09120118 CITY OF CUPERTIr O BUILDING PERMIT
BUILDING ADDRESS: 10367 VISTA KNOLL BLVD CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09120118
CONDITIONING
OWNER'S NAME: FIRST STATEWIDE REALTY 1712 STONE AVE DATE ISSUED: 12/18/2009
..NER'S PHONE: 4086741654 SAN JOSE,CA 95125 PHONE NO:(408)2934717
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT PLUMB
License Classu 'a Lic.# 7 &"-)-j r" r
� pp MECH RESIDENTIAL COMMERCIAL
Contractor O k6 4,14-t Date 1 2—I/&--o 1
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE&INSTALL NEW IN SAME
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION
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:$2206
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32613117.00 Occupancy Type:
APPLICANT CERTIFICATION
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 w ' h may cute against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this pe t. A to Ily,the applicant understands and will comply
with all nwunoin ource gu ions per the Cupertino Municipal Code,Section
9.18. . 4 Issued by: - Date: ellz �
S;�nature Date 2--1 /
❑ 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)
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
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. 1 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 e ' ment or devices which emit hazardous air
contaminants as defined t e Bay Area Air Quality Management District I will
permit is issued. maintain com ' ce a 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 He S ety C y 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 Own r o rtlro ed agent: j�� Q M
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:/ U
—61
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
n the above mentioned property for inspection purposes.(We)agree to save Lender's Address
-mnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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
C� � v� � �
CITY OF CUPERTINO
I,5- 4
FURlvACE/AC
CUPEkTINO PERMIT APPLICATION FORM
Dater
U 131
Building Address:
jD 3�7 �► knot g►vc1
Owner's Name: F-) S 'w of 12 e9 141 Phone#:
o - 671 - 16Sy
Contractor: Ron d;p 1-4 v A C i^-C . Phone#:z/am -a93 --4,
Fax#: ¢0fir-X93--k�,77/
Contractor License#: 7 0 3-r?i Cupertino Business License#:
Contact: -i 0 " %c(w Phone#: 40 r -, -417/;7
Fax#: k- ,P9S--(v7 *.;�/
Building Permit Info:
Elect P�-- Plumb [ it Mech E' -
Residential D] Commercial El
Job Description: I e mo:;e- E +s f-J'Wc u r Nr,c e �I- iN N ti S-7rrmc- oma;ham
For Residential Installations:
Attic ❑ 1St 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:# 2.7 v c� , c)o Type of Construction (Usage Class):
Strapped ❑ On Platform Bonded New LocationEl Replacement
Project Size: Express ❑ Standard ❑ Large [] Major ❑
Valuation: 3 9,0.0(o;b o
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
CITY OF CUPERTINO
ab FURNACE/AC
CITY OF
CUPEt�TINO FEE SCHEDULE
Quantity Fee ID Fee Description. Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Rep;tir/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooHig system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for tie 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 Instz.11/Relocate ea M
suspended heater recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for e a gas piping System P
1-4 outlets
1BPGAS For each gas pipi ig system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of e,-.appliance vent
installed ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repa.r/Alteration/Add to M
ea heating appliaice,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of co:itrols regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted ur it heater.
CITY OF C'UPERTINO
FURNACE/AC
,UPE�TiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units<= l Ok CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standarls Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1 PGASCOM Commerical for c a gas piping System P
1-4 outlets
1 PGASRES Residential for ez gas piping system P
of 1-4 Outlets
1 BPGAS For each gas piling system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= 10k CFM B
1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standarls Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
/ 1 EPERMITFEE Electric Permit E
1 1MPERMITFEE Mechanical Permit M
I
1 PPERMITFEE Plumbing Permit P
I
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
P !`' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
„UPEkTINO
Building Department
JOB ADDRESS: 10 -3( PERMIT#
0 l&11-1-
OWNER'S NAME: ;cJ PHONE #JQS a 06v
GENERAL CONTRACTOR: v,4 0- FAX# ag -- ?/ "7
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Clete 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
S e oc
Owner/C actor Signature Date