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10100004
CITY OF CUPERT INO BUILDING PERMIT BUILDING ADDRESS: 7631 ERIN WAY CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10100004 CONDITIONING WNER'S NAME: SONYA MEISSNER 1712 STONE AVE DATE ISSUED: 10/01/2010 OWNER'S PHONE: 4082571805 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class y C 7-u Lic.# � ( & I REMOVE EXISTING FURNACE INSTALL NEW FURNACE, 4TON Contractor Prf}/� �ti1 r,-,j 4 C2 Date CONDENSER,(2)DUCTS 1 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:$9171 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:35920020.00 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 ente upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless e City of Cupertino against liabilities,judgment,, costs,and expenses which a accrue against said City in consequence of the �� /) Q granting of this pe d'Tonally,the applicant understands and will comply Issued V- !i / /ys Date: with all non-poin ou gulations per the Cupertino Municipal Code,Sectior 9.18. RE-ROOFS: ;nature 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 oiie 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 compensE tion, 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 contractor: 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 re or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equip t devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the I r a Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the pe unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, e n 25 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thi: Owner or authorized agent:. Date: AG—/—/a permit is issued. I certify that in the performance of the work for which this permit is issued,I st all 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 re ating to building construction,and hereby authorize representatives of this city to en er on the above mentioned property for inspection purposes.(We)agree to sav,; ARCHITECT'S DECLARATION ...demnify and keep harmless the City of Cupertino against liabilities,judgmen is, 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 compl with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 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: b 3 t =ri") w PERMIT# O Cl OWNER'S NA ME:.SdnjCLG ZS$ PHONE # 40 � o'r GENERAL CONTRACTOR: ti c- BUSINESS LICENSE# ADDRESS: L CITY/ZIPCODE: *Our municipal code requires all businesses workinlTINSPECTION(S) the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINALOCC WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL B TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors* �gnature 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 Ro Tile ODate wner Contractor Signature CITY CIF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: $9,171 R*PERMITT'YPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY1°{),,II PENTAMATION FURN/AC USE: SFD or Duplex �)t} .� ;,� PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check 0.0 hrs $0.00 1'-= - ' 1'1 ;� Mech.Permit Fee: IMPERMIT :.,,r� 'c.1F T'`«. I.i�r Pei rrr , trc, Other Mech.Insp. 0.0 hrs $42.00 L_J_L_ 01/ t° r'<t. I??, L—i th.<h fn;p. P"c NOTE: Theseees are based on the preliminaryin ormation available and are onlyan estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-05I Eff FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 Perim? Fcc: PME Unit Fee: : 189.00 PME Permit Fee: $42.00 t.'ot�s�rrreriorz '7�7:� ,Icoustical Fee: Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITIMMOC $42.00 StronjZ Motion Fee: $0.92 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: :1274.92 $0.00 TOTAL FEE: $274.92 Revised: 9/29/2010 FnodooroAirRualityfflan Finishes 1.Use Low/No-VOC Paint 1 !AQ/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 p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 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 N.Flooring � f 1.Select FSC Certified Wood Flooring 3 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 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes p 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes p i f t Total Points Available: 140 1391- 57 Total Points Project Recehed: 01 01 0 i� i Gta13/procs!grae ingguidelines/remodeler gr pointsfina12.12.04prolected.xls CITE' OF CUPERTINO FICJRNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: 2� o2,0 .0(-) --- -3a -/ `' - Building Address: `1 (o 3 1 l= r) ,.j U.)�> Owner's Name: Phone #: Q>op4a, m e i5-sn i5-se r --- Ifo S -A S -7 - / Contractor: h AA- �r�aCt e� IG rVj o N, Sons HL),gC Phone #: 4t0 g ,,:;Lg 3 _ y 2 / 7 i _ Fax #: {0S-- 2-9,3 - (o 7 /_ Contractor License #: '7(qRg71 Cupertino Business License #: Contact: Gam, Z µi2 y l aJ 2e� Phone #: G/p F vZg 3 - G/7/7 _ Fax Building Permit Info: Elect 2/ Plumb ❑ Mech ©--" Residential Commercial ❑ Job Description: ?to rh0I)G e z1'Sf1.qS f='r-t ,,.�v4Ce- /^--I S /i /V eki Y7vn/ C'o WewSei' , (-Z-a For Residential Installations: Attic ❑ l" floor 2"d floor ❑ Adhere to minimum setback requirement ❑ � For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new insta'.lation ❑ New installation Planning Approval Required ❑ Cost of Project: /'7/,6 0 Type of Construction (Usage Class): Strapped El On Platform ❑ Bonded New Location Replacement ❑ Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ __ Valuation: tel/ -_ -- 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