11040194 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10321 GREENWOOD CT CONTRACTOR:AIR CONDITIONING PERMIT NO: 11040194
INNOVATIONS INC
OWNER'S NAME: CUPERTINO COMMUNITY SERVICES P O BOX 270075 DATE ISSUED:04/27/2011
r 'ER'S PHONE: 4088570888 SAN JOSE,CA 95127 PHONE NO:(408)297-6209
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class� 8 _ Lic.# [ ! q 9
n j R MECH RESIDENTIAL COMMERCIAL
Contractor , Z / e4,1a1 t C u( Date I
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOATE TWO(2)FORCED AIR FURNACES AT ATTIC
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION OF MULTI-FAMILY DWELLING&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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$13425
permit is issued. �j
APPLICANT CERTIFICATION " c, APN Number:36914025.10321 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.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
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. - _
Issued by: Date:
Signature Date VZ
L OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,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
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aytho ized agent: Date
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Aork's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
g. _.mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36914025.10321
DATE ISSUED. . . . . . . : 04/27/2011
RECEIPT #. . . . . . . . . : BS000013306
REFERENCE ID # . . . : 11040194
SITE ADDRESS . . . . . : 10321 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 0 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10321 greenwood ct. DATE: 04/27/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $13,425
;'PRMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
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 1MRRAA 2 # $126
-T7
TOTALS: $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 preliminary information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (hie Resolution 09-05/ FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $378.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (D No $0.00
Travel Documentation Fee: ITRA VD0C $42.00
i
Strong Motion Fee: 1BSEISMICR $1.34 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $464.34 $0.00 TOTAL FEE: $464.34
Revised: 04/01/2011
Building Department
City Of Cupertino
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
JOB ADDRESS: )o.3 Z l G rt-,eA ,,00S (- L e h'.o. C4 PERMIT# r I 70 too j `9
OWNER'S NAME: PabloM"� n C z PHONE# 40S S7 - O 8$$
GENERAL CONTRACTOR: (,L Inas 0A I cu l BUSINESS LICENSE# 67
ADDRESS: )7(o% oL-je f G1 M, , �-s C-4 CITY/ZIPCODE: q'S<;,3
*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.
1 am not using any subcontractors: y/27/11
Signature 1 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
GFNERAL. PERMIT APPLICATION MEI P
CCIMMUNIFFY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ra i 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255
(408)7-77-3228 - FAX(408)777-3333-buildinq@ uperfinc.o
MISC
ING11�I'MECHANICAL ELECTRICAL
MISCELLANEOUS
Rn_mcn,m)nRr.. APN 9
MATNOM NAME eP"c"N' L
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CITY,STATE,ZIP FAX
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PROTECT IN WM-DLAND
"RE, I URBAN ITIM.RFACF AREA. I=I Yes [f/ PROTECT
FLOOD ZONE C1 YCS V NO
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y I my 3 1 am the property owner or authorized agent to act on the property owner's behalf. I have,read this
1p,mir.-Inon Ir'.(r,the infinTil'-Itioll f have orov*d is correct. L.I;aw-read the Description of Work and verifv it is accurate. I agree to comply cuith all applicable local
state laws rehatiliv,to hui g co tTuctio uthorize representatives of Cupertino to enter the above-,i entified property for inspection purposes
Silf'Tlnt.:l oC pplicant/A r"Mlv — Date:A
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