10010176 ING pEItMIT PERMIT NO;10010176
TIN O BUILD N ACE&AIR
Y OF CU"? RACTOR.AAA FUR SSUED:0112912010
CIT CONT DATE I
CONDITIONING' 293-4'11'1
RAMONA CT 12 STONE AVE PHONE NO:(408)
ESS� 22394 17
BUILDING ADDR 95125 PLUM$
SAN JOSE'CA ' ECT
• PIYU LIN O: BLDG EL CIAL f
NER'S N AME• IT INF MER
G PERM COM
4082535228 LARATION BUILDIN RESIDENTIAL
' U.�NEIt'S pIIONE' OR'S DEC MECH NEW 100,000 BTU
SED CONTRACT 'XIS
FURNACE INSTALL
❑
LIC � - j REMOVE E
C ZO Lic.# _ Z i JOB DESCR AME�oNcATION
1
License Class' : Date FURNACE IN S
Chapter 9
under the
provisions of professions
Contractor licensed and of the Business&
affirm that I am 7000)of Division effect.
I hereby with Section full force and
(commencing license is in declarations:
Code and that my one of the following tWorker's X4742
er ury Valuation:
malty of p for the
affirm under p ate of consent to self-insure Code,
I hereby aff certificate 0 of the La res:
d will maintain a Section 370 Sy.Ft Floor A Occupancy Type:
I have an as provided for i emit is issued as provided for by
Compensation, ice this p this
work for wh , Compensation Insurance°work for which 35101083.00
performance°f the in W orker s ante of the AVN NU
mber:
d will mairita: Code,for the perform OT ST ARTEU
I have an of the WORK IS N
Section 3700 ed TION SIF SS u AN CE Og
Perm is issued. CERTIFICA information is IT EXPIRE •r I
APPLICANT at the above d state laws relating PE YS OF pE INSpECTip�
d state t1i ces an to enter N 180 DA CALLED
licationanaa county ordinances I
cel that I have read,this
all city , riz-representatives We)agree to save WITH OM LAST ..,
I c agree to comply hereby a, o u uses. ( ments, YS FR
correct.I ag inspection p 180 DA Date f�—
construction,and f�i insp ainst liabilities,judg
to building erty Cupertino ag uence of the --
entior►ed prop of Cup iW COT
upon the above m less the�ity against said City d will complyham', jccru Section -�
indemnify and keep which may; e h applicant understan s al Code, Ov.
X enses � �•Wally,the app rtino Municip Issued oy• Y
costs,and e p ermit pddi u Per the Cupe
ranting of this permit.
r,1lations p v
g o�-_poi ROOFS: if a rood
with all it RE- installed,materia
Date _ material being
9.18. ,~~ roofing move all new
rior to any agree to re
inspected p inspection,
e ',, 1 roofs shall be insp btaining an
�atur AI without first o
R DECLAR�'TION for one of installed Date:
•- O�ER_BUILDE s License Law inspection.
❑ t from the Contractor enation, Applicant*exempt nature of App „OR BETTER
affirm that I an► wages! their sole comp Sig BE CLASS A
I hereby reasons: to ees with wag Sec.7044,
or my ei'np y °r offered for sale( L ROOF COVERGS TO
the following�'O erty, AL
1,as owner of the prop the structure is not intended ISCLOSURE
work,and with licensed contractors to
Will do the Code) ATERIALS D ter 6.95
professions am exclusively contracting HAZARDOUS M Chap
Business& rO erty, Professions Code). uirements under 25534• I
1,as owne1.
r of the p $ec.7044,Business& three materials req 25533,au 12 and the
ct the project( the hazardous Code,Sections 25505,ChapteC 9' matE
construct f per one of the following I have read
&Safety Cupertino Municipal Code,
r malty o p e for Worker's California the Cuper Id I store or handla t hazardW
affirm under p for the compliance with a show
I hereby onsent to self-insure
comp Section 255320 ment or devices WhichManagement D�
declarations: Certificate of C e Labor Safety Code' I use equipment Area Air Quality Chapter 9•
Will maintain a Section 3100 of d' should by the Bay al Code,
I have and provided for by it is issued. Ce,as provided for by Additionally, deft, ertino Municip 25534•
Compensation,asp contaminants as a with the Cup 25533,and
Of the work for which Co pensation lnsuof a work for which this
erforniance � workers ance of the maintain comp� ode,Sections 25505,
p d will maintain for the perform
Code, I shall Health&S ,
I have an °f the Labor it is issued, ent:
this perm t orized ag Date:
Section 3700 which worker's Ow er ►
work for e subject to the
Perm it is issued. performance of the to become
tion,I G AGENCY
that in the p ner so as his Certificate of exempt' I must r1DIN erfc
I certify an person in any man If,after making CO STRUCTION LE for the p
employ. y lifornia• Provisions of the Labor yoked. ion lending agency
not of Ca enation p ed re
Compensation laws Comp it shall be deem Construct Civ C.)
orker s affirm that there is a Sec.3097,
become subject to d1e W provisions or this pem' 1 hereby
1 with such p ermit is issued
ATION for which this p
forthwith comply CERTIFIC ation is Lender's Name
APPLICANT
n and state that the Ce°vans state laws relating ddress
application and county ordinan to en Lender s A ITECT'S DECLARATION
certify that 1 have rea�ompl this shall Cit}, rile representat". hag ee to save ARCH
I c ree to comp y hereby authorize Purposes (We) judgments,correct.1 ag o erty for inspection P public records.
building construction,an
d
p Cupertino against liabilituenCedof the
to Ve mentione p of Cup plans shall be used as
the abo less the City Ci in consequence d my
and keep ham' against said �' d will comply I understari
unify y accrue ag t si understands a Code,Section
expenses NV the app ertino Municip professional
and �[itionaUy, Licensed
costs, of this pe iS it.A
ranting • sourc`regulations per the Cup `'' �
g n- 1 Z 7
with all ,
Date
9.18.
Sig
nature
CITY OF CUPERTINO
RECEIPT OPERATOR: patg
PERMIT R COPY # 1
7 ITEMS OF 7
Rng:
Sec: Twp: Sub: Blk: Lot:; 35701083 . 00
APN • " " " •
DATE ISSUED: : : : : : : 01/29/2010 BS000009649
RECEIPT # ;
REFERENCE ID # • • • 10010176
SITE ADDRESS . . . . . : 22394 RAMONA CT
SUBDIVISION
• • • • . • • ; CUPERTINO
CITY
IMPACT AREA . . . . . . -
OWNER PIYULIIN CT
22394RAMONA CCA95014_2733
ADDRESS . . . . . . . . ' ; CUPERTINO CA,
CITY/STATE/ZIP • • •
Rp,NDO AAA HVAC INC
RECEIVED FROM LIC # 8050
Rp,NDO, JIM
CONTRACTOR • • • " P FURNACE & AIR CONDITIONING
COMPANY • " " 1712 STONE AVE
ADDRESS • " " ' SAN JOSE, CA 95125
CITY/STATE/ZIP • • • _ : 408) 293-4717
TELEPHONE
THIS REC NEW BAL
QUANTITY AMOUNT PD-TO-DT --_--_---- ----____--
FE ID UNIT 4--------- ---------- 1.00 0 .00
----------- 1.00 0 .00 0 . 50 0 .00
---- ---- 4, 742 .00 0 .50 0 .00 0 .00
1BCB C VALUATION 4 742 .00 0 .00 42 ,00
1BSE SMICR VALUATION 1RATE 0 . 00.00 42 , 00 42 . 00 0 . 00
42 .00 0 .00 0 .00
lEPE MITFE FLAT 63 ' 00 0 .00
1MPEPIMITFE FLAT RATE 1 .00 63 .00 0 .00 42 .00
1MR UNITS 1 . 00 42 . 00 42 .00 0_00
42 . 00 0 .00
1PPE MITFE FLAT RATE 1 .00 _--------- ---------- ------- 0 .00
1T VDOC FLAT 0 .00 232 . 50
232 . 50
TOTAL PERMIT :
AMOUNT _NUMBER
MET OD OF PAYMENT --------------- -------
----------- 232 . 50 #35515
CHECK ---------------
232 .50
TOTAL RECEIPT VOICE ID DESCRIPTION-_--_____
DESCRIPTION
VOICE ID - ____=__- --------
507 FINAL PLUMBING
05 FINAL ELECTRICAL
08 FINAL MECHANICAL
c-)
CITY OF CUPERTINO
r,
FURNACEAC
.,:.c1: of FORM
PERMIT APPLICATION
Date:
APN # � L-5
��
Building Address:
`- 4 ono:. ne
u -
Owner's Name: jg . I!D 3 - 2-
Phone#: 40� l,�9 3--�/� / 7
Contractor: --Roy-)d 0 14�' rA G� 1���" �'��'��C-e
Fax#:408 --Rci
Cupertino Business License#:
Contractor License#: 7 40 a-�-7 /
Contact: 3 ate V -r4 w Z
�� Phone
Fax#: q&S - Z 3 1 i
Building Permit Info:
Elect[ � Plumb Mech [�
Residential
Commercial ❑
Job Descri tion:'j��r'�'1®��'- �''�S
p
Tu Fi'd Q ce I ti -59/n e
For Residential Installations: 1" floor 2nd floor 1:1Attic [--]
Adhere to min
imum setback requirement
For Commercial Installations:
Additional weight (structural calcs) ❑
Replacement same weight El
Structural Calculations required for new installation El
New installation Planning Approval Required ❑
Cost of Project: L/ -7 �� Type of Construction (Usage Class):
�/� .
nded ❑
LocaiReplacementew
Strapped On Platform
Project Size. Express and Large ❑ Major
----E-T--Bo
Valuation: 31
• relevant port
of the Green Building Checklist & attach it to the
Green Building: Please complete releva p plan set & the sheet index.
application or if applicable, include p
Revised 01/07/09
CITY OF CUPERTINO
FURN
ACE/AC
v cin OF
CUPE�TINGFEE SCHEDULE
Fee Description Fee Permit Type
[—Q—uantity Fee ID Gr
1 MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
FURN/AC
FURNACE
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
Cal Bldg Standards Commission Fee B ALL PERMIT
1 BCBSC g TYPES
1BSEISM
ICR Residential Seismic B
1 MEC LNCK Mechanical Plan Check M
1
MFR=<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
1M
FRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
lE
PERMITFEE Electric Permit Fee E
1M
PERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit
P
Travel Documentation B
1
1 BUSLIC Business License
TRAVDOC
B
0
o� aTnishesn ►M.IndoorA►r Quatity1 IAQIHealth pts Y-yeS 0
1•,Use, -VW Pa"
fishes 2 IAQ1Health pts y=yes.
2.
Use Low VOC,Water-Based Wood Fm 3 IAQ/Health pts Y=Y" 0
3 USe l W VOC A&4***e'*' 3 Resource pts Y=yes
0
4.Use Salvaged Materials for Interior Finishes a 0
5.Use Engineered ineered Sheet Goods with no added Ure 6 IAQ/Health pts Y_Yes 0
FormaldehydeUses 1 IAQIHealth pts Y=yes
plywood for Interio4 IAQ/Health pts Y=yes 0
6.Use Exterior Grade Plyw r source pts Y-Yes
p .w* - 4 Re - 0
7. 49 0
Use FSC Certified Materials for Interior Finish 1 Resource pts y-Yes
B.U cled-Content T �
9.Use Finger-Jointed or Recy 3 IACYHealth pts Y-YeS i
10.Install Whole House Vacuum System
0
N.Flooring B Resource pts Y=Yes 0
0
I.Select FSC Certified WoodFlooring 4 Resource pts Y=Yess Y=Yes
0
2
Use Ra Y flOn We Flooring f 4 Resource pts Y Y
3.Use Recycled Content Ceramic TilesI 5 IAQ/Health pts Y=YeS 0
i pts 0
Y=Yes
4.Install Natural Linoleum in Place of VFloor 4 Resource _ es
5.Use Exposed Concrete as Finished low VOCs 4 Resource pts Y Y i
6.Install Recycled Content Carpet with
140 130 57
Total Points Available: 0 0 0
Total
Points Pro'ect Received:
ointsfina12.12.Q4Protected.xls
G:datalprogslgreenbuildingguidelineslremodel..P rslgreenp
Development.
Comm�tY
10300 Torre venue 95014
Cupertino C
408 777-3228
Telephone( 08 777-3333
Fax(4 )
C11Y ofnt
INODe artme
�U . 1BUAdi.n
iT #
PERM �`7
SS �9� #
OB ADORES PF
J � a
FAX
Gy�NE1Z'S NAME= a J�}�-
L CpNTRACTOR
GENE' -+- Date
sin any subcontractors: Signature �o�.ation:
I am not u g ete the f ollow�n S LICENSE #
actors and com 1BUSINES
livable subcontr NESS NAME
Please check a �� BUS1
SUB
CONTRACT
Cabinets &Wwork
CeMent Flnlsbing
Electrical
Excavation
Fencing
Flooring--
C larpeting
Linoleum/ Wood
Glass / Glazing
Beating
Insulation
Landscaping
Lang
Ma�so�' Metal
Ornanental Sheet
Painting Wiii�paper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet M
Z�
Til Date
pwner/C ctor Sia
o gnture