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10070123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10853 NORTHOAK SQ CONTRACTOR:GARY'S FURNACE PERMIT NO: 10070123 SERVICE _'NER'S NAME: WALTER L DOUCETT 360 CARMELITA DR DATE ISSUED:07/19/2010 OWNER'S PHONE: 4084462637 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)967-8171 LICENSED CONTRACTOR'S DECLARATION F 3 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `./ —7 p 10 l� MECH RESIDENTIAL COMMERCIAL Contractor `IC6 u(�L(-(Ssk /v A/�` /(t l K'w Date —C ` ' I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE CHANGE OVER (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:$1850 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. APN Number:31641015.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above informati n 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, 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 Issued by: Date: 9.18. -iature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature 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 have 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 California 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. 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 contaminants 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 p Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow orthorize agent: Compensation laws of California. If,after making this certificate of exemption,I ' Date: l (/ 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 hereby affirm that there is a construction 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 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 _unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand 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 CUPERTINO RECEIPT NUMBER: BS000010893 RECEIVED BY: PATRICIAG PAYOR: MR. YOSHIHISA MIURA TODAY'S DATE: 07/19/10 REGISTER DATE: 07/19/10 TIME: 08 :35 5 1BCBSC 10070123 $1 . 00 1MFR=<100 10070123 $126 . 00 1MPERMITFE 10070123 $42 . 00 1TRAVDOC 10070123 $42 .00 BUSINESS LICENSE TAX RNEW - GARY'S FURNACE $114 . 00 ---------------- TOTAL DUE: $325 . 00 CREDIT CARD: $325 . 00 REF NUM: VISA TENDERED CHANGE $325. 00 $. 00 CITY OF CUPERTINO 4 ITEMS OF 5 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1};: Lot: APN . . . . . . . . : 31641015 . 00 DATE ISSUED. . . . . . . : 07,'19/2010 RECEIPT #. . . . . . . . . : BS0)00010893 REFERENCE ID # . . . : 10070123 SITE ADDRESS . . . . . : 10;353 NORTHOAK SQ SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER WA:JTER L DOUCETT ADDRESS 10353 NORTHOAK SQ CITY/STATE/ZIP . . . : CUERTINO, CA 95014 RECEIVED FROM . . . . : MR. YOSHIHISA MIURA CONTRACTOR . . . . . . . : MI'JRA, Y. LIC # 21564 COMPANY GA:2Y'S FURNACE SERVICE ADDRESS 36 ) CARMELITA DR CITY/STATE/ZIP . . . : MO'JNTAIN VIEW, CA 94040 TELEPHONE . . . . . . . . : (6 -30) 967-8171 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 850 . 00 1 .00 0 .00 1. 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 211 . 00 0 . 00 211. 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: Iso 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex APPLICATION USE: TYPE: x 9 a O O 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Furnace, Forced-Air 1MFlt=<100 1 $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs I $42.00 `_ NOTE. Thesefees are based on the preliminatUy in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (F'ee Resolution 09-051 Eff. TT,'09) FEF QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $4: '-.00 t Travel Documentation Fee: ITUVDOC $42.00 Select an Administrative Item Bld7 Stds Commission Fee: $0.00 SUBTOTALS: r $210.00 $0.00 TOTAL FEE: $210.00 Revised: 6/30/2010 CITY OF CUPERTINO Q) C-1 a ( � FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # � � � � Date: C Building Address: 10 �' 1 Owner's Name:Name: P one#: -1J ©u c 4�9-- 44G Contractor: Phone#: g V Fax#: Contractor License#: Cupertino Business License#: C- 7_0 4$2 S71 Contact: Phone#: 9 67 $f 7 YYA\(-4 rT-,, Fax #: Ll ���5S V Building Permit Info: Elect Plumb [ Mech Residential Commercial Job Description: C-,� cLa,4,- For Residential Installations: Attic ❑ I` floor"*Ngl 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 Pl pproval Required ❑ Cost of Proje Type of Cnstruction (Usage Class): Strap d n Platform Bondi-.d New Location E] Replacement Pr ject Size: Ex ressf] Standard ❑ Large [] Major❑ Vahiali& 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 INPUT Resources Energy IADIHealth M.Indoor Air Quality and Finishes 1.Use LowMo-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 0 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 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 B.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 0 . 1 1 1 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 •1 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor .1 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs I.Resource pts Y--yess0 . 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received:1 0 0 0 h GAMalprogslgref nb ' mg uidelmeslremodelerslgreenpointsfinal212.D4protected.xis Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: k --3 PERMIT# 2-7 OWNER'S NAME: G PHONE# — q4-&" GENERAL CONTRACTOR: e!Vr rlcc Cc 5r..- BUSINESS LICENSE# G,2.<-1 3 ADDRESS: ' ?e CITY/ZIPCODE: 0-7 l L.J *Our municipal code requires all businesses working it the city 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 SUBCONTVACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 4424-t-- Si mature Date Please check applicable subcontrac ors 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 Tile Owner/Contractor Signature Date