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10080009I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21512 REGNART RD I CONTRACTOR- I PERMIT NO: 10080009 I OWNER'S NAME: SURESH VASA NER'S PHONE: 4082538232 ❑ LICENSED CONTRACTOR'S DECLARATION License Class L, Zv Lic. # .9,1,57;;! `-- U `1 ,,//� Contractor 0/y/Lse- Date 9_7_/o 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. 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 construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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. SignatureDate �^ Z —) 0 L] OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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. 1 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 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 unon the above mentioned property for inspection purposes. (We) agree to save unify and keep harmless the City of Cupertino against liabilities, judgments, _s, 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. Signature. Date DATE ISSUED: 08/02/2010 PHONE NO: BUILDING PERMIT INFO: BLDG F ELECT F PLUMB MECH F RESIDENTIAL [_ COMMERCIAL F JO 3 DESCRIPTION: CHANGE OUT FURANCE & CHANGE OUT CONDENSER **S ?E NOTES** Sq. Ft Floor Area: I Valuation: $5000 AP q Number: 35623043.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Iss ied21 Date: � 2 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is insi alled without first obtaining an inspection, I agree to remove all new materials for inspection. Sig nature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I h ive read the hazardous materials requirements under Chapter 6.95 of the Ca lifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Sa" ety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. O,,,ner or aut orized agent: Date: ^Z 7 CONSTRUCTION LENDING AGENCY I h .reby affirm 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 Name Le rider's Address ARCHITECT'S DECLARATION I u iderstand my plans shall be used as public records. Li:ensed Professional 5 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Iot: APN ........: 35623C43.00 DATE ISSUED.......: 08/02/2010 RECEIPT #......... BS000011051 REFERENCE ID # 10080009 SITE ADDRESS .....: 21512 REGNART RD SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: SURES:3 VASA ADDRESS . 21512 REGNART RD CITY/STATE/ZIP CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM CHOICE MECHANICAL CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ......... 304 ROUGH ELECTRICAL 501 502 FINAL PLUMBING ENERGY 503 505 FINAL ELECTRICAL 507 508 FINAL MECHANICAL FINAL ELECTRICAL ENERGY FINAL MECHANICAL ENERGY FINAL PLUMBING UNIT QUANTITY AMCUNT PD -TO -DT THIS REC NEW BAL FEE ID ------ --- ---- ---------- 1BCBSC ------------- VALUATION ---------- 5,000.00 ---------- 1.00 0.00 1.00 63.00 0.0 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 0.00 126.00 0.00 1MFR=<100 UNITS 1.00 126.00 42.00 0.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 1.00 42.00 0.00 42.00 1TRAVDOC FLAT RATE ------ ------0 ---0.00 - 274.00 274.00 0.00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE -- ------ ID ------------------- DESCRIPTION --------- __ _ ------------ 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 502 FINAL PLUMBING ENERGY 503 505 FINAL ELECTRICAL 507 508 FINAL MECHANICAL FINAL ELECTRICAL ENERGY FINAL MECHANICAL ENERGY FINAL PLUMBING CITY OF CUPERTINO 'ff"ffp'p'ff,�0rV1F1%AFArV"1D DITIT "INC 111VIqlON APPLIANCE / EQUIP TYPE jej rij jrj o i -a —j— FEE If, QTY ADDRESS: I DATE: REVIEWED BY: Lar 1BREMAR 1 VALUATION: J$5,000 $63 APN: BP#: Furnace, Forced -Air ni mit --PERMIT TYPE: Mechanical Permit PLAN C HECK TYPE: Alteration / Addition Repair PRIMARY 1 APPLICATION APPLICATION PPLI 1 RMAP2 up x SFD or Duplex TYPE: A USE: $42.00 0111"Ifii'j! RcOc'­ as Work Without Permit? 0 Yes (D No cc U TOTALS: APPLIANCE / EQUIP TYPE CAPACITY FEE If, QTY BP FEES A/C Units (<=10K cfm) 1BREMAR 1 PME Plan Check: $63 Furnace, Forced -Air IMFR=<100 1 $126 PME Unit Fee: $189.00 PME Permit Fee: $42.00 0111"Ifii'j! RcOc'­ Work Without Permit? 0 Yes (D No $0.0) TOTALS: Travel Documentation Fee: I TRA VDOC $189.00 Mech. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT 1-0ther Mech. Insp.F07,07hrs] $42.001 Select an Administrative Item 77 __j ___ --i., __ i-notim-ttho Dont for addnl info. NOTE: These fees are basea on the preanunary imarms FEE ITEMS (Fee Resolution 09-051 E'If 7,,-1,.,09) Uri "y"t FEE QTY/FEE MISC ITEMS PME Plan Check: $0.0() PME Unit Fee: $189.00 PME Permit Fee: $42.00 0111"Ifii'j! RcOc'­ Work Without Permit? 0 Yes (D No $0.0) Travel Documentation Fee: I TRA VDOC $42.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.00 $0.001 TOTAL FEE: $274.001 Revised: 7/27/2010 alF CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # Date:_ Z %0 Building Address: 2 Owner's Name: Phone #: Contractor: Phone #: S/ -6 •-7 <5 --7 f Z (� Fax #: Contractor License #: �f �/ - Z S Z Cupertino Business License #: Contact: - Phone #: 5/,D '� Z9- � � Cyd � Fax #: tsuiiuuig rC;11111L L111U- Elect Residential Plumb Mech �' Commercial Job Description: 014-� rur nehJUVIlua, Attic ❑ is' floor ❑ 2°d floor El Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Eidditional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ r1 New installation running ^ppiuvcyuii�.0 u Cost of Project: Type of ConAruction (Usage Class): Si crvv 4 fU/*D Strapped ❑ On Platform Bonded New Location Replacement Project Size: Express ❑ 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. v—A; A 0i /07/09 . Indoor Air Quality and Finishes a, 1 M health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 MHealth pts y=yes. 9. Its Lovft'!CAdhashm 31AQ/­iealth pts y --yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQiHealth pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ Health pts y --yes yT 4 IAQ Health. pts y --yes B. Use FSC Certified Materials for Interior Finish 4 Res )urce pts y --yes; 9. Use Fnger-Jointed or Recycled -Content Trim 1 Res)urce pts y=yes 10. Install Whole House Vacuum System 3 IAC/Heaith pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring B Resc urce pts y=yes Use f3atpi* Renewable f9oo" lAaWWS 4 Resc urce pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resc urce pts y=yes 4. Install Natural Linoleum in Place of Vinyl 15 IAQ Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resc urce pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Rescurce pts y=yes Total Points Available:1 1401 1301 57 Total Points Project Received: �C_,7 0 01 0 G:datalpmgslgreenbuildii gguidelinestremodelerslgreenp6intsfinat212.D4protected.xis CUPERTINO V"NTR Af TOR / S1JBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Z/ PERMIT # OWNER'S NAME: PHONE # i # GENERAL CONTRACTOR: C. G✓L9v' BUSINESS LICENSE ADDRESS: Z J �= CITY/ZIPCODE: Cement Finishing "Our municipal code requires all businesses worKing w uir city tu uavc a � —J — ----r----___ ---- NO BUILDING FINAL OR FINAL OCCUPANCY IV,PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. _Z I am not using any subcontractors: g ure Date Si Dl..- nhorlr annlirnhlP cnhcnntractors and complete the following information: Owner / Contractor Signature Date 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