10030097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21620 EDWARD WAY CONTRACTOR:ABC COOLING&HEATING PERMIT NO: 10030097
OWNER'S NAME: CHARLES DONG 31845 HAYMAN ST DATE ISSUED:03/17/2010
NER'S PHONE: 4082557875 HAYWARD,CA 94544 PHONE NO:(510)471-8181
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG f- ELECT r- PLUMB�
License Class C if Lic.# 37 Z 7 9 3 [' r— �—
MECH RESIDENTIAL COMMERCIAL
Contractor7
I hereby a rm t I li used under �e provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE,SAME LOCATION.90,000 BTU,80%
(commen i ith c on 7000)of Division 3 of the Business&Professions AFUE
Code and that my ' use 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 Sq.Ft Floor Area: Valuation:$2200
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:35618013.00 Occupancy Type:
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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by:{'_._ �2_ Date:
Signature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,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, Signature of Applicant: Date: 5 1(( 7 I (Cv
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF C ERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have 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 25532(x)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. 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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owne or
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby 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 is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
-nnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
g,anting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
ure Date r Licensed Professional
Signat
CITY OF CUPERTINO
7 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 35618013 . 00
DATE ISSUED. . . . . . . : 03/17/2010
RECEIPT #. . . . . . . . . : BS000009956
REFERENCE ID # . . . : 10030097
SITE ADDRESS 21620 EDWARD WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CHARLES DONG
ADDRESS 21620 EDWARD WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4765
RECEIVED FROM JEFF RAINEY
CONTRACTOR GERALD UNRUH LIC # 24643
COMPANY ABC COOLING & HEATING
ADDRESS 31845 HAYMAN ST
CITY/STATE/ZIP HAYWARD, CA 94544
TELEPHONE (510) 471-8181
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BCBSC VALUATION 2, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 200 . 00 0 . 50 0 . 00 0 .50 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 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 . 00 42 . 00 0 . 00
TOTAL PERMIT232 . 50 0 . 00 232 .50 0. 00
---------- ----------
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
---- -------------
-- ---------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY Of
CITY OF CUPERTINO
,a FURNACE/AC
CUP RTINO PERMIT APPLICATION FORM
APN# �r ' l., Date: '� I ( o
Building Address:
21620 Edward Way
Owner's Name: Phone#:
Charles Dong 408 255-7875
Contractor: Phone#: 510 471-8181
ABC Cooling and Heating Inc.
Fax#: 510 471-8368
Contractor License#: 382383 Cupertino Business License#:
Contact: Brenda Phone#: 510 471-8181
Fax #: 510 471-8368
Building Permit Info:
Elect[] J Plumb Mech ]
Residential x Commercial ❑
Job Description: Replace Furnace, same location. 90, 000 BTU, 80% AFUE.
For Residential Installations:
Attic ❑ Is'floor x❑ 2nd 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: $2,200.00 Type of Construction(Usage Class):
Strapped El On Platform Bonded New Location ❑ Replacement FLI
Project Size: Ex ress ❑ 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 CUPERTINO
FURNACE/AC
CITY Of
XPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1 MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1 MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/Alteration/Add to " M
ea heating appliance,refrigeration unit,
cooling ung unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1 MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
CITY OF CUPERTINO
FURNACE/AC
CITY OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1MR.APPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
r 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
1 TYPES
1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1 MFR=<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
I 1 EPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit p
1 TRAVDOC Travel Documentation B
1 BUSLIC Business License B
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Lill Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 71(,20 EDcJ.A,� PERMIT#
OWNER'S NAME: G �,,) PHONE# Z '75
GENERAL CONTRACTOR: +-&L ,� E , BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: 1+4- (I,JAN� 4
*Our municipal code requires all businesses working in 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 73/1 7 Aq
'gnature Date
Please check applicable subcontr ct and c lete the following information:
V SUBCONTRACTOR DKSINESS 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
r Co ctor Signature Date