10050051 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10461 PINEVILLE AVE CON'RACTOR:TBD-TO BE DETERMINED PERMIT NO: 10050051
DATE ISSUED:05/04/2010
OWNER'S NAME: WENCHENG SU
PHONE NO:
4ER'S PHONE: 4087253624 '
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB
� 1 `-`73 O
License Class C Lic.# 71 MECH r- RESIDENTIAL COMMERCIAL
Contract Date
JOB DESCRIPTION:FURNACE REPLACEMENT&ADD A/C**SEE NOTES**
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.F t Floor Area: Valuation:$7286
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this anc Type:Occu APN Number:36913020.00 P Y
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter 'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, -[$Q DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Add'ionally,the applicant understands and will comply
with all non-point source ulations per the Cupertino Municipal Code,Section Issu-.d by Date:
9.18.
Signature Date
RE-ROOFS-
Li OWNER-BUILDER DECLARATION All r)ofs 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 inspl;ction.
the following two reasons:
I,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)
1,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 Cal fornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the coir pliance 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Hes lth&Safety Co e,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 Owner adthor
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 he reby 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. 1 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
upon the above mentioned property for inspection purposes.(We)agree to save
i' nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
L and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I widerstand my plans shall be used as public records.
with all non-point source 4ul ions er the Cupertino Municipal Code,Section
9.18. Lig ensed Professional
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913020. 00
DATE ISSUED. . . . . . . : 05/04/2010
RECEIPT #. . . . . . . . . BSO00010321
REFERENCE ID # . . . : 1005C051
SITE ADDRESS . . . . . : 10461 PINEVILLE AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WENCFENG SU
ADDRESS . . . . . . . . . . : 10461 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4522
RECEIVED FROM . . . . : KEN SHIPMAN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMClUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 7, 286 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 7, 286 . 00 0. 80 0 . 00 0 . 80 0 . 00
1EPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1MRRAA UNITS 2 . 00 126 . 00 0 .00 126 . 00 0. 00
1PPERMITFE 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 295 . 80 0 . 00 295 . 80 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
RECEIPT NUMBER: BS000010321
RECEIVED BY: PATRICIAG PAYOR: KEN SHIPMAN
TODAY'S DATE: 05/04/10 REGISTER DATE: 05/04/10
TIME: 12 :34
8
1BCBSC 10050051 $1 . 00
1BSEISMICR 10050051 $ . 80
1EPERMITFE 10050051 $42 . 00
1MPERMITFE 10050051 $42 . 00
1MRRAA 10050051 $126 . 00
1PPERMITFE 10050051 $42 . 00
1TRAVDOC 10050051 $42 . 00
BUSINESS LICENSE TAX NEW-RC' S MECHANICAL SVCS $114 . 00
----------------
TOTAL DUE: $409 . 80
CREDIT CARD: $409. 80 REF NUM: AMEX
'GENDERED CHANGE
$409. 80 $ . 00
CITY OF CUPERTINO
FURNA(:E/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # � C. I � Dat,-3e.--
1
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: 'l� t�32
f �l ? �� Fax#:
Contractor License#: Cupertino Business License#:
2
qV,,
Contact: 7 _ Phone#:
/J Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Residential Commercial ❑
Job Description f24azv-, pcalo/ace-0-ne-f-'H," 77/�)
For Residential Installations:
Attic ❑ I" floor%{ --- 2nd floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight El Additional weight (structural calcs) E]
Structural Calculations required for new installation �]
New installation Planning Approval Required ❑
Cost of Project: Type of Construction(Usage Class):
` 2
Strapped/ On Platform Bonded L 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.
Revised 01/07/09
CITY OF CUP E RTINO
FURNACE�'AC
COPE TING FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURN/AC
FURNACE
--------------
1MCRAA Commercial-Repair/Alte /Add to M
ea heating appliance,reirigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,re frigeration
unit,cooling unit,VAV boxes,
absorption unit or ea hoathing, cooling
absorption,or evaporative cooling sys,
incl install of controls:•egulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,reces sed wall htr, or
floor mounted unit hezier.
F::TI-BPGAS
GASCOM Commerical for ea gas piping System P
1-4 outlets
For each gas piping system of 5 or P
more er outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BC13SC Cal Bldg Standards Cc)mmission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/A]teration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling s ystem,incl
installation of contro.s regulated by
this code.
1MRSUSHTR Residential Install/Rolocate ea M
suspended heater,recessed wall htr, or
floor mounted unit h.-ater.
CITY OF CUPERTINO
.' FURNACEAC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Gro"
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units<= 10k CFM B
1MCRAA Commercial Mech Repair/alt/add M
=IBCBSC= Cal B=Standardsommission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea ga3 piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Com:n/Resid
1 BREMAIRHAN Residential A/C units <= l Ok CFM B
1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residential B
1
1 EPERMITFEE Electric Permit E
I
I 1 MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
M.Indoor Air Ouality and Finishes ,
1.Use LowiNo-VOC Pant 1 IAQ/Hi:alth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/HE:alth pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Hoalth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resou•ce pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Hoalth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/H:alth pts y=yes 0
7.Seal all Exposed ParWaboard or MDF 4 IAQ/H.;alth. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 ReSOLrce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 ResoLrce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/I-ealth pts y=yes ��j 1 =71 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resour;e pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resour;e pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resour;e pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HE alth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resour;e pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resour;e pts y=yes 0
i 1 lid
Total Points Available: 1 1401 130 57
Total Points Project Received: 01 01 0
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