09120024 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19141 MEIGGS LN CONTRACTOR:BOGNER'S ALL AIR INC PERMIT NO:09120024
OWNER'S NAME: DAVID H.PAYNE 5310C SCOTTS VALLEY DR DATE ISSUED: 12/03/2009
( :R'S PHONE: 408 569818 SCOTTS VALLEY,CA 95066 PHONE NO:(831)438-5254
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB F_
License Class Lic.#
OU ,73__ MECH r RESIDENTIAL r COMMERCIAL�
22 e�-O
Contractor Date 7
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE(2)WALL HEATERS
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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. Sq.Ft Floor Area: Valuation:$200
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
permit is issued. APN Number:37537001.00 Occupancy Type:
APPLICANT CERTIFICATION
1 certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued
9.18. 9
Signature)V
Date �3Y
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
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).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25 5,25533,and 25534'i. ,
1 certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: 10�1 . /7� �M ✓ O
Compensation laws of California. If,after making this certificate of exemption,I Date: r
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
�. and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
L
0�1z�0zq
CITY OF
CITY OF CUPERTINO
[a FURNACE/AC
CUP RT NO PERMIT APPLICATION FORM
APN# 2)-] o Date:
� �o I . � i(-l5-09
Building Address:
Owner's Name: Phone #:
0 RwNL_ 4-Ob —S6q 00
Contractor: _ Phone #: t,-3 j_4 SV-G2 S1+
'FIDOGz N Z J / L'L A 12 C l`��- Fax #: � i ' 4:32 ( v2
Contractor License#: Cu ertino Business License #:
IZC�'v XR> 01-7.
Contact: Phone#:
�P Fax #: 9)3(-430—[302
Building Permit Info:
Elect Plumb [�' Mech
Residential �4 Commercial ❑
Job Description:
For Residential Installations:
Attic El1St floor �C 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 Projecv,Z-00 1z Type of Construction (Usage Class):
V
Strapped ❑ On Platform ❑ Bonded= New Location ❑ Replacement
Project Size: Express-ES—Slandard ❑ Large [] Major❑
Valuation:
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.
1✓P 4f� --7 7 - (� Revised 01/07/09
CITY OF CUPERTINO
FURNACE/AC
,UPER,TINO FEE SCHEDULE
Quantity Fee ID Fee Descriptio a Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Rel,air/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,E.bsorption or
evaporative cool.ng system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for-:he repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit VAV boxes,
absorption unit cr ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heatei-,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for ,:a gas piping System P
1-4 outlets
1 BPGAS For each gas pip:ng system of 5 or P
more per outlet.
1MCAPPVNT Commercial for-.he install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICO Commercial Sei,,mic B
1 MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,«bsorption or
evaporative cool ing system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
CITY OF' CUPERTINO
FURNACEAC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1MRAPPVNT Residential fc,r the install/relocate/or M
replacement of ea appliance vent
install & not i ncl in an appl permit.
FURNACE FURN/AC
1PGASRES Residential fc.r ea gas piping system of P
1-4 Outlets
1 BPGAS For each ga, piping system of 5 or P
more per outl,-t.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
' 1 BSEISMICR Residential S,-ismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumt r, 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/bumcr, incl ducts/vents
attached to such appliance over
100,000 BhAi
IEPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Peimit P
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
M.Indoor Air Quality and Finishes
1.Use LowNo-VbC Paint 1 IAO/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 21AO JHealth pts y=yes 0
3.Use Low/tvlo VOC Adhesives 3 IAD/Health pts y--yes D
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 D
6.Use Exterior Grade Plytr000d for Interior Uses 1 IAC/Health pts y=yes 0
7.Sad a11 1i ;6DMoardorMDF _ _ 4IADJHealth. pts - es _ D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yesl I D
10.Install Whole House Vacuum System 3[AQ/Health pts y--yes I 1 0
I= LO 1 1 D
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use RapidfyRenewaWe 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=yesD
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yesF 0
Total Points Available: 1 1401 130 57
Total Points Project Received: 01 01 0
G:datarprogslg-eenbuildingguidelines/remodelers/greenpointsfina12.12.D4profeated.zls
Community Development
10300 Torre Avenue
Cupertino CA 95014
P
Telephone(408)777-3228
CITY OF Fax(408)777-3333
'UPEkTINO
Building Department
JOB ADDRESS: M S (G; PERMIT
OWNER'S NAME: 4 PHONE # �-
GENERAL CONTRA OR FAX #
I am not using any subcontractors: KZ`
i;;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 nn,
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date