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10050089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1114 S STEELING RD CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10050089 CONDI"IONING 1712 STONE AVE DATE ISSUED:05/10/2010 'NER'S NAME: EVELYN MARCOPULOS PHONE NO:(408)293-4717 SAN JC�SE,CA 95125 OWNER'S PHONE: 4084462215 ljy LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Cy C Lic.# 7 849 --7 MECH f" RESIDENTIAL COMMERCIAL ,l� Contractor 1�U rf�� Date o _� �//IJOB DESCRIPTION:REMV EXISTING FURNACE&INSTALL 3 TON FURNACE I hereby affirm that I am licensed under the provisions of Chapter 9 IN (commencing with Section 7000)of Division 3 of the Business&Professions SAME .00ATION 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 Valuation:$3380 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft:Floor Area: permit is issued. Occupancy Type: APPLICANT CERTIFICATION APN]lumber:36226009.00 1 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 'reby authorize representatives of this city to enter upon the above mentione roperty for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep har ess the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses w ch may accrue against said City in consequence of the granting of this pemr . Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all .rrce regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Date mature J_ '❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All r)ofs shall be inspected prior to any roofing material be ing installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, inspl;ction. will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Signature of Applicant: 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 and will maintain a Certificate of Consent to self-insure for Worker's I h:ve read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 2(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Ad litionally,sho I us equipment or devices which emit hazardous air permit is issued. coi taminants as efm by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compfiance th the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's He Saf Co ,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I f O� ner a orized agent: `^1 G_�p become subject to the Worker's Compensation provisions of the Labor Code,I must Date:J forthwith comply with such provisions or this permit shall be deemed revoked. -- ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I t ereb affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information e to which this permit is issued(Sec.3097,Civ C.) 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 Name the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 362260 )9 . 00 DATE ISSUED. . . . . . . : 05/10/ 2010 RECEIPT # . . . . . . . . . BS0000L0362 REFERENCE ID # 10050039 SITE ADDRESS 1114 S STELLING RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER EVELYN MARCOPULOS ADDRESS 1114 S STELLLING RD CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5021 RECEIVED FROM JIM PPNDO CONTRACTOR RANDO, JIM LIC # 8050 COMPANY AAA FLRNACE & AIR CONDITIONING ADDRESS 1712 ETONE AVE CITY/STATE/ZIP . . . : SAN JCSE, CA 95125 TELEPHONE (408) 293-4717 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- -------- 1BCBSC VALUATION 3, 380 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 380 . 00 0 . 50 0 . 00 0 .50 0 . 00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 . 00 iMPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .0042_ - -- -00 0_00 -- - TOTAL PERMIT 232 .50 0 . 00 232 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ---------- CREDIT CARD 465 . 00 VESA --------------- TOTAL RECEIPT 465 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF' CUPERTINO FURNACE/AC CUPEkTiNO PERMIT APPLICATION FORM APN # Date: Building Address: 11Iy � . IVe11,+ 5 124 - - Owner's..Name: Phone #: -- V 2,1 y ri VVI A r to P u Lv s _ 06- -q Z 2/S- Contractor: �fJ �} v,v�tCe �j '4 r�ojo h(v'4- e Phone #: yob , ze7 3 _ y 7x;;, _ Fax #: 1/0b --, .9 j ip ?'7 j Contractor License #: Qg7 / Cupertino Business License #: Contact:GI�t�,� la�-z-rr Phone #. 4D6-- 2-g 3 - W)/ ? Fax #: 4 My --- 2 13 Building Permit Info: Elect ❑ Plumb ❑ Mech [i' Residential Commercial ❑ Job Description: Zern ov i"S 4 nS j=LA rnj a Ck 0 ntd /Ky S fw I I 3 Tom LArNa C 4 I N_� e44-1 For Residential Installations: Attic ❑ 1 S` floor [- 2nd floor ❑ Adhere to minimum setback requirement [� -a For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: 33&0.00 Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement ❑ �i Project Size: Express ❑ Standard ❑ Large [] Major ❑ Valuation: X33 X30.,00 —i 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. J Revised 01/07/09 CITY OF C L PERTINO aeX FURNA(-E/AC CITY Of CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repaiu'Alteration/Add to M ea heating applianc:,refrigeration unit, cooling unit,absorp ion unit,or ea heating,cooling,abs,)rption or evaporative coolie- system,incl installation of controls regulated by this j code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating applianc.;,refrigeration unit,cooling unit,VAV boxes, absorption unit or ca heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. IMCSUSHTR Commercial Instal I'Relocate ea M suspended heater,rccessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ca gas piping System P j 1-4 outlets IBPGAS For each gas piping; system of 5 or P more per outlet. 1 MCAPPVNT Commercial for thc install/relocate/ or M replacement of ea z ppliance vent installed & not incl in an appliance permit. 1 BCBSC Cal Bldg Standar& Commission Fee B ALL PERMIT TYPES I BSEISMICO Commercial Seismic B 1 MRRAA Residential Repair,Alteration/Add to M ea heating applianc e,refrigeration unit, cooling unit,absorF tion unit,or ea heating,cooling,absorption or evaporative coolin,; system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,r.,cessed wall htr, or floor mounted unit heater. CITY OF C UPERTINO ,w FURNACE/AC "n of FEE SCHEDULE CUPEkTINO Quantity Fee ID Fee Description Fee Permit Type Groupj AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial AX i)lnits <= IOk CFM B 1 MCRAA Commercial Mccli Repair/alt/add M --I 1 BCBSC Cal Bldg Standarc s Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B I PGASCOM Commerical for ca gas piping System P 1-4 outlets 1 PGASRES Residential for ca gas piping system P of 1-4 Outlets 1BPGAS For each gas pir.ing system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C L nits <= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standarjs Commission Fee B ALL PERMIT TYPES i 1 BSEISMICR Seismic Residential B i I 1 EPERMITFEE Electric Permit E I 1 MPERMITFEE Mechanical Penn it M 1PPERMITFEE Plumbing Permit P I -1 1TRAVDOC Travel Documentation B 1 BUSLIC Business License B M.Indoor Air Ouality and Finishes 1.Use Low/No-VOC Paint 1 !AQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 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 3IAQ/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 N.Flooring 1.Select FSC Certified Wood Flooring Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl >IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 . { t t Total Points Available: 140 130 57 Total Points Project Received: 0 0 01 G:data/pr�ihuiiding rem lers/greenpointsfinal2.12.04protected.xls Community Development m `w, 10300 Torre Avenue its Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF .;UPEkTINO Buildin r De artment JOB ADDRES PERMIT # OWNER'S NAME: L` v� i Y,..., ,,�;��, ,� �v P� i a_s PHONE # r> GENERAL CONTRACTOR: R , u � i-L r' FAX # 40& <`1 .>- 4, ?'' I'am not using any subcontractors: Signai:ure Date Please check applicable subcontractors and com letE!the followin information: SUBCONTRACTOR BUSINESS 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`Ro T' ` j L Owner/Conga or Signature Date