09080014 CITY OF CUPERT0 0 BUILDING PERMIT
BUILDING ADDRESS: 10395 RIVERCREST CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09080014
CONDITIONING
OWNER'S NAME: EAGLETON JULIANNE 1712 STONE AVE DATE ISSUED:08/04/2009
O�_ ..R'S PHONE: 4087330657 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB
License Class C70 Lic.# 76-,S-t-7 ,1
,,/J MECH r— RESIDENTIAL f— COMMERCIAL
Contractor A N(.�U #Z�)#49L� 0M Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE&INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions FURNACE,COIL,
Code and that my license is in full force and effect. 13SEER CONDENSER 220 POWER HOOKUP
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$6700
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32637003.00 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 y o Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may ccru against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Addi onal ,the applicant understands and will comply
with all no - source r ula i ns per the Cupertino Municipal Code,Section
9.18• Issued b Date:
Sip"ature 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,1 agree to remove all new materials for
the following two reasons: inspection.
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, 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
1 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 1 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 define y the Bay Area Air Quality Management District I will
maintain co a ' 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 Whafc e,Sections25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker'sCompensation laws of California. If,after making this certificate of exemption,1 O ed agent: (� c
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 7
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 1 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
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify 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
CITY OF CUPERTINO
FURNACEAC
CUPEkTiNO PERMIT APPLICATION FORM
APN # Date:
Building Address: /U,3�5 R J C aL 0
Owner's Name)Lk l i G n n e �:�Jc 1 e f o� Phone#:
Contractor: {2a In G U N v N Phone#: z-%6, - 02 q 3 —4-7 1 7
!-) i L 54xme f}c
SGV, 3C)Se, C' u 9SJzs_ Fax#:
Contractor License#: `7 (o R-S-7 t Cupertino Business License#:
Contact: C1 �.�� �u z 2 Phone#: yak-,,;2-c? 3-q'?-/
Fax#: q05 -90 3 - 7
Building Permit Info:
Elect 2 Plumb Kr Mech ['
Residential ® Commercial
Job Description: Rernooe. Cx►5}1n5 j-Wr-A)aCE! S-klIk ce , Ir 0;�., i3s�e� ccs�drnsc�
22.o p,,oer mole- u,a
For Residential Installations:
Attic El1St floor [j 2"d 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: to-700. b 0 Type of Construction (Usage Class):
V
Strapped On Platform Bond ed New Location Replacement
Project Size: Express P--l"'Standard ❑ Large I:1 Major❑
Valuation: # 46_7 00-.0 d
Green Building: Please complete relevant portio a 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
FURNACE/AC
CUPEkTINO FEE SCI:[EDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating applian:,e,refrigeration unit,
cooling unit,absor)tion unit,or ea
heating,cooling,absorption or
evaporative coolir g system,incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,'IAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted un-t heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for t:-le install/relocate/ or M
replacement of eE. appliance vent
installed ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMIC0 Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliaace,refrigeration unit,
cooling unit,abscrption unit,or ea
heating,cooling,zbsorption or
evaporative cool-.ng system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
CITY OF CUPERTINO
FURNACE/AC
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Jnits<= lOk CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for e gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1 BPGAS For each gas pif ing system of 5 or P
more per outlet. C'omm/Resid
1 BREMAIRHAN Residential A/C L nits<= l Ok CFM B
/ 1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standar is Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Perrr.it M
I
1PPERMITFEE Plumbing Permit P
( 1TRAVDOC Travel Documentation B
1BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.use L -VOC Pa" 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes ?IAQ/Health pts y=yes 0
3.Use Lowft NOG� 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 31AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Egased PArOdebim d w MDF 4 IAQ/Health. pts y=yes 0
8.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 f,Resource pts y=yes 0
2-Use Rapi*Ranewable Flooring Materials Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 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
Total Points Available: 1401 130 57
Total Points Project Received:
G:datalprogslgrei!nbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF AI(�
vUDl Ek INN
Buildin De artment
JOB ADDRESS: j i 2.3 !_� �"b'i 4 PERMIT # �� r
OWNER'S NAME: C U r n oA i'of C u i lvj PHONE # ?- 2,5 Z - bµ
GENERAL CONTRACTOR: 'Rz n&o 4 v ,-k-_ FAX #
I am not using any subcontractors:
Signa e Date
Please check applicable subcontractors and complete the followinginformation:
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
Sheet Rock
Tile
Owner/Contractor Signature Date