agency for the performance of
pG> the work for which this permit is issued(Sec.3097,Civ.Q
W A Lenders Name
]z Lender's Address
U 0 I certify that.I have read this application and state that the above information is
LL" cortex I agree to comply with all city and county ordinances and state laws relating to
building convection.and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
C4 (We)agree to save,indemnify and keep WmIpds the City of Cupertino against
tom+ liabilities,judgments,costs and expenses whit a 'A any way accrue against said City z�
U Z in consequence of the grantingof this Date
P" APPLICANT UNDERSTANDS D COMPLY WITH ALL NON-POINT Issued by:
PSEGULA TIONS.
Re-roof:Applicant/con t Dare Type Of Roof HAZARDOUS MA DISCLOSURE
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 roof;shall be inspected prior to any roofing material being installed.
❑Yea t7 no
Will a roof is installed without first obtaining an inspection,I agree to remove
ll 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 I naterials for inspection.
istrict?
❑Yes ONO
1 have read the hazardlws materials nts under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 7550 25534.1 understand that if dee building
�dms no nlly have a tenant.that' ' ponsibility m notify the occupant of the
rcmcnts ich must be mel pri r ' uance of a Certificate of Occupancy. SCgnatur a.of Applicant Date
Z -f-0 All roof coverings to be Class'A,'or better
authorized agent Date
CITY OF CUPERTINO
FURNACE/AC
%-C'CUPEkTINO PERMIT APPLICATION FORM
APN # ( c� 3 O v Date:
Building Address:
75ciU-2
Owner's Name: Phone#:
T h ern e.S L► 2-j /-M,-3to -I& sr
Contractor: Phone#: bla k , a'- 311'
C!KG"iU C in/t Fax#: ZIL12 *-- a4 3-- !0 7 7
Contractor License#: -7 Co Cupertino Business License#:
sn
Contact: _� �y 2 e-,r— Phone#: 4G 9- -.7,7j -z/ 7 7
Fax #:
Building Permit Info:
Elect 5;r Plumb Mech 2-
Residential Commercial ❑
Job Description:
x5
For
For Residential Installations:
Attic 0 l" 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: Type of Construction (Usage Class):
Strapped El On Platform Bonc.ed New Location Replacement
Project Size: Express [;-' Standard ❑ Large Major❑ -_
Valuation:
Green Building: Please complete relevant portio a 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
FURNACE/AC
CUPE�TiNO FEE SCHEDULE
Quantity Fee ID Fee Description. Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Rep,.ir/Alteration/Add to M
ea heating appliar.ce,refrigeration unit,
cooling unit,absorption unit,ot ea
heating,cooling,at i sorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,17AV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1 MCSUSHTR Commercial Instal/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted uni:heater.
1PGASCOM Commerical for e�.gas piping System P
1-4 outlets
1BPGAS 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 ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMIC0 Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating applianre,refrigeration unit,
cooling unit,ab sorption unit,or ea
heating,cooling,ab Sorption or _
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,r-Icessed wall htr, or
floor mounted unit heater.
CITY OF CUPERTINO
FURNACE/AC
CITYCUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Jnits<= l Ok CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standarcls Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. C omm/Resid
1BREMAIRHAN Residential A/C units<= IOk CFM B
f 1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Resident al B
r 1 EPERMITFEE Electric Permit E
' 1MPERMITFEE Mechanical Permit M
' 1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Document ation B
1BUSLIC Business License B
1AWHealth
M.Indoor Air Ouality 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
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 B 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--yess0
Total Points Available: 1401 130 57
Total Points Project Received: 01 01 01
G:data/pr :enbuiidmgguidelines/remodelers/gneenpointsfinal212.D4protecled.xis
Community Development
- 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C(TY OF Fax(408)777-3333
-UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
Gv
OWNER'S NAME: PHONE # elaS
GENERAL CONTRACTOR: d v V FAX # 7 7 i
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com lete the foll. 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 ontractor S' ature Date