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09100224 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1110 STEEPLECHASE LN CONTRACTOR:CONDITIONED AIR PERMIT NO:09100224 OWNER'S NAME: AMODA SRIDHAR 1701 LITTLE ORCHARD ST DATE ISSUED: 10/30/2009 "NER'S PHONE: 4088738534 SAN JOSE,CA 95125 PHONE NO:(408)291-2220 ❑ LICENSED CONTRACTOR'S DECLARATIONr– d BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date_ O ff 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION REMOVE AND REPLACE FURNACE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7400 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35931036.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, v. costs,and expenses which may accrue against said City in consequence of the /lJ elf–v S' of this permit. Additionally,the applicant understands and will comply Issued bp— granting with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature --- —Date�G� .�� All roofs shall be inspected prior to any roofing material being installed.If a roof is I installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: _Date: _ 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 and 534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorised agent: - Date: 4 � I certify 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C) Lender's Name _ APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct.I 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION 'emnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. e,anting of this permit Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional_ 9.18. Signature___ _ Date __ CITY OF CUPERTINO ��n F FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# a IGO 2� 351 51 U 3(P UJ Date: Building Address: MG L Owner's Name: Phone#: c�? 51 Ah f 1�13_43 - 8 5-S y Contractor: Phone#: r� 7-C-t 1.. ,7,-2 2 v (� V17-,z5S C)"( I -�P � Fax #: �-cl � � '2._Z Lt./ Contractor License P: Cupertino Business License#: Contact: Phone#: 3e Fax #: v Building Permit Info: Elect© Plumb Mech E3— Job Description: - ZPvrc;ep1?c Residential Commercial For Residential Installations: Attic El1st floor ❑ 2nd 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): 0 U '(3 Strapped On Platform Bonded New Location❑ Replacement [_V_a!1u­at_ion_- Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FURNACE/AC -UPEkTINO 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,absorption unit,or ea heating,cooling,absorption 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,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACEAC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS 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 1 MFR=<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 I 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.1186 L AYM10-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*VOC A 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal��P i�te wA* 41AQ/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 0 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 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 i 1 Total Points Available: 1401 130 57 Total Points Project Received: 0 0 0 G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal212.D4protected.zls Community Development 10300 Torre Avenue r Cupertino CA 95014 Telephone(408)777-3228 Fu(408)777-3333 CITY OF '"UPEkTINO Buildin De artment JOB ADDRESS: PERMIT# 0 .. PHONE # `1'1'5 151-�3'A OWNERS NAME: tnnU a 11 GENERAL CONTRACTOR AX# I am not using any subcontractors: 4Z��=Z Signature Date Please check applicable subcontractors and complete the followin information SUBCONTRAC'T'OR 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,: Septia- 'ank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature