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09120116 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22440 MCCLELLAN RD CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09120116 CONDITIONING ("' VER'S NAME: DICK MODLAN 1712 STONE AVE DATE ISSUED: 12/18/2009 0 ry NER'S PHONE: 4084101434 SAN JOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATIONF_ r� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# I f0! �f 7) nQY MECH RESIDENTIAL COMMERCIAL Contractor �'C ,�v Date I hereby that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE IN SAME (commencing with Section 7000)of Division 3 of the Business&Professions 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: 1 1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$2510 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35604022.01 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 ha s the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses uch clue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this pe it. A i' nally,the applicant understands and will comply with al on-pot t ourc ti, per the Cupertino Municipal Code,Section 9.18. j Issued by Date: 5- -atum Date ❑ 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 constrict 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 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. 1 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 se equipment or devices which emit hazardous air contaminants as d med by the Bay Area Air Quality Management District 1 will permit is issued. Imaintain co li ce with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,1 shall of Coo',Sections 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 a ed agent: �ybecome subject to the Worker's Compensation provisions of the Labor Code,I must Dateforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 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 constriction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lender's Address ,mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date A 1� 0 � � to CIT"Y OF CUPERTINO FURNACE/AC a-'-CUPEkTINO PERMIT APPLICATION FORM APN # Date: 0 0 1S o � Building Address: act- 44C> lMCClellari (W Owner's Name: Phone #: iMocllar) y0k - y16) - it/3 Contractor: qnd o VA Y o e. i.-J c- A A A F-W rli4e e Phone k 4,0 9_a 93_1I-7,-7 Fax #: 1- ---3,9 3 --& -7 7 / Contractor License#: `-� �� I C3 �� Z C, Cupertino Business License#: � ��`� Contact: �� Z� Phone#: f>S-- 029 3 - V"-;;,i7 Fax #: e-1-0 9 13 -h 7—7 Building Permit Info: Elect PlumCE--�— Mech Residen ial Commercial Job Description: ' rriov-C IQQiOlcc(y lc, �-,nsriirlor Ce civ S4rvc� /o�4�ilJ>v For Residential Installations: Attic ❑ 1` floor D— 2nd 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: 91a 5/� • o o Type of Construction (Usage Class): Strapped On Platform E onded New Location Replacement Project Size: Ex ress ❑ Standard ❑ Large ❑ Major ❑ Valuation: f'(9-5�p 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 CUPEkTINO FEE c►CHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-lepair/Alteration/Add to M ea heating apfliance,refrigeration unit, cooling unit,zbsorption unit,or ea heating,coolb 1g,absorption or evaporative coling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial i br the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounter unit heater. 1 PGASCOM Commerical fir ea gas piping System P 1-4 outlets 1 BPGAS For each gas japing system of 5 or P more per outl(.t. 1 MCAPPVNT Commercial f)r the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance -permit. 1BCBSC Cal Bldg Stan lards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,ahsorption unit,or ea heating,coolin;,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential In;tall/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO VURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Dei cription 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 Outl,:ts 1 BPGAS For each gas piping system of 5 or P more ei outlet. 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B 1MECPLNCK Mechani:al Plan Check M 1 MFR=<100 Furnace ;3yst <=100k BTU install or M relocate ea forced-air/gravity type furnace/l umer, incl ducts/vents attached :o such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace ;cyst > 100k BTU install or M relocate ca forced-air/gravity type fumace/bumer, incl ducts/vents attached 1 o such appliance over 100,00013tu/h 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M ` 1 PPERMITFEE Plumbing Permit p r 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B