Loading...
09080420 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21628 ROSARIO AVE CONTRACTOR:RMI MECHANICAL PERMIT NO:09080420 ('ONTRACTORS r 'ER'S NAME: ROSTAM KHORSHIDIAM 1385 LOWRIE AVE DATE ISSUED:08/31/2009 OWNER'S PHONE: 4082531091 c SAN FRANCISCO,CA 94080 PHONE NO:(650)583-6200 0 /'LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT� PLUMB� License Class C.Z o Lic.# ."7 d�— MECH r RESIDENTIAL F COMMERCIAL � Contractor Date OB DESCRIPTION:REPLACE FURNACE I hereby affirm that I am licensed under the provisions of Chapter 9 (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 Sq,Ft Floor Area: Valuation:$12850 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 .\PN Number:35619014.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued byY Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ture Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is ❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall Owner uthorized agent: m not employ any person in any manner so as to become subject to the Worker's Date: CJ 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name I certify that I have read this application and state that the above information is Lender's Address 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 the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ......;mnify and keep harmless the City of Cupertino against liabilities,judgments, I understand m plans shall be used as public records. costs,and expenses which may accrue against said City in consequence of the y P granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 0 CITY OF CJPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: 4 B u i ding—A­d 0 "t?O G Owners Name: Phone #: Ros f Contractor: Phone#: Fax#: 3 `g!/ Contractor License#: 3 �� !11 Cupertino Business License #: © 660 Contact: 0nj/j Phone#: v� Fax#: 6S0 • Cl Building Permit Info: Elect 0 `` Plumb Mech .Zesidential Commercial ❑ Job Description: Cf For LeMi -nttial Installations: Attic ❑ 1st floor 2°d floor E] Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation [] New installatio4PPlannin A roval Re wired ❑Cost of Projectf Z,gg• Type of Construction (Usage Class): C/G L Zo Strapped ❑ On Platform BondedEJ New Location E] Replacement ❑ Project Size: Express ❑ Standard Large ❑ Ma•or❑ Valuation: 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. elr--- Revised 01/07/09 CITY OF C UPERTINO FURNACE/AC �.UPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rep�Lir/Alteration/Add to M ea heating appliar.ce,refrigeration unit, cooling unit,absoiption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating applimice,refrigeration unit,cooling unit,'JAV boxes, absorption unit oz ea heathing, cooling absorption,or eva jorative cooling sys, incl install of controls regulated by this code. IMCSUSHTR Commercial Instz.11/Relocate ea M suspended heater recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ca gas piping System P 1-4 outlets 1 BPGAS For each gas pipi ng system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of epi appliance vent installed &not it cl in an appliance permit. 1BCBSC Cal Bldg Standaids Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,abscrption unit,or ea heating,cooling,z.bsorption or evaporative cool ung 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 CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES f 1BSEISMICR Residential Se.smic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst-�=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst 100k BTU install or M relocate ea foi ced-air/gravity type furnace/burne incl ducts/vents attached to su,:h appliance over 100,000 Btu/1 1 EPERMITFEE Electric Perm t Fee E 1 MPERMITFEE Mechanical P-rmit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business Limnse B NPUT Resources • IAO/Health M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 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 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Fartideboard-or MDF 4 IAQ/Health pts y=yes 0 B.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 N.Flooring 1.Select FSC Certified Wood Flooring 13 Resource pts y=yes 0 .2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 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 1.Resource pts y=yes 0 Total Points Available: 1 140 1301 57 Total Points Project Received: 0 0 0 G:datalpmgs gm nbuildingguidelines/remodelers/greenpoinisfinal2.12.o4protected.xis Community Development E 10300 Torre Avenue Al Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .:UPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # Z ,� /a -mac L (Q OWNER NAME: — PHONE # p GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 7--'7 ----- 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 4 Owner/Contractor Signature Date