10020142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1389 POPPY WAY CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10020142
CONDITIONING
NER'S NAME: HAY EDWARD A 1712 STONE AVE DATE ISSUED:02/25/2010
OWNER'S PHONE: 4082537732 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C43 ICZ-- Lic.# `7 to k&7
/�n MECH RESIDENTIAL COMMERCIAL r
Contractor R�A—�g4 V-10-1 CR Date 9 J) 5'//O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT SAME LOCATION
(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:$4325
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. APN Number:36618031.00 Occupancy Type:
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
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which ryayoccrue against said City in consequence of the
granting of this pe ' A d' onally,the applicant understands and will comply
with all - of sour a ulations per the Cupertino Municipal Code,Section Issued b Date: 2--2-s t�
9.18. Y�
S; -ature Date�2—ss-
dr 7
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,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 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use ipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as define y eBay Area Air Quality Management District I will
permit is issued. maintain complianc th a Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety C S tions 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 ��O oeor aut o agent: _
Compensation laws of California. If,after making this certificate of exemption,I /" Date: - — Z
become subject to the Worker's Compensation provisions of the Labor Code,I my�t
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which 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 huilding construction,and hereby authorize representatives of this city to enter Lender's Address
'che above mentioned property for in el tion purposes.(We)agree to save
,nify and keep harmless the City o Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may ac a ga' st said City inconsequence of the
granting of this permit.Addition I , e pp
granting understands and will comply I understand my plans shall be used as public records.
with all non- t source regul io p the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signat Date 4�
CITY OF CUPERTINO
FURNACEAC
CUPEkTiNO PERMIT APPLICATION FORM
APN # , -�, Date:
C Com, 1 �`� �1 C,'-' - 8-) C)
Building Address: i ma c' I)o p p q w c�
Owner's Name: 15JPhone#:
�` - -40 S -as3
Contractor: iZG►'laa Phone#: q p j- -,-293
AA4 f tirFax#: 4-O - X9'3 - &7 -71
Contractor License#: �, 1 Cupertino Business License#:
Contact: Phone#: Z W --g'--73 -4-/20
Fax #: 0� pZ 7"7/
Building Permit Info:
Elect Plumb Mech
Residential Commercial ❑
Job Description: Fu r AJO O-e j01gCP m�'�7't Sa k-kte /DC?ter idi..>
For Residential Installations:
Attic ❑ 1St floor [ 2°d floor ❑
Adhere to minimum setback requirement 2-
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: 4 413 Zs vk) Type of Construction (Usage Class):
Strapped ❑ On Platform Bonded New Location Replacement []-
Project Size: Express E'--Standard ❑ Large [] Major❑
Valuation: 4-iw's-o eo
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
FUTMACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ ir.cl 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.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
/ 1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst =100k BTU install or M
relocate ea forted-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst 100k BTU install or M
relocate ea forced-air/gravity type
fumace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/b
1 EPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Pennit P
/ 1 TRAVDOC Travel Documentation B
/ 1BUSLIC Business License B
INPUT RLsourns Energy AQ;Hcaftl
M.Indoor Air Quality and Finishes
1.use io-VOC P*t 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes. 0
3.Use Loft VOG Adf*eeia+es 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 61AQ/Health pts y=yes D
6.Use Extedor Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.%al al Par board or UDF
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 0
N.Flooring
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Rapitly Renewable Flooring Materials 3 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles f 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 3 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs t Resource pts y=yes 0
. 1 1 1
Total Points Available: 140 130 57
Total Points Project Received: 0 0 0
J
G:data/progs/gree nbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls
as Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IPERTINO
Building Department
JOB ADDRESS: 138 PERMIT# - 0
OWNER'S NAME: =d coci r-d PHONE # pg - 3 y ��
GENERAL CONTRACTOR: Ra ndo 14 v,4 FAX # 4 6,j--2 3-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Clete the following 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
SyeetR
ile
Owner/Contr r Signature Date