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10030161I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20102 NORTHCREST SQ "NER'S NAME: LIN VINCENT C t ,i/NER'S PHONE: 4088230152 ❑ LICENSED CONTRACTOR'S DECLARATION LicenseClass(—`fCZE Lic.# % b & b 7 / Contractor &,41+ C- Date 3Z 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. CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 10030161 CONDITIONING 1712 STONE AVE DATE ISSUED: 03/29/2010 SAN JOSE, CA 95125 PHONE NO: (408)293-4717 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB I— MECH r- RESIDENTIAL I- COMMERCIAL F JOB DESCRIPTION: REMOVE EXISTING FURNACE INSTALL FURNACE, CONDENSER 220 POWER HOOK UP 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 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which m crue against said City in consequence of the granting of this permit. A Wonally, the applicant understands and will comply with allnon-p9mifsou, gulations per the Cupertino Municipal Code, Section 9.18., S; -nature Date Z�-�u i ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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 must forthwith comply with such provisions or this permit shall be deemed revoked. 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 to building construction, and hereb uthorize representatives of this city to enter the above mentioned prop or inspection purposes. (We) agree to save nnify and keep harmles e ity of Cupertino against liabilities, judgments, ct,sts, and expenses which a Accrue against said City in consequence of the granting of this permit. onally, the applicant understands and will comply with all no ur egulations per the Cupertino Municipal Code, Section 9.18. 1 Signature Date Z U APN Number: 31637011.00 Valuation: $5620 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date:'3' RE -ROOFS: All roofs 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, shoo use equipment or devices which emit hazardous air contaminants as efi d by the Bay Area Air Quality Management District I will maintain c m ianc with the Cupertino Municipal Code, Chapter 9.12 and the Healt Sa tv C de, Sections 25505, 25533, and 25534. or orized agent: Date: 3 —z-7 —,-G I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 7 ITEMS OF 12 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31637011.00 DATE ISSUED.......: 03/29/2010 RECEIPT #......... BS000010045 REFERENCE ID # ...: 10030161 SITE ADDRESS .....: 20102 NORTHCREST SQ SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER LIN VINCENT C ADDRESS 20102 NORTHCREST SQ CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-0512 RECEIVED FROM ....: AAA FURNACE & AIR C CONTRACTOR RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE (408)293-4717 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 5,620.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 5,620.00 0.60 0.00 0.60 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 PERMIT ---------- 232.60 ---------- 0.00 232.60 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 343.10 --------------- 343.10 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 435779 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO kFURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # ;, Date: Building Address: (AA— ck01 D2 IA C re5-} vtirC Owner's Name: Phone #: NCQ L, Dk -D 3 - b) S- ' -Contractor: A -14 R � U � � � � Phone #: /-p V - 9,93 - y 7 / 7 Fax #: 409 -09-93_ (0 7 7 ) Contractor License #: '7 (o W7 / Cupertino Business License #: Contact: r1 c4r \4 '1&w -Ler -- Phone #: <Lp g -A9 3 - q 7/ 7 Fax #: 4G p - �9 3 � 6 )7/ Building Permit Info: Elect a Plumb �' Mech Residential Commercial Job Description: 42emove £,4ib4►r-15 FurNQ Ce iti 54a i/ /= u revC?C e, 0"CIIP17;5e, d`�O p9wer HOQ16 uP For Residential Installations: Attic ❑ I st floor 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: (0 2,C>. 0 cU Type of Construction (Usage Class): Strapped On Platform Bonded New LocationEl Replacement Project Size: Ex ress ❑ Standard ❑ Large ❑ Major Valuation: �LO, o 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 CUPERTINO FURNACE/AC CUPERTINO 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 InstalI/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not 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 unit,absorption unit,or ea I 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 a, FURNACE/AC CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Units <= I 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 Commercial B 1 PGASCOM Commerical for ea gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M I 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit p { f 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B 1.11set000-VOC'f1aitit 1 IAQ/Health pts y --yes 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 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7�.a�It;epQatulldl 41AQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y --yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y --yes Total Points Available: Total Points Project Received: 1401-1301 57 01 0 — 0 G:data/progslgreenbuildngguidelines/remodelerslgreenpointsfinat212.o4prolected.zls CITY OF ,UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: ad 10Z N C Y -t -,S -i- S14141,0 re PERMIT # oe�) 30C4�/ OWNER'S NAME: yl e PHONE#4.6 -02 3 GENERAL CONTRACTOR: --C4 f iva cQ FAX # 40S-- ;2- 3 I am not using any subcontractors: Signature n-n"lirahla c„hrnnfrarfors and complete the following information: Date Owner/Contra Signature '7-16-1() Date SUBCONTRACTOR BUSINESS 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 Rock Til Owner/Contra Signature '7-16-1() Date