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09050078 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 1554 S STELLING RD A & H JiEATING 09050078 OWNER'S NAME: PERMIT ISSUE DATE FIMPUE ri�IKCltii,&11I� PHONE: A A O. CONTROL NO. (408) 2'19-0722 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG EO PLUMB MECH O a0p LICENSED CONTRACTOR'S DECLARATION ul p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z� with Section 7000)of Division 3 of the Business and Professions Code,and my license is I full f.Classdeffet REMOVE AND REPLACE FURNACE & CENTRAL A/C j a Z License Class; �' � Lie.k c!cIc �f 3 F-O Date_ Contractortf RC f7ECTS DECLARATIDN cd U 1 understand my plans shall be used as public records LU o, iy Licensed Professional rn 3 OWNER-BUILDER DECLARATION t 1 hereby affirm that I am exempt from the Contractor's License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,demolish•or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Ethat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation in y $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or > 9 that he is exempt therefrom and the basis for the alleged cxemplion.Any violation of $15000 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). 366240—r1 . 02 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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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.). 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- ccnse 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 Contractor's License Law. ❑1 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: ❑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. GB11ave 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 Workees Compensation Insurance carrier and Policy number ate: Carrier._,r"f412!R4 PZ(;-0'S Policy No.: OSP-7— CERTIFICATE O EXEMPTION FROM WO COMPENSATION INSURANCE (This section treed not be completed if the permit is for one hundred dollars($100) or Icss) I cer ifv that in the performance of the work for which this permit is issued.1 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 .J O forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY z [�►+ 1 hereby affirm that there is a construction lending agency for the performance of fY. the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name a z Lender's Address U 0 I certify that 1 have read this application and state that the above information is (y correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorim representatives of this city to enter upon the above-mentioned property for inspection purposes. pwr (We)agree to save,indemnify and keep harmless the City of Cupertino against t..m to liabilities,judgments,costs and expenses which may in any way accrue against said City V z in consequence of the granting of this permit. APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR GULATIONS. ��� Re-roofs Signature of Applicant/Contractor V Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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, 00 Yes 25532(a)? Ne All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I Will the applicant or future building occupant use equipment or devices which g agree to remove P emit hazardous air contaminants as fined by the Bay Area Air Quality Management all new maerialS for inspection. District? 0 Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the require cnts which Must be met poor to' c of a Certificate of Occupancy cy. Signature of Applicant Date All roof s coverin to be Class's `'or better Owner or authorized agent Dare g !T CITY OF CUPERTINO { FURIMACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: Owner's Name:E Phone#: _ 2-52-6:513 Contractor: Phone#:;t-7g_0 7R2, oy tfiE(+T-ff,� Fax#: 2.79 10 l Contractor License#: 50cf C f _ Cupertino Business License#: 772 Contact: '� =LTJ Phone#: Fax #: 2-79-1017 Building Permit Info: Elect Plumb Mech Residential Commercial ❑ Job Description: 4 For Residenti 1 Installations: Attic El1st 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: /151--OCAn Type of Constructio (Usage Class): Strapped 0 On Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portic n of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. n— Revised 01/07/09 CITY OF C UPERTINO FURNALCE/AC CUP TYOF O FEE SCHEDULE Quantity Fee ID Fee Description, Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,abso-ption unit,or ea heating,cooling,a j sorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating applialce,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evz.porative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Instill/Relocate ea M suspended heatei,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for .-,a gas piping System P 1-4 outlets 1 BPGAS For each gas pip.ng system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Sei3mic B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appli;mce,refrigeration unit, I cooling unit,abs:)rption unit,or ea heating,cooling,absorption or evaporative coo ling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF C UPERTINO .. . FURNACE/AC CUPEkTINO 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 1 MCRAA Commercial Mec Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO SeismicCommer:ial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ee gas piping system P of 1-4 Outlets lBPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B r 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B I r 1 EPERMITFEE Electric Permit E I IMPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permi': P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B INPUT Resources . IAD/Health M.Indoor Air Quality and Finishes 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 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 6IAQ/Health pts y=yes p 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 S.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 p ' 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 iM 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 1 1 Total Points Available: 1401 1301__ 57 Total Points Project Received: 5f 01 01 0 G:datalprogs/gr:enbuildingguidelines/remodelers/greenpointsfinal2.12.o4protected.xis