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09120113 CITY OF CUPERTIT O BUILDING PERMIT BUILDING ADDRESS: 7537 DUMAS DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09120113 CONDITIONING OWNER'S NAME: JACKMAN CLAUDE A AND JEANNETTE 1712 STONE AVE DATE ISSUED: 12/18/2009 %_ .4ER'S PHONE: 4082521389 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f- PLUMB f— License Class✓)Ez Lic.# _7&k?/ F ,II J MECH RESIDENTIAL COMMERCIAL Contractor""44 t1() iT� /Date 2_-1k_,0 1 p T— JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE IN SAME 1 hereby affirm that I am licensed under the provisions of Chapter 9 LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions 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:$4532 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35924048.00 Occupancy Type: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses w ' ay rue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this pe rt. Ad i fly,the applicant understands and will comply with all no Vnoumc:er$ tions per the Cupertino Municipal Code,Section n 9.18. Issued by: Date: /2,((T w t Sienature Date �/ �/• �� ❑ 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 HAZARDOUS MATERIALS DISCLOSURE declarations: 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& 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 contaminants ase r ed bv.the Bay Area Air Quality Management District I will permit is issued. maintain com ranc 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 Hea rXaa ty Co ections 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 zed agent: �© become subject to the Worker's Compensation provisions of the Labor Code,I must Date:_IO forthwith comply with such provisions or this permit shall be deemed revoked. STRUCTION 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 r the above mentioned property for inspection purposes.(We)agree to save Lender's Address ,reify 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 granting 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 J cl 2- o CITY OF CUPERTINO k FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN #� � � J � (� • � � Date: Building Address: b L1r)-)a s 0 12. ,v-p- Owner's Name: q wCA J a C IC.M0 r\ Phone#: '-�q--;7-S-L Contractor: (And 0 k4v A c- Phone #: 7 I1 Int- FtA Y a Fax #: Contractor License#: C 4? / C7 C) -7( �$ Cupertino Business License#: Contact: C-770q;,1 -F w Ler Phone#:Z.10�--,,2q 3 --q 7� Fax #: '210� -c3-�3 – Building Permit Info: Elect [---- Plumb 13— Mech Residential Commercial Job Description: 2C(Vi Ov-2 cl- VC10 1-xC2 W,sf,4,6 IAJ qr>lt- Lvca-h a/i For Residential Installations: Attic ❑ I" 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:gl#s 3�2 ,06 Type of Construction (Usage Class): U Strapped LJ On Platform 0 Bonded New Location Replacement Project Size: Ex ress ❑ Standard ❑ Lar e ❑ Major❑ Valuationt-f0d.00 — 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 01/07/09 M1- CITY OF CUPERTINO FURNACE/AC CUPEkTINO 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,coolin;;,absorption or evaporative cooling system,incl installation of-,ontrols regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating app.iance,refrigeration unit,cooling ur.it,VAV boxes, absorption unit:or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Ir.stall/Relocate ea M suspended hea':er,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical fcr ea gas piping System P 1-4 outlets 1 BPGAS For each gas p:ping system of 5 or P more per outle-:. 1 MCAPPVNT Commercial fcr the install/relocate/ or M replacement of ea appliance vent installed &not incl in an appliance pen-nit. 1 BCBSC Cal Bldg Stanc ards 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,coolin€;,absorption or evaporative coaling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Ins':all/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACE/AC CUPEkTINO FETE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 MRAPPVNT Resident:a] for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Resident]al for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. /I 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 fumace/b amer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace S yst> l 00k BTU install or M relocate ea forced-air/gravity type famace/b-.imer, incl ducts/vents attached t:) such appliance over 100,000 F�tu/h i 1 EPERMITFEE Electric Permit Fee E I 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit p 1 TRAVDOC Travel Documentation B I BUSLIC Business License B Community Development " 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTiNO Building Department JOB ADDRESS: PERMIT #, S 3 mom_ OWNER'S NAME• c,c►c w%A N k PHONE # 46 GENERAL CONTRACTOR j,1A-e , FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIIVESS 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 Septic Tank Sheet Metal Sheet Roc T• e �ig�=ture­� Date Community Development 10300 Torre Avenue a:... : s�. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,,UPEkTINO Building Department JOB ADDRESS: � � � PERMIT # OWNER'S NAME: G /vl9hrG PHONE # t- GENERAL CONTRACTOR: ,°cam FAX # Lf � Z I am not using any subcontractors: j�, a e Date Please check applicable subcontractors d orh Clete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork 6 Cement Finishing (� Electrical Excavation Fencing C) Flooring: Carpeting C) Linoleum/ Wood 6) Glass/ Glazing Q Heating C) Insulation Landscaping C) Lathing O Masonry Ornamental Sheet Metal Painting/ Wallpaper C) Paving O Plastering O Plumbing 0 Roofing Septic Tank O Sheet Metal Sheet Rock Tile Owner/ o ignature Date