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10040069 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10040069 BUILDING ADDRESS: 7573 PROSPECT RD CONDITIONING 1712 STONE AVE DATE ISSUED:04/09/2010 ER'S NAME: FIFE JAMES S PHONE NO:(408)293-4717 SAN JOSE,CA 95125 OWNER'S PHONE: 4089962432 LICENSED CONTRACTOR'S DECLARATION $UILDING PERMIT INFO: BLDG� ELECT PLUMB License Class_C,4343 G u' Lic.# -7 �� MECH RESIDENTIAL COMMERCIAL� �1 y — Contractor i l� l�r.iy �'��`� Date JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE 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 Valuation:$3186 performance of the work for which this permit is issued. Sq.Ft Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36624034.00 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 180 DAYS FRO777 LAST CALLED INSPECTIO N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ^� costs,and expenses whiclyrriay accrue against said City in consequence of the ( J' Date: granting of this expenses whi dday ,ac accrue the applicant understands and will comply Issued b \ l Date- with all non-p ou(Pe regulations per the Cupertino Municipal Code,Section y; 9.18. y Date *.ure RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is 0 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 o inspection. the following two reasons: p Signature of Applicant: Date: 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I,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 I have read the hazardous materials requirements under Chapter 6.95 of the declarations: CaliforniaChapter 9.12 and the Health& I have and will maintain a Certificate of Consent to self-insure the s compliance with the CupertinodMunic pal Code,Sections e,Chapter 25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Lab Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defingd.by the Bay Area Air Quality Management District I will 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 maintain complia with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health Safety ode,Sections 25505,25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shallrith orized agent: �t not employ any person in any manner so as to become subject to the Worker's g Date: Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I mustSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION ermit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is e correct.[agree[o comply with all city and county ordinances and state laws relating t�-'->iilding construction,and hereby authorize representatives of this ee osave enter ressthe above mentioned property for inspection purposes.(We)agrn..cmnify and keep harmles the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARAcosts,and expenses whi y accrue against said City in consequence of they fans shall be used as public records. granting of this pe Ad rtionally,the applicant understands and will comply I understand m p LSi.'gnature all o* s c� egulations per the Cupertino Municipal Code,Section Licensed Professional . --Date �- CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 7 ITEMS OF 7 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36624034 . 00 DATE ISSUED. . . . . . . : 04/09/2010 RECEIPT #. . . . . . . . . : BS000010146 REFERENCE ID # 10040069 SITE ADDRESS 7573 PROSPECT RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FIFE JAMES S ADDRESS 7573 PROSPECT RD CITY/STATE/ZIP CUPERTINO CA, CA 95014-5242 RECEIVED FROM RANDO AAA HVAC, INC CONTRACTOR RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP SAN N JOS3,4CA 95125 TELEPHONE FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL ---------- ------------- ---------- ---------- ---------- 00 0 .00 1 . 00 0 • 1BCBSC VALUATION 3, 186 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 186 . 00 1 .00 40 . 00 0 . 00 40 . 00 0 . 00 1EPERMITFE FLAT RATE 1MPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 . 0 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 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 ---- 42 . 00 ---- 0 . 0- TOTAL PERMIT 232 . 50 0 . 00 232 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE-NUMBER __ --------------- -- CHECK 232 .50 #35904 --------------- TOTAL RECEIPT 232 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------------- -------- -------- --------- 507 FINAL PLUMBING 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPS TINO PERMIT APPLICATION FORM Date: APN # � , r � .� �-� -10 Building Address: -7 5-13 r- os pec,1- (Z�t C c.�pe,� ,� C c� Owner's Name: Phone#: �aY,ne s '�� y0$- 9� b -�y 32 Contractor: 'j 0 rck cy Phone#: �/f�� cam?3 �F 17 Fax#: 409- 699 3 -- &2 Contractor License#: -7 b S9-1 Cupertino Business License#: Contact: no. 6-�arv4 ( �y -Tuwz-e.r Phone#: L+D&�- 993 ` y-/7 UVJ C_)GFax #: 406- a-t3--to Building Permit Info: Elect❑ Plumb ❑ Mech [g Residential Commercial Job Description: )<ePyxpve- c�, fLe P tOCE )Ci s�►y 1=Ur/,.,a 0- e For Residential Installations: 1 S` floor [� 2°d floor El Attic ❑ Adhere to minimum setback re uirement For Commercial Installations: Replacement same weight ElAdditional weight (structural calcs) E] Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project:91,3 c�(o 00 Type of Construction (Usage Class): Strapped H On Platform H Bonded H New Location Replacement Pro'ect Size: Ex ress ❑ Standard ❑ Large ❑ Major❑ Valuation: SSa �o v 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 CUPERTINO FURNACE/AC CITY OF FEE SCHEDULE CUPEkTINO Quantity Fee ID Fee Description Fee Permit Type Group 1M LAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install &not incl in an a 1 permit. FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets IBPGAS For each gas piping system of 5 or P more per outlet. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M IMFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst> l 00k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E I MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 - I TRAVDOC Travel Documentation B 1BUSLIC Business License B IAOHealth . n oor it ua ity an erns es 1.10-11b 'fift 1 IAQ/Health pts y=Yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowlNo VOG 1AlhOM 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 0 Formaldehyde 61AQ/Health pts y=yes 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0 41AQ/Health. pts y=yes 0 8.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.1 I 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 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 4 Resource pts Y--yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y--yes001 1 1 1 —Total Points Aval ab F-1401 130 57 Total Points Project Received: 01 01 0 1 G:data/progs/greenbuildngguidelines/remodelers/greenpointsfina12.12.04protecte . Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF XPEkTINO Buildin De artment JOB ADDRESS: -7 5.7 3 P r OSe e� R-4 PERMIT #` � OWN- C UpER'S NAME- e PHONE # 4094 9 3 `4 l r GENERAL CONTRACTOR: o -�9 E3 F} " INaCc FA # 9--ag 3 I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the folloEin information: LICENSE # SUBCONTRACTOR BUSINESS NAM Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating FInsulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal 00wner/C;ontor Signature Date