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10010133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 816 COTTONWOOD DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10010133 CONDITIONING IWNER'S NAME: JEANETTE CONSTANZO 1712 STONE AVE DATE ISSUED:01/25/2010 .OWNER'S PHONE: 4082573086 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class( q3 Ze Lic.# ��� S 7/ /' _ MECH RESIDENTIAL COMMERCIAL Contractor d27/?G1'U M✓19'd IA`'e- Date l o I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNANCE&INSTALL NEW (commencing with Section 7000)of Division 3 of the Business&Professions FURNACE IN Code and that my license is in full force and effect. THE SAME LOCATION. 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:$3335 permit is issued. APPLICANT CERTIFICATION APN Number:36918018.00 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 which Mitioaccru a' st said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of th' i A ,t applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point rce regul o er the Cupertino Municipal Code,Section 9.18. -�' Z i Issued-hYI� �-. -- Date:/ � J c; nature Date 1 S ❑ 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 def a by the 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 co Iia a ith the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's H & afe e,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I Ow r a orized agent: become subject to the Worker's Compensation provisions of the Labor Code,I mustl Z forthwith comply with such provisions or this permit shall be deemed revoked. Date: STRUCTION 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 Vthe above mentioned roperty for inspection purposes.(We)agree to save :lift'and keep h les the City of Cupertino against liabilities,judgments, Lender's Address cons,and expense hich m y rue against said City in consequence of the granting this p it.Ad o lly,the applicant understands and will comply ARCHITECT'S DECLARATION with al(.non- i t sour ations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signatur Date ��?� !� Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 31 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36918018 . 00 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT #. . . . . . . . . : BS000009610 REFERENCE ID # . . . : 10010133 SITE ADDRESS . . . . . : 816 COTTONWOOD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JEANETTE CONSTANZO ADDRESS . . . . . . . . . . : 816 COTTONWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RANDO AAA HVAC, INC 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 31335 . 00 1 . 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 3, 335 . 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO k RNA EA F ' U C / C CITY OF lZe/1! j�/ERMIT APPLI �/ r/: / CUPE�TINO PCATION APN # Date: Building Address: S 1 0 ..) Uj v Owner's Name: Phone#: 7U,&aV1eA+-e.- 0oN-xS-ky)7-o 14P • 3 5"'? -- ocf 6 Contractor: Acme-to �Wl4 C >/j C_ Phone #: IM& kFax #:-'a- -a9 3 - (a -7-7 i Contractor License #: `] kc,4� � -) I Cupertino Business License#: Contact: G1 q �Z.e r- Phone #: � T�. Oafs 9 9 3--,v --) r 7 Fax #:IJDY - c;ql, 93 - 7`7j Building Permit Info: Elect Plumb Mech Residential Commercial Job Description: e YYn pv-e �'� I'S i-"n 6 F(4 4 Ce 4 INS 1,1 I� ccs Ft�l r ova C� /AJ 5qfX(f /664fk v,� For Residential Installations: Attic 1:1 1st floor 2" floor ❑ Adhere to minimum setback requirement []' For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation [❑ New installation Planning Approval Required ❑ Cost of Project:', �, Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express Standard ❑ Large Major Valuation:-j 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 01707/09 CITY OF CUPERTINO FURNACE/AC CITOF CUPEYTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1 MR.APPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install & not incl in an a 1 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. 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Residential Seismic B l 1 MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace S yst <=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 > 100k BTU install or M relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h IEPERMITFEE Electric Permit Fee E I MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit p r I M aq&K 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B INPUT A0 . n oorlr ua lty an in s es 1.Ut9to OWOC Pajht 1 IAQ/Health pts y--yes; 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adh Oves 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts Ayes 0 7%.WOM c ,Ai: F 4 IAQ/Health. pts Ayes 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 8 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 Ayes 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 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes p 1 1 1 Total Points AvailabWel 1 1401 1301 -- 57 Total Points Project Received:1 01 01 0 G:data/progslgreenbuilcOWidelinestremodelers/preenpantsfinat212.04 r cted.xis Community Development �S;, .. ; 10300 Torre Avenue Ax y Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .'UPEkTINO Building Depart ent JOB ADDRESS: 3�-J 0+4-oj weacc b K- PERMIT # A�V/0/ 3,5 OWNER'S NAME: e,r)ebE e Cb n5+c o z, PHONE #4 b - - -30 GENERAL CONTRACTOR:IgnCto FAX#-'fo� - 99 3 -.o 7-, 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 Met4 Sheet c T' Owner/Contra r Signature Date