10080013I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10675 CLUBHOUSE LN
I'_^rNER'S NAME: RENO & ANNA DI BONO
I %-, -VNER'S PHONE: 4082523808
IT LICENSED CONTRACTOR'S DECLARATION
License Class L y 3 L' Z L Lic. # 7 tc S >f ? I
Contractor, tire' Date
I hereby affirm hat 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.
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.
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
to building constriction, and hereby authorize representatives of this city to enter
upon the above mentioned prope for inspection purposes. (We) agree to save
indemnify and keep harmless C' of Cupertino against liabilities, judgments,
costs, and expenses is ay a rue against said City in consequence of the
granting of this p it. dit ally, the applicant understands and will comply
with all non-po' t sou ulations per the Cupertino Municipal Code, Section
9.18. ,
� S; -nature
1 Date �'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec,7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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, I
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.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
;orrect. I agree to comply with all city and county ordinances and state laws relating
o building construction, and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes. (We) agree to save
•nify and keep harmless the City of Cupertino against liabilities, judgments,
s, and expenses which ma a against said City in consequence of the
wing of this pe-4,Mdeionally, the applicant understands and will comply
th all non -point urc eg tions per the Cupertino Municipal Code, Section
v`
1.18. /-`
Date Q — - ✓ v
CONT RLACTOR: AAA FURNACE & AIR PERMIT NO: 10080013
COND TIONING
1712 S'rONE AVE DATE ISSUED: 08/03/2010
SAN JOSE, CA 95125 PHONE NO: (408)2934717
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r—
MECH I— RESIDENTIAL F COMMERCIAL r—
JOB ]DESCRIPTION: REMOVE & RESET EXISTING FURNACE & ADD
CONDE NSER
HOOK 1 JP 220 POWER
Sq. Ft floor Area:
APN Ni mber: 35604042.00
Valuation: $5054
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued I Date: Z d
RE -ROOFS:
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
inspectio 1.
Signatur of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have re id the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Cede, Section 25532(a) should I store or handle hazardous material.
Addition illy, should Iquipmmt or devices which emit hazardous air
contaminants as def ed the Bay Area Air Quality Management District I will
maintain co ce w' the Cupertino Municipal Code, Chapter 9.12 and the
HP afe o , Sections 25505, 25533, and 25534.
Owe i rized agent:
Dater
CONSTRUCTION LENDING AGENCY
I hereby a 'firm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Vame
Lender's
ARCHITECT'S DECLARATION
understai A my plans shall be used as public records.
Acensed Professional
CITY OF CUPERTINO
5 ITEMS OF 30 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lo--.
APN ........: 35604042.00
DATE ISSUED.......: 08/03/2)10
RECEIPT #.........: BSOOOO1L064
REFERENCE ID # ...: 1008001.3
SITE ADDRESS 10675 C:�UBHOUSE LN
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER ............: RENO & IOWA DI BONO
ADDRESS ..........: 10675 CLUBHOUSE LN
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: RANDO A!�A HVAC, INC
CONTRACTOR RANDO, JIM LIC # 8050
COMPANY ..........: AAA FURPIACE & AIR CONDITIONING
ADDRESS 1712 STONE AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95125
TELEPHONE (408)29-1.-4717
FEE ID UNIT QUANTITY
---------------------------------
AMOUNT'
PD -TO -DT THIS REC NEW
BAL
1BCBSC VALUATION 5,054.00
----------
3.00
------------------------------
0.00 1.00
0.00
1BREMAIRHA NO.UNITS 1.00
6_.00
0.00 63.00
0.00
1MFR=<100 UNITS 1.00
12(.00
0.00 126.00
0.00
1MPERMITFE FLAT RATE 1.00
4.00
0.00 42.00
0.00
1TRAVDOC FLAT RATE 1.00
4.00
0.00 42.00
0.00
TOTAL PERMIT
----------
274.00
---------- ---------- ----------
0.00 274.00
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
'DICE
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
APPLIANCE / EQUIP TYPE
ADDRESS:
DA—E:
QTY
REVIEWED BY:
BP FEES
APN:
BP#-
*VALUATION:
1$5,054
xPERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE:
Alteration / Addition Repair
PRIMARY SFD or Duplex
USE: p
1MFR=<100
APPLICATION 1 RMAP2
TYPE:
$126
x w
PME Unit Fee:
$189.00
as
$42.00
- 11
APPLIANCE / EQUIP TYPE
CAPACITY
FEE ID
QTY
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
1
PME Plan Check:
$63
Furnace, Forced -Air
1MFR=<100
1
$126
PME Unit Fee:
$189.00
PME Permit Fee:
$42.00
- 11
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: I TRA VDOC
$189.00
Mech. Plan Check
1 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 0.0 I hrs 1 $42.00
FF
!ici
NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dept for addh 7 info
FEE ITEMS (]-'ce Resolution 09-051 E'll.'7,1/09)
FEE
QrY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$189.00
PME Permit Fee:
$42.00
- 11
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: I TRA VDOC
$42.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$274.00
$0.00j TOTAL FEE:
$274.00
Revised: 7/27/2010
CIN
CITY OF CUPERTINO
"J FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # -'S —
Date -
Building Address:
1005 CIA 400s Lone
Owner's Name:
Phone #:
b 6 n
*�-aS2-3ffor
_
Contractor: 2q nao H \),4 C
i
Phone #: 41o& -a 9 3— c/-) /7
Fax #: a -7
Contractor License #: 7
Cupertino Business License #:
Contact: -701, u u) e -T Phone #: qO�--m2 Q 3 y 7t
--- Fax
Building Permit Info:
Elect ❑� Plumb ❑ Mech [4'
_
Residential Commercial ❑
Job Description: ke- Se+ e)Z1 Sf,nG F(A r^*ce Cid C1n e in Ser -
J
H -66 L op 225
For Residential Installations: --
Attic ❑ 1 t floor 1?" 2nd floor ❑
;ForAdhere to minimum setback requirement E;-
ForCommercial Installations: ----
Replacement same weight ❑ Additional weight (structural Gales) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project J 05-441S 4/ Type of Construction Usage Class):
Strapped On Platform Bonded-[- New Location Replacement fl''
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Valuation: --- --
Green Building: Please complete relevant portion of i he Green Building Checklist & attach it to the
application or if applicable, include .n plan set & the sheet index. A
Revised 01/07/09
1. Use Low/No-VOC Paint
1 ;AQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 3esource pts
y=yes
Formaldehyde
31AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
i IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
l IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
I Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
Resource pts
y=yes
3 IAQ/Healthis
p
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
3 3eSDurce pts
y=yes
2. Use Rapidly Renewable Flooring Materials
3. Use Recycled Content Ceramic Tiles
4 3esource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
4 3esource pts
y=yes
5. Use Exposed Concrete as Finished Floor
5 AQ/Health pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
J
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Buildin
*GENERALCONTRACTOR:
DRESS: '
Club �'1dvS e LGne
'S NAME:
I
I am not using any subcontractors:
Please check
^--I- - - --
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
De artment
PERMIT #
PHONE # 61..
3 5 -
FAX #
Signature
nd completE the
RT TQYXT1Uc e x
Date
`7
Date