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10120156CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22622 OAKCREST CT CONTRACTOR: A & A PLUMBING PERMIT NO: 10120156 OWNER'S NAME: SHABEL JACK AND JENNIE 1030 E EL CAMINO REAL STE 248 DATE ISSUED: 12/21/2010 OWNER'S PHONE: 6509652444 SUNNYVALE, CA 94087 PHONE NO: (408)738-8878 .�/ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class L36' ( 21,0 Lic. # 16011>Z3 REPLACE FURNACE IN SAME LOCATION Contractor 1,Z1h Date 17-- 2_ - 10 I hereby affirm that I am licensed under &e 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: $4475 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: 34248002.00 Occupancy Type: permit is issued. p.� 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 _,. ---7 ....--- -- -- Issued by: _'_ Date: granting of this permit. Additionally, the applicant understands and will comply 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 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, 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. 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 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 Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 255333, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: �G�t�OI ('�;Q�.fC,Date: 1 2-- ` o 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, 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 5 ITEMS OF 5 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34248002.00 DATE ISSUED.......: 12/21/2010 RECEIPT #.........: BS000012333 REFERENCE ID # ...: 10120156 SITE ADDRESS .....: 22622 OAKCREST CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: SylviaM COPY ## : 1 OWNER ............: SHABEL JACK AND JENNIE ADDRESS ..........: 22622 OAKCREST CT CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-0830 RECEIVED FROM ....: A&A PLUMBING CONTRACTOR .......: MIKE FOX LIC # 25401 COMPANY ..........: A & A PLUMBING ADDRESS ..........: 1030 E EL CAMINO REAL STE 248 CITY/STATE/ZIP ...: SUNNYVALE, CA 94087 TELEPHONE ........: (408)738-8878 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 4,475.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 4,475.00 0.50 0.00 0.50 0.00 1MFR=<100 UNITS 2.00 252.00 0.00 252.00 0.00 1MPERMITFE FLAT RATE 2.00 84.00 0.00 84.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 TOTAL PERMIT ---------- 379.50 ---------- 0.00 ---------- 379.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 379.50 --------------- 379.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 6113 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO 1 "9�ll�►l FF.F. FRTIMATOR - BUILDING DIVISION W11ADDRESS: 22622 oakcrest ct. DATE: 12/21/2010 REVIEWED BY: bobs. UNITS APN: ;;�4a` (4 Q aZ I BP#: C) a'�l *VALUATION: $4,475 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex d r`zr' �:+ PENTAMATION FURN/AC PERMIT TYPE: WORK To Clear Code Enforcement Case: SCOPE Stap1)/. lash I cue APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES 1'z r,= if Furnace, Forced -Air 1MFR=<100 1 # $126 11crinil /'c'c' Stap1)/. lash I cue PME Unit Fee: $126.00 PME Permit Fee: $42.00 � t11=til!°tiC 2017 I LLA 1c't311S(ft'Ldl /u'1`fC't. `t`t': Work Without Permit? 0 Yes © No $168.00 TOTALS: Travel Documentation Fee: ITRA VDOC $126.001 1 NOTE• Thr based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn'l info. ese ees a e FEE ITEMS (Fee Resolution 09-051 EtF T til0) Mech. Plan Check 0.0 hrs $0.00 QTY/FEE MISC ITEMS Mech. Permit Fee: IMPERMIT 1'z r,= if 00 Other Mech. Insp. 0.0 hrs $42.E3 F-1 P"; _ $0.00 NOTE• Thr based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn'l info. ese ees a e FEE ITEMS (Fee Resolution 09-051 EtF T til0) FEE QTY/FEE MISC ITEMS I'Wii' C hcx:A' f r: .Supp/. PC 1 Cc F-1 PME Plan Check: $0.00 11crinil /'c'c' Stap1)/. lash I cue PME Unit Fee: $126.00 PME Permit Fee: $42.00 � t11=til!°tiC 2017 I LLA 1c't311S(ft'Ldl /u'1`fC't. `t`t': Work Without Permit? 0 Yes © No $168.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 i. SUBTOTALS: r$379.50 $0.00 TOTAL FEE: $379.50 Revised: 12/07/2010 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 20 OWNER'S NAME: Le– PHONE # 9 C GENERAL CONTRACTOR: BUSINESS LICENSE # 3 ADDRESS: /076-15. EL Co w�tko ?,,\5 . co, CITY/ZIPCODE: ti fl *Onr mnnicinal code reonires all husinesses workinu in the city to have a Citv of Cupertino bukiness 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: 17 — Z- 1—[�) Signature Date Please check applicable subcontractors and complete the following information: V 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 Owner / Contractor Signature Date 1. Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y --yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y --yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with' no added Urea Formaldehyde 61AQ/Health pts y --yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Partioleboard or MDF 4 IAQ/Health pts y=yes B. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y --yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring B Resource pts 2 Use Rapidly Renewable Flooring Materials 4 Resource pts 3. Use Recycled Content Ceramic Tiles 4 Resource pts 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts 5. Use Exposed Concrete as Finished Floor 4 Resource pts 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts Total Points Available: Total Points Project Received: 140T 1301 e7 0 0 0 G:datalprogs!greenbuilifingguidelineslremodelers/greenpointsfina1212D4proteDied.xis CITY OF CITY OF CUPERTINOits '�Y FURNACE/AC FU O CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: 22 Q2,Z OaKc�reS� �� C,v tr-i�lv�o, Lc• �15v�� If residential, is house an Eichler? Yes ❑ No t• If yes, needs planning approval. Owner's Name: Phone #-� Contractor: e� �,5YhA Phone Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: Fax/e-mail: Building Permit Info: Elect Plumbg Mech Residential P Commercial ❑ Job Description: �v�S�o.\�o.�c��� cr� SOK %A-�) \,AAtiaW )7—u\rY\MC.C, F.e yq ova\ o v 8 -\)y r\U C,C 4 c-�bv,we * C-01A"W- e dM -o, 2�Jr t.�hth� wad c�3►r 5c,a\�►n� osr re.���rh �'tvr c,cvhpar�-w�w�' S t�e� d���� i�'�'��^oJe� ��ext�v� v� k o o�v-vb. For Residential Installations: Attic ❑ 1St floor ❑ 2"d floor 014 Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight Additional weight (structural calcs) ❑ Structural Calculations re re for new installation ❑ New installation Planning Approval Re wired ❑ Cost of Project: �� C� 7s 0 p Type of Construction sage Class): Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement,, Project Size: Counter 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._ xevised i Liuei i u