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09090179 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7930 FALL CT CONTRACTOR:SANDIUM PERMIT NO:09090179 OWNER'S NAME: CORINNA&TERRY FU 4223 VERDIGRIS CIR DATE ISSUED:09/24/2009 ER'S PHONE: 4087180730 SAN JOSE,CA 95134 1 PHONE NO:(408)894-9072 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB License Class CZo Li..# 9V«oi ,,( MECH I— RESIDENTIAL r— COMMERCIAL Contractor sa.4 Date n ? 09 . JOB DESCRIPTION:FURNACE REPLACEMENT 1 hereby affirm that I am licensed under the provisions of Chapter 9 (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:$2500 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as provided for by APN Number:36213007.00 Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this 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 to 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 ------ Date: granting of this permit. Additionally,the applicant understands and will comply Issued by' with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date q[Z_+-u-f— RE-ROOFS: _ b 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. I hereby affirm that I am exempt from the Contractor's License Law for one of Date: the following two reasons: Signature of Applicant: 1,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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) 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. 1 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 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I have and will maintain Worker's Compensation Insurance,as provided for by 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. I certify that in the performance of the work for which this permit is issued,I shall Owner authorized (1 � 'l not employ any person in any manner so as to become subject to the Worker's ie,A Date: 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 1 certify that I have read this application and state that the above information is Lender's Address correct.1 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION it viify and keep harmless the City of Cupertino against liabilities,judgments, I understand m plans shall be used as public records. c and expenses which may accrue against said City in consequence of the Y granting of this permit.Additionally,the applicant understands and will comply Licensed Professional with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 6 ITEMS OF 6 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36213007 .00 DATE ISSUED. . . . . . . : 09/24/2009 RECEIPT #. . . . . . . . . BS000008753 REFERENCE ID # 09090179 SITE ADDRESS 7930 FALL CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CORINNA & TERRY FU ADDRESS . 7930 FALL CT CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM MICHA LE GLEEE LIC # 28867 CONTRACTOR . . . . . . COMPANY SANDIUM ADDRESS 4223 VERDIGRIS CIR CITY/STATE/ZIP SAN JOSE, CA 95134 TELEPHONE (408) 894-9072 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL- ---------- ---------- ---------- ---- ---------- ------------- 0 .00 1BCBSC VALUATION 2, 500 . 00 1 . 00 0 . 00 1 . 00 1BSEISMICR VALUATION 2, 500. 00 0 .50 0 .00 0 . 50 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 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 ---- 42 . 00 ------0_00 TOTAL PERMIT 169 .50 0. 00 169.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- - CREDIT CARD 169 .50 VISA --------------- TOTAL RECEIPT 169 .50 VOICE ID DESCRIPTION VOICE- -------- ID DESCRIPTION -- ----------------- ----- -- ----------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL s DRoI O-1 9 CITY OF CUPERTINO FURNACE/AC CUPEI�TIN CITY OF O PERMIT APPLICATION FORM Date: APN # �( �I cD 0 Building Address: �(�� 8 �� '�" , Phone#: *p$ W 0 73 c7 Owner's Name: (� Phone#: LEp,? $74,. '�9? z. Contractor: Fax#: Cupertino Business License#: Contractor License#: Phone#: Contact: Fax#: Building Permit Info: Plumb [`�� Mech Elect©'' Commercial ❑ Residential Job Description: For Residential Installations: Ist floor 2nd floor ❑ Attic ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Additional weight(structural calcs) ❑ Replacement same weight ❑ ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ ction(Usage Class): Cost of Project: Type of Constru CS S ❑ ❑ Bonded New Location Replacement trapped On Platform Major Major ElProject Size: Express E tandard E] Large El� Valuation: q 2 SO a Please complete relevant portion of the Green Buildi sheet ind Checklist & attach it to the Green Building: applicable, include in plan set & the application or if Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CUPEkTINO 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. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 113PGAS 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 incl in an appliance permit. 113CBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic 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. 1MRSUSHTR 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 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets IBPGAS 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 1MECPLNCK 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 1 MFRN>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 i 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B Community Development 10300 Torre Avenue s Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTIN0 BuildinDe artment JOB A7D�DRE SS: C PERMIT # OWNER'S NAME: _1:. . PHONE # 43 7( 30 GENERAL CONTRACTOR: �,,,�, FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 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