The URL can be used to link to this page

10080014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19915 PRICE AVE CO 14TRACTOR:AAA FURNACE&AIR PERMIT NO: 10080014 CONDPFIONING 'NER'S NAME: MICHELLE CHID 171!STONE AVE DATE ISSUED:08/03/2010 OWNER'S PHONE: 4089962697 SAN JOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATION BU[-DING PERMIT INFO: BLDG r ELECT r PLUMB License Class'(?3 e L C Lic.# (c 1 MECH r RESIDENTIAL r COMMERCIAL Contractor Alii V J0 14 t4 `'- Date ��t' JO B DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE 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:$1804 1 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. APN Number:36905043.00 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 WORK 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 harml e City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expen hJA, ma accrue against said City in consequence of the granting of t ' permid'ionally,the applicant understands and will comply with all - oint sou a gulations per the Cupertino Municipal Code,Section Issued by:- Date: 9.18. _ -ature +1� Date >1 3 _ RE-ROOFS: OWNER-BUILDER DECLARATION Al.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, Sit nature 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 t ave 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 0 lifornia 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 co ntaminants a e d d by the Bay Area Air Quality Management District I will maintain ance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health Sa ty Co ',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 vne orized agent: Compensation laws of California. If,after making this certificate of exemption,I Date: 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 1 ereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION fo•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 the above mentioned property for inspection purposes.(We)agree to save mif costs,and expenses accrue against said City in consequence of they and keep harmless a City of Cupertino against liabilities,judgments, hich ARCHITECT'S DECLARATION granting of this pe ic, d'ionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-poi sou a gulations per the Cupertino Municipal Code,Section 9.18. L censed Professional Signature Date �-3 -'� O- CITY OF CUPERTINO 4 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36905043 . 00 DATE ISSUED. . . . . . . : 08/03/2010 RECEIPT #. . . . . . . . . BS000011064 REFERENCE ID # . . . : 10080014 SITE ADDRESS . . . . . : 19915 PRICE AVE SUBDIVISION . . . . . . CITY CUPEFTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MICHELLE CHIU ADDRESS 1991E PRICE AVE CITY/STATE/ZIP CUPEF.TINO, CA 95014 RECEIVED FROM RANDO AAA HVAC, INC CONTRACTOR RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 STONE AVE CITY/STATE/ZIP . . . : SAN FOSE, CA 95125 TELEPHONE (408; 293-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- 1BCBSC VALUATION 1, 804 . 00 1 .00 0 .00 1.00 0 .00 1MFR=<100 UNITS 1. 00 126 . 00 0 .00 126 . 00 0 .00 1MPERMITFE FLAT FATE 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 211 .00 0 .00 211. 00 0 .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 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CIUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: R�PERMITTYPE: Mechanical Permit PLAN C HECK TYPE: Alteration /Addition / Repair PRIMARY %. APPLICATIO�,0 USE: SFD or Duplex „F_ , TYPE: � W 00 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE Il) QTY BP FEES Select a Mech Item Furnace, Forced-Air 1MFR=<100 1 $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 ;�.r= "`'` {�'`�``' Mech.Permit Fee: 1MPERMIT Other Mech.Insp. T 0.01 hrs $42.00 tis=' NOTE. These fees are based on the preliminatry in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 Et: TT,'09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.0) PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.0 0 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ___ SUBTOTALS: $211.00 $0.00 TOTAL FEE: $211.00 Revised: 7/27/2010 OF CUPERTINO CITY + =rte FURNACE/AC CITY OF CUPEkTINO PERMIT APPLICATION FORM ho APN # Date: r ` L" Building Addre : S r; c e Owner's Name: Phone #: Contractor: �(�C — � i9 � f�✓-n�4 C e Phone #: C�p &- -- a19�3� y� i ') �anad � Fax #: d�- -z;9-4 3 — & 7 `7 1--- Contractor License #: '7 OE�S ( Cupertino Business License #: Contact: Phone #:Z/09 -�93—y C� � Fax #: �f-- a- 93 - 67 Building Permit Info: Elect Plumb �}� Meeh -- . Residential ®' Commercial ❑ Job Description: W rnc ve p ► ace. rl 9 t4 rnJ aC e . For Residential Installations: d ls` floor [✓]� 2 nfloor 1:1Attic El Adhere to minimum setback requirement [� ----L ercial Installations: nt same weight Additional weight (structural calcs)Calculations required for new installatio i ❑lation Planning Approval Required ❑ _ --- Cost of Project: Type of,' onstruction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Lar c_❑ Major ❑ Valuation: 1 o4/, dU Green Building: Please complete relevant portil)n of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. C�- -. Revised 01/07/09 M.Indoor Air 0uality 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 3 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 J 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 3 7.Seal all Exposed Particleboard 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 f f f N.Flooring 1.Select FSC Certified Wood Flooring 3 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 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 1 1401 1301 57 Total Points Project Rec 1 01 0 0 G:data/progs freer uiidin eines/remodalers/greenpointsfinal . 2. protect=d.xls Community Development µ, 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF 'UPE�TINO Buildin r De artment JOB ADDRESS: PERMIT # r Ce ATuQ- OWNER'S NAME: PHONE #41)s GENERAL CONTRAr�af-Axj FAX# fr -9 3- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank 1,19er/CoEntractor Ti Signa e Date