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09080011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21669 TERRACE DRIVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09080011 CONDITIONING OWNER'S NAME: ARAM HENESIAN 1712 STONE AVE DATE ISSUED:08/04/2009 G .E,R'S PHONE: 4082532235 'AN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class `-0—UJ Lie.# -7 (O b17 MECH RESIDENTIAL COMMERCIAL Contractor �(�/iCpJ TIVn Date v I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CUT OUT EXISTING FURNACE INSTALL 10,000 (commencing with Section 7000)of Division 3 of the Business&Professions FUR Code and that my license is in full force and effect. FURNACE,3 1/2 TON COIL& 15.5 EER CONDENSER,200 POWER HOOK UP 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. 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 3q,Ft Floor Area: Valuation:$7000 permit is issued. APPLICANT CERTIFICATION %PN Number:356 17 008 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmle he City of Cupertino against liabilities,judgments, costs,and expe4whcrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of thisy,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all s per the Cupertino Municipal Code,Section 9.18. 'U Issued b�: Signature Date Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contamginanlsded by the Bay Area Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued,I shall maintawith the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's } ,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,Ibecome subject to the Worker's Compensation provisions of the Labor Code,1 must Ow eragent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name up, `e above mentioned property for inspection purposes.(We)agree to save in fy and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cosi,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FURNACE/AC CUPS TINO PERMIT APPLICATION FORM APN # `7 Date: �o� , G D Building Address: 1 l� �erraC e. DO-1 VQ Owner's Name: Phone#: (-,?53 -X235 p Contractor: jZ. n n el O i+V q 0- ) - Phone#: p�_2�j n Sase Sr/Zi' Fax#: 46 - 099. - 1077 � Contractor License#: (0 �g i Cupertino Business License#: Contact: &- cka y Tcx w`Zc2 Phone #:q6 f 13 - q 7� 7 Fax #: .2 93 -& 771 Building Permit Info: Elect E;?' Plumb []� Mech Residential Commercial Job Description:C.-Lk+-Ot-0 ��iS��S �urN��c'C iNSfv�1 /,60,006 af1i ji��c�, 3Vi76n, C'OA'L -r is S.e6 p—C°ayieJeo se 7-1-0ZG POct>cs l2 rjo0lt- UP , For Residential Installations: Attic F-1I" floor [;�- 2°d floor ❑ Adhere to minimum setback requirement (�- For Commercial Installations: Additional weight (structural calcs) F-1Replacement same weight F1 Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: -7OC>C�. C)u Type of Construction (Usage Class): V Strapped On Platform Bond,-d New Location Replacement Project Size: Express Standard ❑ Lar e [] Major❑ Valuation: sr-7C)c)0.(, 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. 6— Revised Revised 01/07/09 CITY OF CUPERTINO FURNALCE/AC -UPEkTINO FEE SCHEDULE Quantity Fee ID Fee Deseriptior. Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliaiice,refrigeration unit, cooling unit,abso:-ption unit,or ea heating,cooling,a')sorption or evaporative cooli:ig system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for tae repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit o;-ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Instill/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ca gas piping System P 1-4 outlets IBPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards 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,cooling,,tbsorption or evaporative cooling system,incl installation of ccntrols regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted u:iit heater. CITY OF CUPERTINO FURNACE/AC UffCUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok 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 ei gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas piI ing system of 5 or P more per outlet. C'omm/Resid 1BREMAIRHAN Residential A/C Lnits<= l0k 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 f 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M I 1PPERMITFEE Plumbing Permit P 1 1TRAVDOC Travel Documentation B 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1.Use LmNo-1146 Paint 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 31AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7,Seal al+Exposed:P.articlleboard.orMDF 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 E Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials I Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles z Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl :i IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor Resource pts y=yes D 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 . 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 " q -o� G:data/progs/gree nbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development lbaw 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 _UPEkTINO Buildin De artment JOB ADDRESS: ,z / (p tag `T-e r-r-oc e iD e. PERMIT # OWNER'S NAME: Cr, es i u n PHONE # vov a 9 3 -ct GENERAL CONTRACTOR: ,j o Jj v R 2, . c- FAX# I am not using any subcontractors: Si,n e 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 Owner/Contractor Signature Date