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10110058 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10480 DAVISON AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 10110058 OWNER'S NAME: WENWU CHUI 7020 COMMERCE DR DATE ISSUED: 11/09/2010 ER'S PHONE: 3017060438 PLEASANTON,CA 94588 PHONE NO:(925)4444444 LICENSED CONTRACTOR'S DECLARATION !, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Zy Lie. �y# O 1-U c(V MECH(_ RESIDENTIAL[_ COMMERCIAL� Contractor L) OW5 Date f—'?— I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE ONLY (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:$6885 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 permit is issued. (, n APN Number:36926035.00 Occupancy Type: APPLICANT CERTIFICATION JNry` 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Isgiu"ed by: Date:/�—�s`Q 9.18. � /,I Signature' Y/�I��J�Z4,G Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous dir Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and 25534. 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 Own�eeJ or luth rued a e t: Compensation laws of California. If,after making this certificate of exemption,I �'!A�a. Date: l become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constriction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save reify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date INPUT Resources • AD .Indoor Air Quality an FIRM es 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 0 D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed Aartioleboard or 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B 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 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 5.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 t Total Points Available: 1 1401 130 57 Total Points Project Received:1 1 01 01 0 G:datalprops/greenbuildingguidelines/remodelers/greenpointsfina1212 04protected.xls Building Department City Of Cupertino LM 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: oy 4SU tQXulCP56,pl (��, PERMIT# 410 /e/o65j--e OWNER'S NAME: (,()eyl `a aALL 1 PHONE# -3,"/ 7000 - Dy5S--' GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 10w0 '©pivne,-&e p` CITY/ZIPCODE: &0C5C«tt) ? . 'FqY -Ss *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. L 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 ql"� 4---z'0 Owner/Contractor Signature Date CITY OF CUPERTINO FURNACE/AC a PERMIT APPLICATION FORM cup ERT APN Date: q`1 c Building Address: �, v a U �� Phone#: Owner's Name: 90 1 7 0 0'-l3 q U)e 11 LhC,t 1 Phone#:q-ZS L4 v y- ttyV V Contractor: 5,�/U(Le d�Pw-Aj ' Fax#: Cupertino Business License#: Contractor License#: 19 17 D 4 U Phone#: Contact: Fax#: Building Permit Info: Plumb [�� Mech Elect[�-- Commercial ❑ Residential Job Descripnt�io�n: 6 laue For Residential Installations: It floor �' 2"d floor ❑ Attic ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Additional weight(structural calcs) ❑ Replacement same weight ❑ El Calculations required for new installation New installation Planning Approval Required ❑ Class Cost of Project: Type of Construction(Usage ) New Location Replacement Bonded Strapped Platform On Project Size: Express ❑ Standard❑ Large❑ Major❑ Valuation: 4 • complete relevant portion of the Green Building Checklist & attach it to the Green Building: compinclude in plan set& the sheet index. application or if applicablep Revised 01/07/09