10100003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7747 SQUIREHILL CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10100003
CONDITIONING
.`WNER'S NAME: ANITA TYSSELAND 1 112 STONE AVE DATE ISSUED: 10/01/2010
OWNER'S PHONE: 4082536004 S AN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION J OB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License ClassN Z4 Lic.# 7 b��`7 I REMOVE EXISTING FURNACE INSTALL 4 TON
(CONDENSER
Contractor �"t9 Etrn14 C2 Date 10-1 -141 FURNACE,220,110 POWER HOOK UP
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:$8500
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 110— A.PN Number:36223019.00 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 Issued b Date
granting of this permit. itionally,the applicant understands and will comply y
with all non-poin rc r gulations per the Cupertino Municipal Code,Section _
9.18.
l RE-ROOFS:
" gnatur =^— vl� Date C y ill roofs shall be inspected prior to any roofing material being installed.If a roof is
i istalled without first obtaining an inspection,I agree to remove all new materials for
i►spection.
❑ OWNER-BUILDER DECLARATION
:.ignature 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)
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. 1 will
I hereby affirm under penalty of perjury one of the following three inaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: health&Safety Code,Section 25532(a)should tore or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's inaterial. Additionally,should I use equipme o devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the :iir contaminants as defined by the Bay a Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wi ert nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by he Health&Safety Codef ecti ns 50 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date: _
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,[ CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 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
m the above mentioned property for inspection purposes.(We)agree to save
-jemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the [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
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 / SUB(±ONTRACTOR LIST
JOB ADDRESS: s (1) .re- 41')1 C4-- PERMIT#
OWNER'S NAME: 4y%,'" j,, s S e N to _ PHONE#
GENERAL CONTRACTOR: atr,*� BUSINESS LICENSE#
ADDRESS: /1/2- $ 402 *, JGte- I CITY/ZIPCODE: —< t— 4 , C
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL 0UP NC NSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU C T ACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. / / _/�
I am not using any subcontractors: ` ��`
Signa 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
ile
Owner/Co actor Signature Date
CITY OF CUPERTINO
6 ITEMS OF 29 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36223019. 00
DATE ISSUED. . . . . . . : 10/01/2010
RECEIPT #. . . . . . . . . BS000011611
REFERENCE ID # . . . : 10100003
SITE ADDRESS . . . . . : 7747 SQUIREHILL CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER ANITP TYSSELAND
ADDRESS 7747 SQUIREHILL CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5016
RECEIVED FROM . . . . : AAA FURNACE
CONTRACTOR . . . . . . . : RANDC , JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN DOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
FEE ID UNIT QUANTITY AMC,UNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 8, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 8, 500 . 00 0 . 90 0 . 00 0 . 90 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
1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0. 00
1TRAVDOC FLAT FATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 274 . 90 0 . 00 274 . 90 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CU PERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: BP#: *VALUATION: $8,500
R*PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY [t;t i Z. PENTAMATION FU RN/AC
USE: SFD or Duplex : ��« � �t:1:� ; 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: F $189.00
Mech.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT " - f't F;t< I trr;
LiOther Mech.Insp. 0.0 hrs $42.00 �� }�1_�'' r '=° "''"
NOTE: These fees are based on the preliminary in ormation avail able and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolution 09-05]_L'. 7/UI0j FEE QTY/FEE MISC ITEMS _
F7T- T
PME Plan Check: $0.0(
I'crinrt f`cc" __F -- I
Supp[ Iivy 1-1A,
PME Unit Fee: $189.00 T7=
PME Permit Fee: $42.00
("onswitcrion l'ix
Work Without Permit? 0 Yes E) No $0.0()
�'lcat�rl�tt« f�c'cr�;
Travel Documentation Fee: ITRA VDOC $42.01)
Strong Motion Fee: $0.8:1 Select an Administrative Item
Bldj4 Stds Commission Fee: IBCBSC $1.G)
SUBTOTALS: $274.85 $0.00 TOTAL FEE: $274.85
Revised: 9/29/2010
INPUT FIESDUTCeS Energy F
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes .?IAQ/Health pts y=yes 0
3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 31AQ/Health pts y=yes 0
s 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=ye
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.Use FSC Certified Materials for Inferior 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
. { ! F
N.Flooring
1.Select FSC Certified Wood Flooring : Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials -' Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles ' Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl IAQ/Health pts y=yes
5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0
6,Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes 0
Total Points Available: 1 1401 130 57
Total Points Project Received: ; 01 01 0
G:data/progs)gree uuildingguidelines/remodelers/greenpo' tst' 12.12.04protected.x1s
CITY OF CUPERTINO
FURNACE/AC
CUPCITY OF
EkTINO PERMIT APPLICATION FORM
APN # Date:
2 O l � 9 -30 -/o
Building Address:
Owner's Name:7 7 47 1Phone #:
A N 0-c, -T- 5:5 e I a nek Z10Fr-d-S 3 -boa q _--
Contractor: TzQndO �+V►4C H-R YLri'NaCQ Phone #: qo rr -- 2-9 3 - V
Fax #: 41E'�)&' -- 9 3 _ 077 1
Contractor License #: `7 8? / Cupertino Business License #:
Contact: g yZ Q Phone 1717
Fax #: L/Ojr - 093 — �0 7 7 J
Building Permit Info:
Elect [ Plumb ❑ Mech
Residential Commercial ❑
Job Description: -
44 -Fa \. C0n0 e h S P,y- 2 Z D 4- 11 U ('0 LA-�G r 1'100&
For Residential Installations:
Attic ❑ 1S` 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: 9_560- 60 Type of C:)nstruction (Usage Class):
Strapped On Platform Bond-d New Location ❑ Replacement ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ —_._.
Valuation: —
.Do
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