10080004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11371 BUBB RD CONTRACTOR:ALLIED AIRE SERVICE INC PERMIT NO: 10080004
OWNER'S NAME: SHAUL BERGER 470 S HILLVIEW DR DATE ISSUED:08/02/2010
VER'S PHONE: 4086661677 MILPITAS,CA 95035 PHONE NO:(408)934-8844
❑ LICENSED CONTRACTOR'S DECLARATION
�D
_ .� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class GNU C�Lic.# �
K ✓' /-o MECH r RESIDENTIAL r— COMMERCIAL
Contractor Date � �
I hereby of rum that I am licensed under the provisions of Chapter 9 JO13 DESCRIPTION:REPLACE EXISTING FURNACE SAME LOCATION ADD A/C
(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:$4000
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. APP(Number:35623047.00 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 relating PERMIT EXPIRES IF WORT{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 "
9.18. Issued by,. Date-�2
Signature_ Date , �v
RE-ROOFS:
OWNER-BUILDER DECLARATION All r)ofs 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,
Sign rture 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 hal a 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 Calij ornia 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. Safei y 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 cont:Lminants 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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Own hor a ge>at:
Compensation laws of California. If,after making this certificate of exemption,I � a 1�/ Date: F1 110
--
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 her(by affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for w-rich 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
anify 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 and;rstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Licer sed Professional
Signature = Date
CITY OF CUPERTINO
5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35623047 . 00
DATE ISSUED. . . . .. . : 08/02/2010
RECEIPT #. . . . . . . . . : BS000011046
REFERENCE ID # . . . : 10080004
SITE ADDRESS . . . . . : 11371 BUBB RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER SHAUL BERGER
ADDRESS 11371 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ALLIES AIRE SERVICE
CONTRACTOR . . . . . . . : STEINER, ARNOLD R LIC # 19207
COMPANY . . . . . . . . . . : ALLIE:D AIRE SERVICE INC
ADDRESS 470 S HILLVIEW DR
CITY/STATE/ZIP . . . : MILPI'PAS, CA 95035
TELEPHONE (408) 334-8844
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 4, 000. 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
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 :?74 .00 0. 00 274 . 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
RECEIPT NUMBER: BS000011046
RECEIVED BY: PATG PAYOR: ALLIED AIRE SERVICE
TODAY'S DATE: 08/02/10 REGISTER DATE: 08/02/10
TIME: 10 : 13
6
1BCBSC 10080004 $1 . 00
1BREMAIRHA 10080004 $63 . 00
1MFR=<100 10080004 $126 . 00
1MPERMITFE 10080004 $42 . 00
1TRAVDOC 10080004 $42 .00
BUSINESS LICENSE TAX RENW- ALLIED kIR $114 .00
----------------
TOTAL DUE: $388 .00
CHECK $388 .00 REF NUM: #21651
TENDERED CHANGE
$388 . 00 $. 00
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: D ATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARYAPPLICATION
USE: SFD or Duplex TYPE, 1 RMAP6
i?
� W
as
00
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
Furnace, Forced-Air 1MFR=<101) 1 $126
A/C Units (<=10K cfm) 1BREMAIF. 1 $63
TOTALS: $189.00
Mech.Plan Check hrs $0.00
0.0 -
Mech.Permit Fee: I MPERMIT
Other Mech.Insp. 0.0 hrs $42.00 =_t1 .77
1 7_1
L_
NOTE: Thesefees are based on the preliminatrTy in ormation availairle and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-05I F,ff' 7/ ,09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $189.00
PME Permit Fee: $42.00
F—A
Work Without Permit? Q Yes (F) No $0.00
Travel Documentation Fee: ITRAVDOC $42.00 A
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.001 $0.00 TOTAL FEE: 1 $274.00
Revised: 7/27/2010
CITY OF CUPERTINO
FURNACE/AC
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date, /
� :��L C",
Building Address:
Owner's Name: Phone#:
Contractor: Phone#:
�
Fax#: ��''e
Contractor License#: Cupertino Business License#:
��ze4-57-
Contact: Phone#: e
0-V clS Fax#:
Building Permit Info:
Elect a Plumb Mech El
Residential Commercial
Job Description:
For Residential Installations:
Attic ❑ 1St 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 ❑
Cast of Project: Type of Construction(Usage Class):
Strapped 0 On Platform Bonded New Location tj Replacement
Project Size: Express �andard ❑ 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
M.IndDDr Air Quality and Finishes
1.Use Low/No-VOC.Paird 1 IAOAi"th pts y=Yes D
2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHealth pts y=yes D
3.Use LowNo VOC Adhedwes 3 IAO/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Re source pts y--yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AOJHealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAt1/Health pts y=yes D
7:Seal MaF oseel or MDF _ __ _ 4 IAOJHealth is = es D
B.Use FSC Certified Materials for Interior Finish 4 RE source pts y--yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 RE source pts y=yes 0
10.Install Whole House Vacuum System 3[AQMealth pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Re:ounce pts y=yes 0
2.Ilse flapidlJbnewaWe flooring Materials 4 ReE ource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Re:ource pts y--yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 ROE ource pts y--yes D
5.Install Recycled Content Carpet with Low VOCs 4 Re ource pts y--
yes 0
1 1 t
Total Points Available: 1 1401 1301 57
Total Points Project Received:
Mdata/progs/greenbuld igguidelines/remodelerslgreenpoint5final212D4pm1aD1ed.xls
Building Department
City Of Cupertino
Ilia 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: ,� PERMIT# CYv
OWNER'S PHONE# ✓ `"—
GENERAL CONTRACTOR , ire BUSINESS LICENSE#
ADDRESS: s, CITY/ZIPCODE: /l f 045S
*Our municipal code requires all businesses working in the --ity to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INS 'ECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: 61
Signature Date
Please check applicable subcontractors and complete t ie following information:
&/ SUBCONTRACTOR BUSINESS 1\AME 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