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10090047 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10118 MELLO PL CONTRACTOR:AIR MAZE SERVICES INC PERMIT NO: 10090047 OWNER'S NAME: EDITA TEJNIL 933 IQFER RD STE A DATE ISSUED:09/08/2010 NER'S PHONE: 4087380333 SUNNYVALE,CA 94086 PHONE NO:(408)738-0333 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r License Classc-zo Lic.# 93Z( Z-7 ,,/� � MECH r RESIDENTIAL[— COMMERCIAL Contractor f j' 2- f' 4-2fi s<l'�/l Date - JOB DESCRIPTION:ADD FURNACE&A/C REPLACEMENT 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:$7079 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. g vv, APN Number:36905033.00 Occupancy Type: 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 relatin; PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 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 pe t. Additionally,the applicant understands and will comply with all non- sou regulations per the Cupertino Municipal Code,Section Issued - . Dater Cp 9.18. Signature Date &C RE-ROOFS: CJ 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 A inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensatic n, 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 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 com iance w' the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. HWea Cod , ctions 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shal not employ any person in any manner so as to become subject to the Worker's r or' ed ent: ) 8 t Dater Compensation laws of California. If,after making this certificate of exemption,I Qf[� become subject to the Worker's Compensation provisions of the Labor Code,I in rst forthwith comply with such provisions 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 relat ng 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 mify 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 OI' CUPERTINO 5 ITEMS OF 5 PERM--T RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B'-k: Lot: APN 313905033 .00 DATE ISSUED. . . . . . . : 03/08/2010 RECEIPT #. . . . . . . . . B,3000011402 REFERENCE ID # . . . : 1)090047 SITE ADDRESS 1)118 MELLO PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER EDITA TEJNIL ADDRESS 10118 MELLO PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CONWAY GOTHARD CONTRACTOR CONOWAY GOTHARD LIC # 31218 COMPANY . . . . . . . . . . : P.IR MAZE SERVICES INC ADDRESS 933 KIFER RD STE A CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 738-0333 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- -------- 1BCBSC VALUATION 7, 079. 00 1 .00 0 .00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 00 0 . 00 1MFR=<100 UNITS 1. 00 126 .00 0. 00 126 . 00 0 .00 iMPERMITFE 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 . 00 0.00 274 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ---------------- ------------- CREDIT CARD 274 .00 VISA --------------.. TOTAL RECEIPT 274 .00 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 CITY OF' CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: $7,079 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY 7 /, [; PENTAMATION 1 RMAP2' + USE: SFD or Duplex tri,(ar�iz �,t_ra PERMIT TYPE: WORK cJ 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 Check0.0 hrs $0.00 11himb 1''w( h" % L r� _ Plan t rrEc Mech.PermitFee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 0owr Ph nah In.1E3 C)tfsesI�fc>c-Ix rf. tl°tf%. InJ. t°��c: I'iiarnh. liis/z (� 1st�t My' l,cc NOTE: These fees are based on the preliminary informatio n available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Ef. ',-1101 FEE QTY/FEE MISC ITEMS P1uu Clrc>c:l1•c-e: supp/. P("'/'_CC PME Plan Check: $0.00 Permit 1"ce: .SillpL 117s17 Fee PME Unit Fee: $189.00 PME Permit Fee: $42.00 ("ollso-11crion Tax Icousticc11 Rcvr`cv 1(V., Work Without Permit? 0 Yes (F) No $0.00 I'lunriing 1"cue .' Travel Documentation Fee: 1TRAVDOC :142.00 i .S`trom, Alotion Fcc. Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS $274.00 $0.00 TOTAL FEE: $274.00 Revised: 9/01/2010 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: /fl J f/� PERMIT OWNER'S NAME: ;-�4 ��at '^. PHONE# D� �.3 `D� U33 GENERAL CONTRACTOR: BUSINESS LICENSE#ADDRESS: Gj33 l6 Z Q- CITY/ZIPCODE:S A �'� *Our municipal code requires all businesses working in the city to ave a City of Cupertino usiness license. NO BUILDING FINAL OR FINAL OCCUPANC`.' INSPEC ON(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC 7r, TO HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / q 6 / D I am not using any subcontractors: ( I Date ignature Please check applicable subcontractors and com Mete 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 4 f^ Date Owner/Contractor Signature INPUT Rcsoxres Energy !AD!health 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 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 Hosed Partfoleboard or MDF 4 IAQ/Health.pts y=yes 0 B.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 I0 ' 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 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 I 1 1 1 Total Points Available: 1401 130 57 Total Points Project Received: 0 0 0 G:datalprogs greenbuildngguidelinesl2modelerslgreenpointsfina1212D4proterted.xis Ion CITY OF CUPERTINO FURNACE/ACCUEI�TINO PERMIT APPLICATION FORM APN # Date: �� l Building Address: Owner's Name: Phone#: Contractor: Phone#: L1 39 - ?3 3 t+;)L ffi/�'l�_ S a-4AFax#: Ito Contractor License#: Cupertino Business License#: Contact: Phone#: �� 5-1 3 - `f L`'0 ren o C/� Fax #: Building Pe 'iu Info: Elect Plumb {]� Mech Residential VJ Commercial Job Description: l For Residential Installations: 2"d floor Attic Ell st 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): StrappedH On Platform Bonded New Location Replacement Project Size: Express ❑ Standard LargMajor❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, in clude in plan set & the sheet index. 0 Revised 01/07/09