10050088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21094 RED FIR CT CONTRACTOR:AAA FURNACE&AIR FDATE
T NO: 10050088
CONDI fIONMG
'NER'S NAME: RUBY SOMMERVILLE
1712 S"'ONE AVE ISSUED:05/10/2010
OWNER'S PHONE: 8312349188SAN JOSE,CA 95125 NO:(408)293-4717
LICENSED CONTRACTOR'S DECLARATION BUILI)ING PERMIT INFO: BLDG r ELECT PLUMB
License Class—0 /c Z c. Lie.# ?(P b S 7 MECH r RESIDENTIAL r COMMERCIAL r
Contractor,3dGYU 110 0- Date S
JOB DESCRIPTION: INSTALL FURNACE NEW
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:$2100
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 APN Number:35905047.00 Occupancy Type:
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 pro y for inspection purposes. (We)agree to save
indemnify and keep harml s the City of Cupertino against liabilities,judgments, 180 D S FROM ST CALLED INSPECTION.
costs,and expenses whi may accrue against said City in consequence of the `
granting of this permit. A lditighally,the applicant understands and will comply rr,,
with all non- o s r ere ations per the Cupertino Municipal Code,Section Issued by V / Date:
9.18.
nature
Date
RE-ROOFS:
.0 OWNER-BUILDER DECLARATION All rc ofs shall be inspected prior to any roofing material being installed.If a roof is
instal ed 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 inspe tion.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signs ture of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). —
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
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 Cali'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 com)liance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safe ty 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,shoo 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 def ed by the Bay Area Air Quality Management District I will
maintain co
"an
a with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Hea t ety ode,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 q�y,i thorized 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 he eby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for,vhich 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 Len der's Address
the above mentioned property for inspection purposes.(We)agree to save
.nnify 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 ur derstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Lie-nsed Professional
Signature Date
CITY OF CUPERTINO
PERMIT REC�ZIPT OPERATOR: patg
7 ITEMS OF 14 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35905047 . 00
DATE ISSUED. . . . . . . : BS000010362
RECEIPT # . . . . . . . . .
REFERENCE ID # 10050088
SITE ADDRESS 21094 RED FIR CT
SUBDIVISION . . . . . .
CITY CUPERT7:NO
IMPACT AREA . . . . . .
OWNER RUBY SOMMERVILLE
ADDRESS 21094 RED FIR CT
CITY/STATE/ZIP CUPERTCNO, CA 95014
RECEIVED FROM JIM PAADO
CONTRACTOR RANDO, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS 1712 STONE AVE
CITY/STATE/ZIP SAN
JOSE,47A7 95125
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOENT PD-TO-DT THIS REC- -NEW-BAL-
----------
-------
-------------
----------
0 .00 1 . 0 0 . 00
1BCBSC VALUATION 2, 100 . 00 1. 00 0 . 00 0 . 50 0 . 00
1BSEISMICR VALUATION 2, 100 .00 0 .50 0 .00 42 . 00 0 . 00
1EPERMITFE FLAT RATE 1. 00 42 . 00
1 . 00 42 . 00 0 .00 42 . 00 0 . 00
1MPERMITFE FLAT RATE 1 .00 63 . 00 0 . 00 63 . 00 0 . 00
1MRRAA UNITS 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00
1 .00 42 . 00 0 . 00 42 . 0 . 00
1TRAVDOC FLAT RATE ---- --
TOTAL PERMIT
:232 .50 0 . 00 232 . 50 0 . 00
VOICE ID
DESCRIPTION VOICE ID DESCRIPTION
_ _
--
-----------------
507 FINAL PLUMBING
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
� c �c�
CITY OF CUPERTINO
`swl�
FURNACE/AC
CUPEkTiNO PERMIT APPLICATION FORM
APN # �_ C}`� L lY� —7 Date:
Building Address:(9 lb4L4 `Z rd r%Y CIT
Owner's Name: 1'Rub q S O rn rnei-v)le Phone #:
1- 23y - 7J9T
Contractor: 94nctC) A-lgpt- i44rNuCQ— Phone #:4a—.2-*3 _41�� 7
Fax #: --213 `7
Contractor License#: 7(o"-71 Cupertino Business License#:
Contact: 74fY �y Z.ei� Phone #: eleg -2-y5-- 4/7/ 7
/ Fax #: Z16 Y — 21 7 - /
Building Permit Info:
Elect ❑ Plumb ❑ Mech [
Residential Commercial ❑
Job Description:
For Residential Installations:
Attic ❑ 1" floor 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 Planning Approval Required ❑
Cost of Project: /0 v . 0 U Type of Construction (Usage Class):
Strapped F1 On Platform ❑ Bonded 0 New Location Replacement ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Valuation: glero 0
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 CU'ERTINO
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Comm erci al-Rep air//d terati on/Add to M
ea heating appliance,i-efrigeration unit,
cooling unit,absorpti on unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the r,-pair of alt/add to M
ea heating appliance,-efrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of control 3 regulated by
this code.
1 MCSUSHTR Commercial Install/Relocate ea M
suspended heater,rec-,ssed wall htr, or
floor mounted unit h,;ater.
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping :ystem of 5 or P
more per outlet.
1 MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl i i an appliance
permit.
1BCBSC Cal Bldg Standards commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/?.Iteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorpti on unit,or ea
heating,cooling,absc rption or -
�' evaporative cooling system,incl
installation of controls regulated by
this code.
1 MRSUSHTR Residential Install/R elocate ea M
suspended heater,rec;essed wall htr, or
floor mounted unit beater.
1
CITY OF CU PERTINO
FURNACEAC
CUPEkTINO FEE SCHEMULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Ur.its <= l Ok CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICO Seismic Commercia B
1 PGASCOM Commerical for ea g as piping System P
1-4 outlets
1 PGASRES Residential for ea gE s piping system P
of 1-4 Outlets
1 BPGAS For each gas pipin,; system of 5 or P
more per outlet. Cor:im/Resid
1 BREMAIRHAN Residential A/C uni-s <= l Ok CFM B
1 MRRAA Residential Mech R;pair/alt/add M
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1 1 MPERMITFEE Mechanical Permit M
J 1 PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentat on B
1 BUSLIC Business License B
1
INPUT ReSDUTres Energy 1AIDIHealth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paini 1 IF Q/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 II.Q/Health pts y=yes 0
3.Use Low/No VOC Adhesives 31/,Q/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 F esource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea 0
Formaldehyde 61/kQ/Health pts y=yes
6.Use Exterior Grade Plywood for Interior Uses 1 kQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 41,�Q/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 AQ/Health pts y=yes 0
N.Flooring
1.Select FSC Certified Wood Flooring 6 R;source pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 R,source pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 R Dsource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 1,+Q/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 R:source pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 R3SDUrce pts y=yes 0
TO
Total Points Available: 14OF 130 57
Total Points Pro'ect Received: 0 0 0
CS
G:data/progs/greenb iildingguidelineslremodelers/gre points' 12.12.04protected.xis
Community Development
w 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
XPEkTINO
BuR4n De artment
JOB ADDRESS:,316
4-/(4 I ��.I ► r' C PERMIT# v
OWNER'S NAME: u h 6 Y-n rY\ fr PHONE #AX - 2 5 3 7
GENERAL CONTRACTOR: t413✓3 # -7 `7
I am not using any subcontractors:
-t Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINES,13 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
Sheet Metal
Sheet Rock
e
Date
owner/Contrac ignature