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10090158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20549 CEDARBROOK TER CONTRACTOR:A&A PLUMBING PERMIT NO: 10090158 OWNER'S NAME: JOE HSU 1030 E EL CAMINO REAL STE 248 DATE ISSUED:09/16/2010 4ER'S PHONE: 4087209388 SUNNYVALE,CA 94087 PHONE NO:(408)738-8878 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class 63C Lu_ Lic.# <� Z r ` MECH RESIDENTIAL COMMERCIAL Contractor \ W'\\ Date q—A— 16 I hereby affirm that I am licensed unde• he provisions of Chapter 9 JOB DESCRIPTION:REPLACEMENT OF FURNACE AND A/C UNIT (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:$6000 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:32345014.00 Occupancy Type: permit is issued. O APPLICANT CERTIFICATION 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 constriction,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 sours egulations per the Cupertino Municipal Code,Section Issued bye '- � " � Date 9.18. � - � �� Signature /�y�/� 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: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the stricture 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 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. 1 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 air 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. 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 Ariz 1 agent: J^ Compensation laws of California. If,after makingthis certificate of exemption,I / ate: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction 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 -unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expenses which may accrue against said City in consequence of the 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY $# 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32345014 . 00 DATE ISSUED. . . . . . . : 05/16/2010 RECEIPT #. . . . . . . . . : BE000011479 REFERENCE ID # . . . : 1C090158 SITE ADDRESS . . . . . : 2C549 CEDARBROOK TER SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JC,E HSU ADDRESS 2C549 CEDARBROOK TER CITY/STATE/ZIP . . . : CLrPERTINO, CA 95014 RECEIVED FROM . . . . : A & A PLUMBING CONTRACTOR . . . . . . . : MIKE FOX LIC # 25401 COMPANY A & A PLUMBING ADDRESS 1( 30 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 6, 000 . 00 1 .00 0 .00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0. 00 63 . 00 0 .00 1BSEISMICR VALUATION 6, 000. 00 0 .60 0. 00 0 .60 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 274 .60 0 .00 274 .60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 .60 #6072 --------------- TOTAL RECEIPT 274 .60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- • -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL INPUT Resources 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes0 7.Seal all EVosed Parti board 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 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 D 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 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 1 1401 1301 57 Total Points Project Received: 0 0 0 G:data/progs/gn!enbuilcingguidelines/remodelers/greenpointsfinal212o4proiected.zls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 26 L��{�,r �,- _ PERMIT# OWNER'S NAME: PHONE# �Oq 739 GENERAL CONTRACTOR: BUSINESS LICENSE# �� Z ADDRESS: � �,� �r \c G,`I CITY/ZIPCODE: *Our municipal code requires all businesses working it 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 SUBCONTEACTORS�HAY OBTAINED A CITY OF 1CUPERTINO BUSINESS LICENSE. 75'9t� Lam- In 1/ 4 I am not using any subcontractors: Si;nature 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 Owner/Contractor Signature Date CITY OF CUPERTINO FUR.N'ACE/AC CUPEk ANO PERMIT APPLICATION FORM APN # � � Date: 1 _ Building Address: Owner's Name: Phone#: Contractor: Phone#: � _ � �\ `V U Yh\V� Fax#: Contractor License#: C� -z T Cupertino Business License#: Contact: Phone#: K—7A- �P 9 N\�.�� ---- Fax#: Building Permit Info: Elect Plumb [�-}' " Mech Residential 0 Commercial Job Description: ` ' -� 1 Nc-vee-t\� G-'� � U�('Y��S � G� For Residential Installations: Attic ❑ 1St floor rk 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) E] Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): � � G6C) ✓ G w Strapped On Platform H Bonded New Location0 Replacement Project Size: Ex ress [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