10010134 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11135 LA PALOMA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10010134
CONDITIONING
+OWNER'S NAME: JOHN YIAO 1712 STONE AVE DATE ISSUED:01/25/2010
NER'S PHONE: 4083094678 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB
License ClassC%40(C ZC Lic.# 76s& --7/
MECH RESIDENTIAL COMMERCIAL
Contractor a M/�U f ftM-f- ING Date I _Z5-—L O
JOB DESCRIPTION:REMOVE EXISTING FURNACE&DUCTS,INSTALL NEW
I hereby affirm that I am licensed under the provisions of Chapter 9
FURNACE&2 DUCTS IN THE 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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$5218
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35616035.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses whi a crue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this perm' . A do ally,the applicant understands and will comply
with all n int s urce a tions per the Cupertino Municipal Code,Section
9.18. Issued Date:
Signature Date ^7-
El
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
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 and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I usequipment or devices which emit hazardous air
contaminants as define the Bay Area Air Quality Management District I will
permit is issued. maintain com nce i 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 H & lety ections 25505,25533,and 25534.
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 Ow r ized agent: -
become subject to the Worker's Compensation provisions of the Labor Code,I must
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
C N RUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
urn the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify and keep harmless the City of Cupertino against liabilities,judgments,
L ,,and expenses which ma accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit. diti a ,the applicant understands and will comply
with all no - t so e r a' ns per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 31 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35616035 . 00
DATE ISSUED. . . . . . . : 01/25/2010
RECEIPT # . . . . . . . . . : BS000009610
REFERENCE ID # . . . : 10010134
SITE ADDRESS . . . . . : 11135 LA PALOMA DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER JOHN YIAO
ADDRESS . . . . . . . . . . : 11135 LA PALOMA 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 51218 .00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 51218 .00 0.60 0 . 00 0 . 60 0 . 00
lEPERMITFE 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
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00
---------- ---------- ---------- --------
TOTAL PERMIT 127.60 0 .00 127 . 60 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
.S
FURNACE/AC
CUPS TINO PERMIT APPLICATION FORM
APN # Date:
-/ 653 1
Building Address:
11 13S Lei -Pa f o r ,&, 'b 12
—
Owner's Name: Phone #:
IQ 40k - 309 L/to `7 8-
Contractor: �n b V�- 1 N c- Phone#: 4-D� -,Z 5,3 W 7
} I
H- Ft4r/Q C4 C-� Fax#: 40k--- �;)- 13 --40 7-7
Contractor License#: 709-S-7 / Cupertino Business License#:
Contact:(!-7CW1\4 �li �� Phone #: 14a-�29 3.--,q
Fax #: a��. _ c2-9 3 (& "1
Building Permit Info:
Elect Plumb Mech
Residential a Commercial
Job Description: �1 Com; 1�"-t 5J,n5 FLS r'nv4 c e ci- tjC.y�-& //v
j ) ek-") 1�7�4 r-N a Ccs - 2.) zuC --$ S4q ry]e I OC44
For Residential Installations:
Attic ❑ 1` floor ❑ 2nd floor ❑
Adhere to minimum setback requirement 12-
For
Commercial Installations:
Replacement same weight [:] Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Re uired ❑
Cost of Project: 1 2 9 Type of Construion (Usage Class):
VU
Strapped On Platform Bonded ET New LocationEl Replacement
Project Size: Express [Standard ❑ Large MajorEl
Valuation:45 2-18%a
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
CITCUPEY OF
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 & not incl 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.
r 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
I
TYPES
1 BSEISMICR Residential Seismic B
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 S yst > l 00k 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
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit p
1 TRAVDOC Travel Documentation B
1 BUSLIC Business License B
INPUT wees Energy 1ADIHealth
. n oor Ir ua ity an ins es
1.use tb"O4OC RWht 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 MhOves 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/FHealth pts y=yes 0
7,a*4jal i r" 4 M/Health. pts y=yes p
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
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 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 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes p
1 1 1
Total Points Available:1 1401 130 57
Total Points Project Received: 01 0 p
G:data/progs/greenbuildrigip lines/remodelers/greenpantsfina1212.04pr ected.xls
• Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY
_. . .0F! Fax(408)777-3333
'UPEkTINO
Building Depart ent
JOB ADDRESS: 1 1 1 Z5 Lc-A p Ci 1 a i'mc► Da— PERMIT #
OWNER'S NAME: j A v PHONE #401- - L/h Y
GENERAL CONTRACTOR: kit(0 VA C ;,,j FAX#40s Os --.z q , Ce 7 --7
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and co m Tete the following information:
Fa
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 Rpcig
Ale
Owner/Contractor Date