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09090007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10725 ALDERBROOK LN CONTRACTOR:RMI MECHANICAL PERMIT NO:09090007 CONTRACTORS 'ER'S NAME: CHOU YEONG-FENG AND FLORENCE H 1385 LOWRIE AVE DATE ISSUED:09/01/2009 OWNER'S PHONE: 4085357093 S SAN FRANCISCO,CA 94080 PHONE NO:(650)583-6200 I //LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB F License Class l�Z Li,.# G 9 ( �✓ G MECH RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirrrf that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE (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 Sq.Ft Floor Area: Valuation:$6940 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 APN Number:36921003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �y v granting of this permit. Additionally,the applicant understands and will comply Issued Date: with all non-point source regulations per the Cupertino Municipal Code,Section " 9.18. ture �1�' Date � � v RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is ❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by 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 Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. 1 certify that in the performance of the work for which this permit is issued,I shall Owuprr a horized agent: Q ' � not employ any person in any manner so as to become subject to the Worker's J r y/L� Date: _( 1 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .suity and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 0�1'C) d � � CITY OF C UPERTINO FURNACE/AC CU PE INO PERMIT APPLICATION FORM APN # �� v3 • v Date: �// Buil ng Addres ; /o7�— �4An49k 4,-7 ` � �: Owner'4Name: F16�"4e G Ott Phone Contractor: rZl�l?�' Phone#: d��vs w bra _ Fax #: �S"b S83'$111 Contractor License /„300 Cupertino Business License #: -�V 65-0 Contact: fJ120rr11AJC/ Phone#: A5-0 6�53 161vv Fax Building Permit Info: Elect �� Plumb Mech Nr Zesidential Commercial ❑ Job Description: k-r'e' For Residential Installations: Attic ❑ 1"floor C9 2°d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight 5a Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: �( � Type of Construction (Usage Class): J Strapped ❑ On Platform X Bonded ❑ New Location ❑ Replacement [� Project Size: xpress ❑ Standard R Large ❑ Major ❑ Valuation: v 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 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36921003 . 00 DATE ISSUED. . . . . . . : 09/01/2009 RECEIPT #. . . . . . . . . : BS000008581 REFERENCE ID # . . . : 09090007 SITE ADDRESS . . . . . : 10725 ALDERBROOK LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHOU YEONG-FENG AND FLORENCE H ADDRESS . . . . . . . . . . : 10725 ALDERBROOK LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4603 RECEIVED FROM . . . . : RONALD J MAFRICI CONTRACTOR . . . . . . . : RONALD MATRICI LIC # 30650 COMPANY . . . . . . . . . . : RMI MECHANICAL CONTRACTORS ADDRESS . . . . . . . . . . : 1385 LOWRIE AVE CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080 TELEPHONE . . . . . . . . : (650) 583-6200 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 940 . 00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 6, 940. 00 0 .70 0. 00 0.70 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 .70 0 . 00 232 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 232 . 70 VISA --------------- TOTAL RECEIPT 232 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO ` FURNACEAC ,XPERjTRNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for 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 mounted unit heater. 1PGASCOM Commerical for ea gas piping System I P 1-4 outlets 1 BPGAS For each gas piping system of 5 or I P more per outlet. 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee I B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic I B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC IPGASRES Residential for ea gas piping system of P 1-4 Outlets I 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 1 MECPLNCK Mechanical Plan Check M 1MFR=<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 IMFRN>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 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development SM 10300 Tone Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .UPEI�TINO Building Department JOB ADDRESS: (0775- A (p` er bro o K•• k,,, I PERMIT # 0067 OWNER'S NAME: PHONE # ` a 8 3 zd o GENERAL CONTRACTOR IFAX # I am not using any subcontractors: �- _` Sinature Date Please check applicable subcontractors and complete the following information: ( 0 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation iLandscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / $ 9 Owner/Contractor Signature Date