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11010155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10150 PHAR LAP DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11010155 CONDITIONING OWNER'S NAME: JOHN KOEPPEN 1712 STONE AVE DATE ISSUED:01/31/2011 VNER'S PHONE: 4082931482 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class eCfJ G ZG Lic.# 7 &&T 7 ► REMOVE AND REPLACE FURNACE IN SAME LOCATION Contractor FUr-iJ 4-t-k- Date 7 3 r 1 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4060 1 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:32639007.00 Occupancy Type: permit is issued. 1/ 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 WITHINPERMIT 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 DA OM LAST CALLED INSP ECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, I costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this pe i onally,the applicant understands and will comply with all non-point ourc re lations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date ' _31—r ( 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 for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I 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. I will I 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 st a or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use eq ' m r vices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B Are Air uality Management District I performance of the work for which this permit is issued. will maintain compliance wi the per o nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' 25 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I 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 certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ^demnify and keep harmless the City of Cupertino against liabilities,judgments, ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,,.tinting 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 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 32639007. 00 DATE ISSUED. . . . . . . : 01/31/2011 RECEIPT #. . . . . . . . . BS000012609 REFERENCE ID # 11010155 SITE ADDRESS 10150 PHAR LAP DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JOHN KOEPPEN ADDRESS . . . . . . . . . . : 10150 PHARLAP DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1114 RECEIVED FROM . . . . : AAA FURNACE CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (408) 293-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 060 .00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 4, 060 .00 0 . 50 0 .00 0 . 50 0 . 00 1MFR=<100 UNITS 1 .00 126 .00 0 . 00 126 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 -----4200 ------0_00 ---------- ---------- TOTAL PERMIT 211 .50 0 .00 211. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------- CHECK 423 . 00 37937 --------------- TOTAL RECEIPT 423 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- __ _ -- ----------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 16150 PERMIT# OWNER'S NAME: e n PHONE# - 4 82— GENERAL ZGENERAL CONTRACTOR: AA6 ,- i Ck BUSINESS LICENSE# ADDRESS: 1 '712 S *- CITY/ZIPCODE:-'3,QktC k, C c 5�-.S i Z-S— *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet R Til Own Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $4,060 R-PERM,T TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 P/r(w"). P"'-'w C/7"(1 /'/gym Clhc'k Mech.Permit Fee: 1MPERMIT Pliwnh, ( Pori 1""C Other Mech.Insp. F070hrs $42.00 <)rr<<�, Prt rr?,/rrs/> C�rir f'1:1��c 1,asl' 8ftxJ,. hash. f��,e Piitrui�. lase, T�,z, t�i<�c.1<<s/z l�-e NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 E . 7ff /1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. 11 C./'"ec° PME Plan Check: $0.00 Permit Fec": Suppe hasp Fee F_ PME Unit Fee: $126.00 PME Permit Fee: $42.00 C..`onso-rr('ziO7 KIX 4cousih.,al Rel°hnv I've: Work Without Permit? 0 Yes E) No $0.00 Plannlno, Fees: c's: Travel Documentation Fee: ITRA VDOC $42.00 T_= A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.50 $0.001 TOTAL FEE: $211.50 Revised: 01/15/2011 CITY OF CUPERTINO 0-1 FURNACE/AC TINO PERMIT APPLICATION FORM CUPEI� /()/O 1 5�s/ Date: APN # i (567 V`2 1 -31 - 11 Building Address: 1 6 i G lea r L De- Phone#: Owner's Name: _ S`-1 J6 1+ '� K �'c p P e n Phone#: Contractor: 90 1,-,P'-93 _ y 2/ �' �C- Fax #: 40 - 093 --& 7`71 Contractor License#: Cupertino Business License#: 7� J G-70()'? l�ljj _,,2qj--Z/2/ � Contact: Dr,- nG C-��P Phone #:y � ��-,�y T,w 7 Fax #: Zfek —o � ''(� 7 '7 Building Permit Info: Elect❑ Plumb ❑ Mech ElK Residential Commercial Purtncc A) Job Description: S For Residential Installations: 2°d floor ❑ Attic ❑ 1St floor [�' Adhere to minimum setback requirement 51 For Commercial Installations: Additional weight (structural calcs) El Replacement same weight ❑ Structural Calculations required for new installation ❑ New installation Planning,Approyal Required e of Construction (Usage Class): Cost of Project: !On •�� .Strapped Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Lar e Major❑Valuation: LlaeO Ov 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