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10120102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10192 DUBON AVE CONTRACTOR:COLD CRAFT INC PERMIT NO: 10120102 OWNER'S NAME: JOHN LOGAN 181 LOST LAKE LN DATE ISSUED: 12/15/2010 "OWNER'S PHONE: 4082522275 CAMPBELL,CA 95008 PHONE NO:(408)374-7292 _J LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# REPLACE GAS FURNACE WITH A 95% EFFICIENT UNIT Contractor Date 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:$4598 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:34214055.00 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 by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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) 1,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 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(x)should I store or handle hazardous I 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertin unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 505,2 3,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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, -)sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. nting of this permit.Additionally,the applicant understands and will comply 4ith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10192 duban ave. 7D-ATE: 12/15/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$4,598 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY t PENTAMATION SFD or Duplex �ti FURN/AC USE: _- PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: 1 $126.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT .- r Other Mech.Insp. 1 0.0 1 hrs $42.00 t,.�,�'�"t,l r,f',tt.�>. Lj NOTE. Thesefees are based on the preliminary information available and are only an estimate. {Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-051 P('. 7,"1i40J FEE QTY/FEE MISC ITEMS l'�fltt Cine'('; 101. PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Constriwrion Tcn- F �t;t12d1/ft ti�ilJt'1'It'It-'1'('c.': Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $211.50 $0.00 TOTAL FEE: $211.50 Revised: 12/07/2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34214055. 00 DATE ISSUED. . . . . . . : 12/15/2010 RECEIPT #. . . . . . . . . : BS000012256 REFERENCE ID # . . - : 10120102 SITE ADDRESS . . . . . : 10192 DUBON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JOHN LOGAN ADDRESS . . . . . . . . . . : 10192 DUBON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JOHN LOGAN CONTRACTOR . . . . . . . : PENNING, KENT LIC # 18644 COMPANY . . . . . . . . . . : COLD CRAFT INC ADDRESS . . . . . . . . . . : 181 LOST LAKE LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 374-7292 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 598 . 00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 4, 598 . 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 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211.50 0 .00 211. 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 211.50 VISA --------------- TOTAL RECEIPT 211.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL isOWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333- building a()cuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 1 D 1 9 2_ DU UQ APN BP# OWNER NAME l�d 11�1.� OWNER ADDRESS DESCRIPTION OF WORK: re (ie t') l (l) We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 13-- 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. F�2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. jk3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �11_4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "ernployer" under state and federal law. a6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 4L7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 4-8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderFo"n 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: to PERMIT# Z. ` OWNER'S NAME: o + PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 1g( 146 1A,e CITY/ZIPCODE: ra-impLA L/ 95-009) 'Our municipal code requires all businesses working in the city to have a City of Cuperti o 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: 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 Rock Tile UA CD caner/ nt ctor Signature Date .Windows 1.Install E-Rergy-E ficier+t Windows a.Oouble-Paned 1 Energy pt y=Yes 0 b.Low-Emissnviiy(Low-E) 2 Energy pts y--yes 0 c.Ww.Conductivity Frames 2 Energy pts y=yes 0 2.install Low Heat Transmission Glazing 1 Energy pt y=yes 011 1 1 1 J.Heating Ventiiation and Air Conditioning 1.Use Duot Mastic on All Duct Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/HeaJth pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 0 S.install Attic Ventilation Systems 1 Energy pt Y--yes 0 7.Install Whole House Fan 4 Energy pts y=yes 0 B.Install Sealed Combustion Units a.Furnaces 3 IAO/Health pts y--yes 0 b.Water Heaters 3 IAQ/Health pts y--yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pts Y--yes 0 10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes7 0 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stovWiinserts 1 IAQMealth pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy pt y=yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAO/Health pts y--yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y--yes0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0 i i 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0 2.Install Solar Water Heating System 10 Energy pts y=yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 B.Select Safe and:Durable Robfing Materials 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes 0 1 1 1 L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts Y--yes 0 E 1 1 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 D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes D 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 D 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use RapidfyRertevrrable 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 D 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 1 1 1 Total Points Available: 1 1401 1301 57 Total Points Project Recelved:1 1 01 01 0 G:data/progslgreenbuildngguidelineslremodelers/greenpointsfinal21204protectedAs CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM Ibl-Lb1o2 APN # � I' 1 r���S Date: i2^l�� 2z(t) Building Address: �V Vt Owner's Name: -- - Phone#: , ©���.� C' G�`®� �oca� ©0 -aL5 -2 -75 Contractor: ©� i Phone#: Ca Fax#: Contractor License#: Lo I �p/:*�c{3 Cupertino Business License#: 62-�� >7 [ 86 q Ll Gpf2� Contact: �G�U t� �( Phone#: 408 --3,74_ 7-1g2 t o►r Fax #: Building Permit Info: Elect [� Plumb Mech �P Residential Commercial ❑ Job Description: p �C� W��Y oCa 65t-S u P Cd�"� vrw�C`C w'i 0. S a e r"►t�Cv���'� tJti'l� For Residential Installations: Attic F] 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: Type of Construction (Ue Class): Strapped ❑ On Platform Bonded New Location ❑ Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ 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. Revised 01/07/09