The URL can be used to link to this page

10020141 CITY OF CUPERTIr 0 BUILDING PERMIT BUILDING ADDRESS: 11091 SANTA TERESA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10020141 CONDITIONING ( "NER'S NAME: COLEMAN EUGENE M AND FRANCES S 1712 STONE AVE DATE ISSUED:02/25/2010 G. NER'S PHONE: 4082523690 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT[_ PLUMB License Clasnses C?CJ Lic.#� (0&& 7 MECH F RESIDENTIAL F COMMERCIAL I— Contractor Afi r��1 Irk r Am CeDate � `Zr 'l a I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMV EXISTING FURNACE,CONDENSER&COIL. (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW FURANCE,CONDENSER&COIL IN SAME LOCATION 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. 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: Valuation:$6230 permit is issued. APPLICANT CERTIFICATION APN Number:35616005.00 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses whic'dd' accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this pe i onally,the applicant understands and will comply180 DAYS FROM LAST CALLED INSPECTION. with all non- oin sou e ations per the Cupertino Municipal Code,Section 9.18. Z,2--y6 Si^nature Date Z S _/0 Issued Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by t Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compl4witupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's H th&Safet25505,25533,and 25534. Compensation laws ofCalifomia. If,after making this certificate ofexemption,Ibecome subject to the Worker's Compensation provisions ofthe Labor Code,I must+ Owrrautho forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name V the above mentioned property for inspection purposes.(We)agree to save nify and keep harmles e City of Cupertino against liabilities,judgments, Lender's Address cc�Ls,and expenses whic ay rue against said City in consequence of the granting of this permit. ddi i lly,the applicant understands and will comply ARCHITECT'S DECLARATION with all n a e r tions per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. a Signature Date Licensed Professional CITY OF "-UPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35616005 . 00 DATE ISSUED. . . . . . . : 02/25/2010 RECEIPT #. . . . . . . . . BS000009826 REFERENCE ID # . . . : 10020141 SITE ADDRESS 11091 SANTA TERESA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER COLEMAN EUGENE M AND FRANCES S ADDRESS 11091 SANTA TERESA DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4726 RECEIVED FROM . . . . : RANDO AAA HVAC, INC CONTRACTOR RAADO, JIM LIC # 8050 COMPANY AAP FURNACE & AIR CONDITIONING ADDRESS 1712 STONE AVE CITY/STATE/ZIP . . . : SAT JOSE, CA 95125 TELEPHONE (4C8) 293-4717 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- -------- 1BCBSC VALUATION 6, 230 . 00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 6, 230 . 00 0 . 70 0 .00 0 . 70 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 2 .00 126 . 00 0 . 00 126 . 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 295 . 70 0 .00 295 . 70 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT .APPLICATION FORM APN # _ Date: Building Address: 11091 1 T e r-e-sc, Owner's Name: Phone M rar)Ces olerman 2- Contractor: Contractor: Q n d 0 14 v A C,'-,C , Phone #: SHA f,,rNaCe_ Fax #: 46,1- 223—47 7`7 1 Contractor License #. .7 to n--7 j Cupertino Business License#.- Contact: :Contact: C' Phone #: Fax #: �O�- ��I,� _�0 7 --7/Building Permit Info: Elect � Plumb �� Mech Residential Commercial Job Description: 'Remove �`�ciS� nJc GwN�� cca Pr►��,- tr►�,L i�vsii �v e,� ;�.,�,,,rrccs, Co,-.v PvSe�- a C��,� � ,., S�, ►-ne ►oc'csti�,., For Residential Installations: Attic ❑ l" floor 2"d 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:-Y/-(,O X30.0 0 Type;of Construction (Usage Class): �/ Q Strapped Lj On Platform Bonded Lj New Location Replacement Project Size: Express a—'—standard ❑ Large ❑ Major❑ Valuation: & 2-30-6o 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 CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replaceinent of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Out.ets 1 BPGAS For each gas piping system of 5 or P more per outlet. / 1 BCBSC Cal Bld,; 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 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 furnacef)umer, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbin;Permit p I 1TRAVDOC Travel Documentation B 1 BUSLIC Business License B FnMoorira ity and Finishes 1.tisetlimMO Vt C-Pafitt 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Lowft VOC Adhoves 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 p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7,.w ORfl m W 4 M/Health. pts y=yss 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 p 1 i 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 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 p 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 i Total ointsvat a Tel 140 130[_ 57 Total Points Project ReceivE:D 101 01 01 G:daWnvgs/greenbuildngguidalines/remodelers/greenpointsfina12.12.04prolected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Building Department JOB ADDRESS: 11 v"I'l S ei nke, 7r r r s� .I'2 PERMIT # � 2-e ` OWNER'S NAME: E c nces C-.,--) )ernan PHONE # OS�- -Z 3b 90 GENERAL CONTRACTOR: d'O VAC.. FAX # - 3 77 I am not using any subcontractors: Si;nature 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 TilJZ er/Contracto ignature Date