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09080257 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 949 ROSE BLOSSOM DR CONTRACTOR:AAA FURNACE& PERMIT NO:09080257 AIR CONDITIONING vNER'S NAME: CHIA LIN SHIH 1712 STONE AVE DATE ISSUED:08/21/2009 OWNER'S PHONE: 6507144872 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 $ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class 0 H3 t ZU Lic. � �O `�/ f– •-_� llll # MECH RESIDENTIAL COMMERCIAL Contiactor7���Q YI L1�d 0� JOB DESCRIPTION: INSTALL FURNACE&BRING UNIT TO 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions CURRENT CODE 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. Sq.Ft Floor Area: Valuation:$2190 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 APN Number:35906039.00 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 Wy accrue against said City in consequence of the Issued b Date: granting of this permit. rtionally,the applicant understands and will comply y' with all non-poin sou egulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: ature Date_. ��� "�rl All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials fir inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba . rel,Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the C er' Municipal Code,Chapter 9.12 and I Nave and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code c t 50 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. /f 1 certify that in the performance of the work for which this permit is issued,[shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certiticate of exemption,I becorae subject to the Worker's Compensation provisions of the Labor Code,I muse I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ilding construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. 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_ CITY OF CUPERTINO ' FUIVIACE/AC CUPEkTINO PERMIT APPLICATION FORM 09 APN # Date: Building Address: 9 Owner's Name: Phone#: C,h G L, S 141 4 US-0 - 14 - Lt[3-2 2 Contractor: �"1 p HVAC 1�C Phone#: c,<U&-t- Contractor: -9 7/7 Fax#: 4a -a9 3 Contractor License#: "7 (0 y-&-/ Cupertino Business License#: Contact: . aQ y 7 u LjZ P� Phone#: & -9L? 7 3 -t I Fax #: Building Permit Info: Elect 0/ Plumb Mech ©� Residential Commercial Lj Job Description: 1,Aj,j+c1 1 I .+=Q r,&JGX C e 4 Q f r G t4 eo cod P For Residential Installations: Attic ❑ 1St floor [] 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: 9p, o o Type of Construction (Usage Class): Strapped ❑ On Platform Bonc ed M New Location Replacement Project Size: Express ❑ Standard ❑ Large ] Major❑ Valuation: sr 02 /1?6 di v Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, inc vde in plan set & the sheet index. 0-7 Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CITYCUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group y FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,at sorption 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 appliar ce,refrigeration unit,cooling unit,`IAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of conxols 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 1BPGAS For each gas pipi:lg system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of e<< appliance vent installed & not incl in an appliance ermit. 1BCBSC Cal Bldg Standards 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,Ebsorption 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 uwiit heater. CITY OF CUPERTINO FURNACE/AC CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Descripti Dn Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install &not in�l in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. IBCBSC Cal Bldg Stancards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst =100k BTU install or M relocate ea for-,ed-air/gravity type furnace/burnei, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst l 00k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h IEPERMITFEE Electric Permit Fee E 1 / 1 MPERMITFEE Mechanical Pi;rmit Fee M 1PPERMITFEE Plumbing Pernit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B INPUT Resources Energy AOiHealth M. n oor Air Quality and Finishes 1.use iDWND-VOC Paint IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes 0 3.Use Low&VOC Adhesives .I 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 IAQ/Health pts y=yes 0 7.Seal all.,E)qosW4Pa ei1=ME xND,F l.IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish t 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 i 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 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 f)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 t Resource pts y=yes 0 . 1 1 1 Total Points Available: 1401 130 57 Total Points Project Received: 01 01 0 I OL7 G:data/progs/gree ibuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue ;,_ ;: Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEIZTINO Building Department JOB ADDRESS: PERMIT# L} ��o ' I o sso,� n - d C1 2-S>-7 OWNER'S NAME: C-� ,`Cx i PHONE # �, p -'21 GENERAL CONTRACTOR: a nGQo y U q c-- /,--j c- FAX # 440 a -o2 - 6 7 7/ I am not using any subcontractors: Si;nature Date Please check applicable subcontractors and co m Mete 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 Met Shee o T' e Owner/Contract gnature Date