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10010131 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10232 PARLETT PL CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10010131 CONDITIONING NER'S NAME: BILL BARTHELL 1712 STONE AVE DATE ISSUED:01/25/2010 OWNER'S PHONE: 4088796747 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 0!t3 Lic.# 7&d�-7 MECH RESIDENTIAL COMMERCIAL Contractor lid U / -/�� Date ! c3 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE AND INSTALL NEW (commencing with Section 7000)of Division 3 of the Business&Professions FURNACE 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:$5378 permit is issued. APPLICANT CERTIFICATION APN Number:31626062.00 Occupancy Type: I certify that fhave 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 may a e against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this pe .' A i n y,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all no t urce r ul ons per the Cupertino Municipal Code,Section 9.18. �..-- ---'� 2 '_�l D ature Date " - Z� _/ t;► Issued.�y �--. ..._._.y.� _ .....� Dat ._._ ❑ 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, Signature of Applicant: Date: Business&Professions Code) 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 quipment or devices which emit hazardous air permit is issued. contaminants fi 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 plia a w' 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 Health& afe o ,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow er r a orized agent: _ Date: forthwith comply with such provisions or this permit shall be deemed revoked. (jC 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 the above mentioned property for inspection purposes.(We)agree to save .. �,-nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which c e against said City in consequence of the granting of this permit. dditio Il ,the applicant understands and will comply ARCHITECT'S DECLARATION with all non- our reg ti s per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date 4 Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 31 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31626062 . 00 DATE ISSUED. . . . . . . : 01/25/2010 RECEIPT # . . . . . . . . . : BS000009610 REFERENCE ID # . . . : 10010131 SITE ADDRESS . . . . . : 10232 PARLETT PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BILL BARTHELL ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2208 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 51378 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 51378 . 00 0 . 60 0 . 00 0 . 60 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 . 60 0 . 00 232 . 60 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPS OF PERMIT APPLICATION FORM APN # cq4 O & a Date: 3/6 I � l� Building Address: I 3 2 ��r-1 e-� ?Ic� C e Owner's Name: Phone #: 1 � 1 40 S- !Fe--7 1 - (0741 Contractor: A Phone#:4o? -a.q,3—C1 7/ RQn6o tA Q__ I " Fax#: c-?q -w 7 7 i Contractor License#: "-7(0 8-g--1 1 Cupertino Business License#: FOS' Contact: ChaQ.� j ~teen Phone #: Z4 & -,;Lg 3 44 7 I Fax #: 40S -J93 --G i Building Permit Info: Elect 15--"' Plumb Mech Dr Residential Commercial Job Description: eO-N Ov-e- )c,54 n�) R rAi 0 C t 1 N_S+0 l I N e LO F G'Ove.?e For Residential Installations: Attic ❑ I` floor 1vr 2nd 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 Ap roval Required ❑ Cost of Project: 5 3-79--00 Type of Construction (Usage Class): Strapped F1 On Platform Bonded New Location Replacement Project Size: Ex ressr✓ Standard ❑ Lar e ❑ Major ❑ Valuation: 5 3'7S .© co 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 CITOF CUPEYTINO 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. 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace S yst <=I 00k 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 furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h IEPERMITFEE Electric Permit Fee E f 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P / 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B CITY OF CUPERTINO j FURNACE/AC CUPS OF FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= 1 Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units <= 1 Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit p 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B BeSDUTCOS EnergyAO . n oor rr ua riy an rn s es 1•lite t"M64OC M 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 A4hoves 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 y=yes 0 NPF 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 0 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 ! ! ! Total Points Avai a e: 140 1301 57 Total Points Project Received: 0 1 0 0 G:data/props/greenbuilcfingguidelines/remodelers/greenpointsfina12.12.04protected.xls y Community Development }: 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CtTlf OF Fax(408)777-3333 .,UPEkTINO Building Depart ent JOB ADDRESS: PERMIT # � � P1 ez c.e ! Opl o1�3 / I 0 Z3 2 ?ct Y-1 e OWNER'S NAME:'--g, t 1 i >ci r--4x-e LA.- PHONE # 4bS- - 9 - (b 747 GENERAL CONTRACTOR: 7-\ �C) FAX # lyS 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 She ck Owner/ n actor Signature Date