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09050114 CITY OF CUPERTINO RMI f? BUILDING DIVISION PERMIT *� � SF � PERMIT NO. BUILDING ADDRESS: 10410 MILLER AVE COLD CRAFT INC PERMIT ISSUE DATE OWNER'S NAME: A O. 0 8 9 CONTROL NO. PHONE: (408) 374-7292 BUILDING PERMIT INFO :HTIECT/ENGINEER: BLDG ELECT PLUMB MECH u O p LICENSED CONTRACTOR'S DECLARATION Job Description W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is RMV & REPLACE 1 FURNACE & 1 A/C UNIT n`4 y in full force and effect t v�Z Lice I s Lle•g y Date -Contractor ARCHITECTS DECLARATION wU 1 understand my plans shall be used as public records a 4 u.y Licensed Professional 0 W 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 K Pi which requires a permit to construct.alter,improve,dcmolLeh,or repair any structure y Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation £=G that he is licensed pursuant to the provisions of the Contractor's Lidxnse Law(Chapter 9 Sq.Ft.Floor Area X t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9471 y 9 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 net more than five hundred dollars(M). 37505042 . 01 0 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(X4,Business Re sired Ins ectlons and Professions Code:The Contractor's License Law does 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 arc 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.). 0 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 conuactor(s)licensed pursuant to the Contractor's License Law. 0 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: 0 I have and will maintain a Certificate of Consent to self-insert for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the irk for which this permit is issued. J I have and will maintain Workees 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 am; Carver►1�U 0V i V\ Ir rrt n(l�lky Ne.:A, I G 503 No(I 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 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 revoked. Z R CONSTRUCTION LENDING AGENCY F~.d►Q.) I hereby affirm that there is a construction lending agency for the performance of a!✓ the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Lender's Address U 0 1 certify that I have read this application and state that the above information is IL 0� corccL 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 Oa (We)agree to save,indemnify and keep harmless the City of Cupertino against In liabilities,judgments,costs and expenses which may in any way accrue against said City G V Z in consequence of the granting of this permit. �+ APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bar: Date SOUR REGUL TIONS. r- 1 Re-roofs i a ofA llcant/Contr tot Dare T of Roof 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(x)? - All roofE shall be inspected prior to any roofing material being installed. 0 Yes tfN. 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 r naterials for inspection. District? 0 Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCode,Sections 25505,25533 and 25534.1 understand that if the building does nQt currently have a tenant,that it is my responsibility to notify the occupant of the reyui cots which oat be met prier to issuance er ate artoceo (� D Signaturh•of Applicant Date All roof coverings to be Class"�{"or better w r or autho zed agent Date CITY OF CUPERTINO .. FUW[ACE/AC CP I,TINO PERMIT APPLICATION FORM APN#3-7 5D �a .�1 Date: Building Address: 10Zk t C) M ll Q_ -W A q 5014 Owner's Name: c .\^ � � Phone#: Contractor: Phone#: A OQj- -S --1 2q 2 CCAO CS (A-C+ I�C Fax#: - �) ' 1 &�3 Contractor License#: Cupertino Business License#: Contact: L t_ Phone#:�0 6- S�L{ -1 2q 2 � ,c UL Cl l� �Z- Fax#: 4C 0�j- Building Permit Info: Elect Eg----- Plumb 8� Mech E Residential LtT Commercial ❑ Job Description: e-rnp vc r,-Pi.ace- O nE Tt Zr SCR- ©nt For Residential Installations: Attic ❑ 1" floor []/ 2°d floor ❑ Adhere to minimum setback requirement Er For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ElStructural Calculations required for new installation ❑ New installation Planning Approval-Required ❑ Cost of Project: $Q4-1 t` oo Type of Construction(Usage Class): Strapped ❑ On Platform Bond-d New Location 4 Replacement Project Size: Express❑ Standard V Large[] Major❑ Valuation: (�)t4 Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable,incl ide in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO FURN NCE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Deseriptic n Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,abs:)rption unit,or ea heating,cooling,absorption or evaporative cooing system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appli mce,refrigeration unit,cooling uni;,VAV boxes, absorption unit or ea heathing, cooling absorption,or e-v aporative cooling sys, incl install of ccntrols regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heatf:r,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ;a appliance vent installed &not :ncl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Se.smic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,ab:orption unit,or ea Iheating,cooling,absorption or evaporative coc ling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heat,;r,recessed wall htr, or floor mounted unit heater. CITY OF C UPERTINO .V� FURNACE/AC CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICO Seismic Commer:,ial B 1PGASCOM Commerical for ca gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets I BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B / 1 MRRAA Residential Mecb Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Peru.it M 1 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documen-ation B 1BUSLIC Business License B M.Indoor Air Quality-and Finis es INPUT ResDurces Energy IAO/Health 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOID,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowMo 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 6IAQ/Health pts y=yes D 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 1 1 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 ' 1 1 i 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 D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 1 1401 1301 57 Total Points Project Received: 01 0 0 � =t r iAjqOaV\ LQ �_k 5- iq log G:data/progs/gr:enbui ldingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF CUPEkTINO Buildirt De artment JOB ADDRESS: PERMIT # � 1 � l tom' �v'- . PHONE #0 OWNER'S NAME: KG ON � FAX # GENERAL CONTRACTOR: if C I am not using any subcontractors. Signature Date Please check applicable subcontractors and complete the folloEinBUSINESS LICENSE # SUBCONTRACTOR BUSINESS NAM Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting 4Glas�s/ noleum/ Wood Glazing eag Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date