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10080017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20072 RODRIGUES AVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10080017 CONDITIONING 'BIER'S NAME: FERMINO MICHELIS 1712 STONE AVE DATE ISSUED:08/03/2010 OWNER'S PHONE: 4084464742 SAN.FOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F— ELECT r PLUMB F— Z'lLicense Class Oq/ Lic.# r I MECH RESIDENTIAL COMMERCIAL Contractor flo 'p I C to ly�l.i?ti c Date� —3 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 75 GAL WATER HEATER (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:$1871 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 pen-nit is issued. APN Number:36932005.00 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 harmless the City of Cupertino against liabilities,judgments, 80 DAYS FROM LAST CALLED INSPECTION. costs,and expenses whi a citue against said City in consequence of the granting of this pe w? do ally,the applicant understands and will comply with all n- t urc ations per the Cupertino Municipal Code,Section Issued s"'1 Date:e�— L� 9.18. ` 3ture Date — RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is insta led 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:.ture of Applicant: Date: will do the work,and the stricture 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 hay 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 Calif 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. Safe 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 Add tionally,should Iquipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this cont iminants as de ed the Bay Area Air Quality Management District I will maintain compl' a the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. He h&S ty o ,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 Owdr o a rized agent. a Compensation laws of California. If,after making this certificate of exemption,I Date: — J — C) 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 constriction 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 Len-ler'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 Len-ler's Address the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 unt terstand 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 OF CUPERT ENO OPERATOR: patg PERMIT RE CEI2T COPY # 1 4 ITEMS OF 30 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36932005 . 00 DATE ISSUED. • • • • . . : 08000010: 164 RECEIPT #• • " ' 10080017 REFERENCE ID # • • SITE ADDRESS 20072 RODRIGUES AVE SUBDIVISION • • • . . . : CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . • • • • • OWNER FERMINO MICHELIS ADDRESS 20072 RODRIGUES AVE CITY/STATE/ZIP CUPERTItfO, CA 95014 RECEIVED FROM : RANDO X; A HVAC, INC RANDO, JIM LIC # 8050 CONTRACTOR • • • AAA FURiACE & AIR CONDITIONING COMPANY • • • • • . . . . 1712 STONE AVE ADDRESS " " : SAN JOSE, CA 95125 CITY/STATE/ZIP (408) 293-4717 TELEPHONE . • • • • • • NEW BAL UNIT QUANTITY AMOUP;T PD-TO-DT -THIS-REC- ---_------ FEE ID ------ ---- 1.00 0 .00 _____ _ ---------- ---------- 1 .00 0 .00 0 .00 VALUATION 1, 871.00 62 00 0 .00 42 .00 1BCBSC 1. 00 25.00 0 .00 1PPERMITFE FLAT RATE :?5 .00 0 .00 0 .00 1.00 0 .00 42. 00 1PRWHEATR UNITS 1.00 12 .00 -- 1TRp,VDOC FLAT RATE ----- ----- ---------- 110. 00 0 .00 110 .00 0 .00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------" ------------------- 518 WATER HEATER CITY OF CUPE RTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: APN: REVIEWED BY: BP#: *VALUATION: $1,871 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair APPLICATION 1 RPWH PRIMARY SFD or Duplex TYPE: USE: 1 a O �ky—j 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Water Heater 1BP EAT 1 $25 TOTALS: $25.00 Plumb.Plan Check 0A hrs $0.00 Plumb.Pennit Fee: IPPERMITih- Other Plumb Insp. 0.J hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are on1v an estimate. Contact the De t or addn'l info. FEE ITEMS (H'ee Resolution 09-051 b'ff' 7/1:Y)<)j FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 -77 PME Unit Fee: $25.00 PME Permit Fee: $42.00 Work Without Permit? () Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 A Select an Administrative Item 134y Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $110.00 $0.00 TOTAL FEE: $110.00 Revised: 7/27/2010 CITY OF CUPERTINO OWATER HEATER CUPE TINO PERMIT APPLICATION FORM � Date: APN Building Address: ; Owner's Name: �,, , �� S Phone #: C%L Uy� �� y - Phone .7 Contractor: M kt Co Fax#: e�� - ��, s �� ; 2 r Cupertino Business License #: LContractor State License #: Contact: �� -77w 2 _ Phone #: - 7,3 `l 7 ' Fax#: ye' _ - ' rBld ilding Permit Info: ❑ Elect Plurab []' Mech Er- Residential Commercial ❑ Job Description: r 7 Strapped ❑ Bonded [� New Location LJ Replacement S pped ❑ On Platform Valuation (cost of project): Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portio i of the Green Building Checklist & attach the application or if applicable, include in plan set & the sheet index. Green Buildin Points achieved: Revised 03/10/10 Indoor Air Quality and Finishes 0 1.Use LowJNo-VOC Paint 1 IAQ/Healt) pts y=yes P Y=Y 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Healt i is es 0 3.Use LowiNo VOC Adhesives 3 IAQ/Healt i pts y=yes 3 Resource is Y=Yes 0 4.Use Salvaged Materials for Interior Finishes P Y-Y 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 6 IAQ/Heal h pts y=yes Y 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Heal h pts Y= es 0 7.Sea]all Exposed P;aficleboard or MDF 4 IAQ/Heal.h pts y=yes D 8.Use FSC Certified Materials for Interior Finish 4 ResourcE pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resourco pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Hee Ith pts yges N.Flooring 8 Resource is es 0 1.Select FSC Certified Wood Flooring P Y=y 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts Y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Hea th pts y=yes 0 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6.Install Recycled Content Carpet with Low VOCs 4 ResourcE pts y=yes 0 Total Points Available: 140 130 57 Total Points Project Received: 0 0 0 G:data/progslgreenbuildinogu elines/remodelar grgreenpomtsV212.04protected.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST -> a � fCITY/ZIPCIODE: IT# JOB ADDRESS: CXR P o � L OWNER'S NAME: F-P r M 'AJ�n '�► C �' r �'3 NE# y GENERAL CONTRACTOR: �C, ,,e�a �/� NESSNSE# ADDRESS: /L �/z► ��4z �,� , re'- *Our municipal code requires all businesses working in the cit;i to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete 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 caner/Contractor S' re Date