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10020082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7925 RAINBOW DR CONTRACTOR:ALLIED AIRE SERVICE INC PERMIT NO: 10020082 OWNER'S NAME: PRESSMAN GERALD L AND STEPHANI 470 S HILLVIEW DR DATE ISSUED:02/16/2010 ,sER'S PHONE: 4082537176 MILPITAS,CA 95035 PHONE NO:(408)934-8844 ❑ LIICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT[— PLUMB License Class��vC-��J Lic.#!.� �Ol-"'��r� �� / MECH r— RESIDENTIAL[— COMMERCIAL Contractor�P�� Date oS 1` U I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RMV&REPLC EXISTING FURNACE 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:$2500 1 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:36210010.00 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 18 AYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAY M LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply / with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: ! Date: 9.18. Signature '�� DateIo RE-ROOFS: LI 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) 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 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 equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. 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 Ow r tho ize��gent Compensation laws of California. If,after making this certificate of exemption,IDate�4 O 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. 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 building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, 1 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 I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Licensed Professional Signature a Date E rG' CITY OF CUPERTINO 7 ITEMS OF 7 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blc: Lot : APN . . . . . . . . : 36210010 . 00 DATE ISSUED. . . . . . . : 02 /16/2010 RECEIPT #. . . . . . . . . : BSDO0009752 REFERENCE ID # . . - : 1OD20082 SITE ADDRESS . . . . . : 7925 RAINBOW DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PRESSMAN GERALD L AND STEPHANI ADDRESS . . . . . . . . . . : 7925 RAINBOW DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4944 RECEIVED FROM . . . . : ALLIED AIRE SVC INC CONTRACTOR . . . . . . . : STEINER, ARNOLD R LIC # 19207 COMPANY . . . . . . . . . . : ALLIED AIRE SERVICE INC ADDRESS . . . . . . . . . . : 47D S HILLVIEW DR CITY/STATE/ZIP . . . : MI'JPITAS, CA 95035 TELEPHONE . . . . . . . . : (4)8) 934-8844 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 2, 500 . 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 PERMIT 232 . 50 0 .00 232 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 232 . 50 #21297 --------------- TOTAL RECEIPT 232 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CITY OF CUPEkTINO PERMIT APPLICATION FORM 1 9 "2 APN # Date: Building Address: Owner's Name: Phone#: Contractor: Phone#: �d' 31V e� 41c 6-- Fax#: -311 kS�; Contractor License#: Cupertino Business License#: Contact: Phone#: Fax #: Building Permit Info: Elect 15 Plumb Mech Residential 9 Commercial ❑ Job Description: _S For Residential Installations: Attic El I" floor t� 2nd floor E] Adhere to minimum setback requirement El For Commercial Installations: Replacement same weight F Additional weight(structural calcs) ❑ Structural Calculations required for new installation. D New installation Planning Approval Required El Cost of Project: Type of Construction(Usage Class): Strapped El On Platform El BoncedF] New Location ❑ Replacement-E Project Size: ExpressE] StandardF] Large Major 0 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 COF CUPEKTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group IMRAPPVNT Residential for the install/relocate/or M replacement o,ea appliance vent install &not ijicl in an appl permit. FURNACE FURN/AC 1PGASRES Residential foj-ea gas piping system of P 1-4 Outlets 1BPGAS 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 IMECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burne:-, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst 100k BTU install or M relocate ea forced-air/gravity type furnace/burne-, incl ducts/vents attached to su,;h appliance over 100,000 Btu/l IEPERMITFEE Electric Perm;t Fee E 1MPERMITFEE Mechanical P,;rmit Fee M ( 1PPERMITFEE Plumbing Per.nit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 IT1f OF Fax(408)777-3333 XPEkTINO Buildi rig Department JOB ADDRESS: PERMIT r OWNER'S NAME:,,% PHONE GENERAL CONTRACTOR: FAX # /ma y I am not using any subcontractors: — �•-- � Signature Date Please check applicable subcontractors and complete 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 Sheet Rock Tile Owner/Contractor Signature Date