09100065 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7756 SQUIREHILL CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09100065
CONDITION ING
O�vIVER'S NAME: FISHER JAMES L AND BEVERLY P 1712 STONE AVE DATE ISSUED: 10/09/2009
l, .JER'S PHONE: 4089969446 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
d LICENSED CONTRACTOR'S DECLARATION � � �
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License ClassC G ZU Lic.# 7(D �F 7 �
MECH� RESIDENTIAL � COMMERCIAL �
Contracto C��� Date /U--9^�9
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE,INSTALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions FURNACE,
Code and that my license is in full force and effect. CONDENSER,COIL,220 POWER HOOK UP
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as pmvided 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 provided for by Sq.Ft Floor Area: Valuation:$9450
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36223027.00 Occupancy Type:
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
corcect.1 agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter pERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemni£y and keep harmless City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which y cctue against said City in consequence of the 180 D YS FROM LAST CALLED INSPECTION.
granting of this perm' 'ionally,the applicant understands and will comply
with all non-point ourc gulations per the Cupertino Municipal Code,Section ,,p�/ �y
9•18• Issued by: ,f�,y /� � � �v Date:
Si�nature Datl� —� ^o�"
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that 1 am exempt from the Contractor's License Law for one of �nstalled without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
t,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the stn�cture is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the pmperty,am exclusively contracting with licensed contractors to
constnict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,fot the perforrnance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain co liance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,l shall Health&S e e,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making t6is certificate of exemption,I Ow er o au rized agent: �G—s� U �,
become subject to the Worker's Compensation provisions of the Labor Code,[must Date: -
foRhwith comply with such provisions or this permit shall be deemed revoked.
ONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a constmction lending agency for the performance of work's
I certify that[have read this application and state that the above information is for which this pennit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building constn►ction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
,nify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the pRCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I undecstand my plans shall be used as public records.
9.l 8.
Licensed Professional
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36223027 .00
DATE ISSUED. . . . . . . : 10/09/2009
RECEIPT #. . . . . . • • • : BS000008872
REFERENCE ID # • . • : 09100065
SITE ADDRESS . . . . . : 7756 SQUIREHILL CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FISHER JAMES L AND BEVERLY P
ADDRESS . . . . . . . . . . : 7756 SQUIREHILL Cfi
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : R.ANDO, 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 9, 450 . 00 1 . 00 0. 00 1. 00 0 . 00
1BREMAIRHA NO.UNITS 1. 00 63 .00 0 . 00 63 . 00 0 . 00
1BSEISMICR VALUATION 9, 450. 00 1 .00 0 . 00 1. 00 0 . 00
lEPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1MFR=<100 iJNITS 1 . 00 126 .00 0 . 00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00
1PPERMITFE FLAT R.ATE 1 . 00 42 . 00 0 .00 42 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT : 317 . 00 0. 00 317 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 317. 00 VISA
---------------
TOTAL RECEIPT : 317 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
v � , � � � �► �
CITY OF CUPERTINO
FURNACE/AC
CUPE(�TINO PERMIT APPLICATION FORM
APN #� �� �� ��r �� Date:
Building Address:
._1 i ��r e h� �l 0UT �-
Owner's Name: Phone#:
' �-le r � ' " � ' lc��f-E�
Contractor: �Q n��j �J f�-C ��C Phone#: �.o�- - o2-rj 3_t� �� 7
Fax#: d - 0�3 -" (0 7�
Contractor License#: `7(p�,� -7/ Cupertino Business License#:
Contact: ����,./ %���L��2, Phone#: ��� -02 9_j -t�7i 7
/
Fax#: U�-' -0'2 cf' —!� � � i
Building Permit Info:
Elect [� Plumb � Mech �
Residential Commercial ❑
Job Description: emOJe �x,S� �h$ G��rN4C'�', �N S��f/ N='`� %y�'�'�� e', COrc%r'riS�r—
CtJ�� � Z Z c� �O���°r" /'�D/c ci�. /
For Residential Installations:
Attic ❑ 1 St 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: C�,c�l�,0 p Type of Construction (Usage Class):
Strapped On Platform Bonded New Location ❑ Replacement 0�
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Valuation: ���-� ,U�
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 O1/07/09
. CITY OF CUPERTINO
��`�' FURNACE/AC
CUPE�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
1 furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> l 00k 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
I 1 MPERMITFEE Mechanical Permit Fee M
f 1 PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
CITY OF CUPERTINO ,
`'-�"' FURNACE/AC
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= l Ok CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1 PGASCOM 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. Coinm/Resid
1 1 BREMAIRHAN Residential A/C units<= l Ok CFM B
1 MRRAA Residential Mech Repair/alt/add M
1 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
� 1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
. , .
M. n oor Air uality and Fmishes
�•���-��'� 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Fnishes 2 IAQ/Health pts y—yes 0
3.l3seLvwRio�J�dt�+es 31AQ/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.�aalali,�#'�CiebcsaAd:��F 41AQ/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
10.Install Whole House Vacuum System 3 IAC�/Health pts y=yes 0
1 i 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0
2.�Jss Rapidl�Renewable Floairg Maiarials 4 Resource pts y=yes D
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: 140 130 57
Total Points Pro'ect Received: 0 0 0
�
G:datalprog�lgreenbuildngguidelines/remodelerslgreenpointsfinal2.12.D4protected.xls
:�-.� � . Community Development
-`� 10300 Torre Avenue
w ��. '
r -��' Cupertino CA 95014
Telephone(408)777-3228
CITIf OF Fax(408)777-3333
�UPE�TINO
Buildin De artment
JOB ADDRESS: ����, S y t.� ,'r 2 �i,// �r • PERMIT#^ ( � Q o � �_
C�
OWNER'S NAME: 'q rry�¢� r h r PHONE # a Y 9 6 �9 S<4�
GENERAL CONTRACTOR: /Q�n�°c,� � ✓t�C: :•�c FAX # �� �y3 -�o �7 �
I am not using any subcontractors:
Signature Date
Please check a licable subcontractors and com lete the followin information:
SUSCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Fini.shing
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 c
Owner/Contract ignature Date