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09120109 (3) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10510 OAKVILLE AVE CONTRACTOR:CRAFTSMENS GUILD INC PERMIT NO:09120109 OWNER'S NAME: MARCOTTE RICHARD A 10566 S DE ANZA BLVD DATE ISSUED: 12/17/2009 'ER'S PHONE: 4084972617 CUPERTINO,CA 95014 PHONE NO:(408)366-1000 ❑ LICENSED CONTRACTOR'S --DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB� License Class Lic.# 6 ! I J / MECH RESIDENTIAL COMMERCIAL Contractor /� A^s 14 i1 ate O I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE,AC&ELECTCL PANEL (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. Sq.Ft Floor Area: Valuation:$6000 1 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:36913001.00 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 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 J with all non-point source regulations per the Cupertino Municipal Code,Section Issued by Date:/ �� 9.18. Signature Date p RE-ROOFS: C� 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,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). I 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. 1 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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Worker's Owner a thoriz agent: 6 Compensation laws of California. If,after making this certificate of exemption,I Dater( / 1 7 l 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, L 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 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 CITY OF CUPERTINO \ y I V`� FURNACE/AC (� CUPEkTINO PERMIT APPLICATION FORM APN # C Date: Building Address: 1051 62a-k v(p e /4L^e Owner's Name: yY, �,� �¢,.. „? Phone#: 4 9 -7 Z 1 -1 Contractor: I Phone#: o 3 6 4coo ��f-�s r1�►.s �s-�l 04 ,1,� Fax#: qo g �3.6c- (/ f3 Contractor License#: 5-o-7151 Cupertino Business License#: Contact: 110 S ^ C-f a7 -9 g 51 Phone#: Fax#: Building Permit Info: Elect Plumb Mech -.- Residential Commercial El Job Description: For Residential Installations: Attic ❑ I"floor 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 Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 6700 Strapped On Platform El Bonc ed New Location ❑ Replacement Project Size: Express ❑ Standard ❑ Large ] Major❑ _ Valuation: Green Building: Please complete relevant portio n 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 C UPERTINO ` FURN�XEAC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rep air/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,abso�rption unit,or ea heating,cooling,amorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliaice,refrigeration unit,cooling unit,VAV boxes, absorption unit o:• ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Inst�dl/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ca gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &not ir cl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliazce,refrigeration unit, cooling unit,abserption unit,or ea heating,cooling,absorption or _ evaporative cooling system,incl installation of co itrols regulated by this code. 1MRSUSHTR Residential Insta:l/Relocate ea M suspended heater,recessed wall htr, or floor mounted ur it heater. CITY OF CUPERTINO FURrJACE/AC COF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential foi the install/relocate/or M replacement o:.7 ea appliance vent install &not incl in an a pl permit. FURNACE FURN/AC I 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. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B I MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst =100k BTU install or M relocate ea forced-air/gravity type fumace/burne-, incl ducts/vents attached to su,;h appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst 100k BTU install or M relocate ea foi ced-air/gravity type fumace/bume r, incl ducts/vents attached to su-,h appliance over 100,000 Btu/r. / 1EPERMITFEE Electric Perm.t Fee E 1 MPERMITFEE Mechanical P-.rmit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B at - CITY OF C'UPERTINO FURNALCE/AC CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Descriptio:l Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1 MCRAA Commercial Mec:h Repair/alt/add M 1BCBSC Cal Bldg Standa3ds Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ;a 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. ,'-omm/Resid 1 BREMAIRHAN Residential A/C units <= I Ok CFM B i 1MRRAA Residential Mech Repair/alt/add M 1BCBSC Cal Bldg Standa:-ds Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permi: P 1 TRAVDOC Travel Documer.tation B 1BUSLIC Business Licens,; B Community Development 10300 Torre Avenue • : ; Cupertino CA 95014 Telephone(408)777-3228 uCITV OF Fax(408)777-3333 .UPEkTINO Buildin De artment JOB ADDRESS: �G S p a•k,, , PERMIT # d ?7�Z�CD� OWNER'S NAME: H V\ PHONE # 6— 1 dab GENERAL CONTRACTOR: FAX# 3 CC-- a I am not using any subcontractors: -to K�> 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 Sheet Rock Tile Owner/Contractor Signature Date