11040195 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10311 GREENWOOD CT CONTRACTOR:AIR CONDITIONING PERMIT NO: 11040195
INNOVATIONS INC
OWNER'S NAME: CUPERTINO COMMUNITY SERVICES P O BOX 270075 DATE ISSUED:04/27/2011
ER'S PHONE: 4088570888 SAN JOSE,CA 95127 PHONE NO:(408)297-6209
❑
LICENSED CONTRACTOR'S DEECLARATION BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB
License Class C. � Q Lic.# p-1 h y g
MECH F RESIDENTIAL COMMERCIAL �
Contractor LI /�eCit/1 i Date Z 7A 1
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATE TWO(2)FORCED AIR FURNACES AT ATTIC
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION OF SFDWL AND ADD NEW DUCT WORK
Code and that my license is in full force and effect.
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 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 provided for by Sq.Ft Floor Area: Valuation:$13425
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
5 G APN Number:36914025.00 Occupancy Type:
I certify that I 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: _ _ -- Date:
Signature Date Z 1
L 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 I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct 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
1 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&
I 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,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner oraugiori d agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must S Date: Z t
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit 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 construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i-' -nnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
giu.iting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY ## 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36914025. 00
DATE ISSUED. . . . . . . : 04/27/2011
RECEIPT #. . . . . . . . . BS000013306
REFERENCE ID # . . . : 11040195
SITE ADDRESS . . . . . : 10311 GREENWOOD CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CUPERTINO COMMUNITY SERVICES
ADDRESS 10114 VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : STEPHEN T COLLINS
CONTRACTOR . . . . . . . : RICARDO CARRASCO LIC # 28467
COMPANY AIR CONDITIONING INNOVATIONS I
ADDRESS P O BOX 270075
CITY/STATE/ZIP . . . : SAN JOSE, CA 95127
TELEPHONE . . . . . . . . : (408) 297-6209
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13,425 .00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 13,425.00 1.34 0. 00 1.34 0 . 00
1MFR=<100 UNITS 2 .00 252. 00 0.00 252 .00 0.00
1MPERMITFE FLAT RATE 1.00 42. 00 0. 00 42 .00 0. 00
1MRRAA UNITS 2 . 00 126 .00 0. 00 126.00 0.00
1TRAVDOC FLAT RATE 1.00 42. 00 0. 00 42 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 464 .34 0.00 464 .34 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 928 .68 MC
---------------
TOTAL RECEIPT 928.68
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10311 greenwood ct. DATE: 04/27/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$13,425
Y PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
__[PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/AC
WORK relocate 2 forced-air furnaces at attic location of multi-family dwelling add new duct work.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 2 # $252
Heating System 1 MR RAA 2 # $126
TOTALS: 1 $378.00
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00
NOTE: Thesefees are based on the prefindnarp in ormation available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Iff %Z%10) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $378.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $1.34 Select an Administrative Item
1314,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $464.34 $0.00 TOTAL FEE: $464.34
Revised: 04/01/2011
Building Department
City Of Cupertino
IM, 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST n
JOB ADDRESS: I Cj, cu f h4,).C,4 PERMIT#
OWNER'S NAME: P46o PHONE# 'U7 - P $$3
GENERAL CONTRACTOR: C.I BUSINESS LICENSE#
ADDRESS: 7 ,'6 19 L"re- C, M, I 4- &,A CITY/ZIPCODE: qS037
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: i
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
2 (408)777-3228•FAX(408)777-3333•buildin-g( cupertino.org MISC
CUPERTINO
PLUMBING 2MMCHANICAL LECTIUCAL ❑MISCELLANEOUS
PROJECT ADDRESS lo j 1 I Green
OWNERNAME I� CJS PHONE E-MAIL
STREET ADDRESSj o)O V6411-
'1 � � CITY.STATE T1 C wO I ,1. + FAX
1 ViJ �i.0 .{
CONTACT NAME ;J 1 rW 1�' I,�O g 6S7-o sd(�v E-MAIL
STREET ADDRESS C1 I CITY.STATE, O FA C
to I�U vl� � � �k.
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /1 /L e /C� l LICENSE NUMBER,y-7 I L' LI `, 3E O BUS.LIC 0 ^ V, I
COMPANY NAME a7 / ! E-MAI a ` FAX l�� .!`�I rb�+-�_ qQU
f C r'l�L�'wVl rC�> �lL I +'�'1� u4jL l Ca% SbC `I '!
STREET ADDRESSi
7 5 `BJP. �t Cmr. rn zIt' w5 C SU P 4 Y
- a y
ARCHITECT/ENGINEER NAME LICENSE NUMB'BIER BUS.LIC l�
COMPANY NAME E-MAII FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
TSE OF ❑ SFD or Duplex Multi-Family PROJECT IN WILDLAND PROTECT IN /
STRUCTURE: ❑ Comrllercial URBAN INTERFACE AREA [I Yes [r1 NG FLOOD ZONE C3 Yes F No
DESCRIPTION OF WORK �'f � ] � A_G J 1j�-r/G `('/�1�
Jo �i� 0/• �19� I fiY l/
c
G+/aQ�� / cess mal 3Z Z +l,,f�✓ v .
TOTAL VALUATION: RECEIYEI�BY awn
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provide orrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to=* stru on. I horize representatives of Cupertino to enter the above-iden'feed pro erty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
MEPM1scApp 2011.doc revised 03/16/11