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09110090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20125 CEDAR TREE LN CONTRACTOR:A&H HEATING PERMIT NO:09110090 OWNER'S NAME: ANDREW WAN 770 CHESTNUT ST DATE ISSUED: 11/16/2009 5 ER'S PHONE: 4085294235 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 3 ` MECH RESIDENTIAL COMMERCIAL Contractor CT Date G I hereby affirm hat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE&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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7000 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:31634006.00 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 ,�-- with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: �� Dat/ 9.18. Signature "eoo RE-ROOFS: CJ 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: 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) 1,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. 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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the P Health&Safety Code,Sections 25505,25533,and 25534. 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 04wzorauthorized P Compensation laws of California. If,after making this certificate of exemption,Iow,:!_ G become subject to the Worker's Compensation provisions of the Labor Code,1 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 i nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION c, 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31634006 . 00 DATE ISSUED. . . . . . . : 11/16/2009 RECEIPT #. . . . . . . . . BS000009208 REFERENCE ID # . . . : 09110090 SITE ADDRESS . . . . . : 20125 CEDAR TREE LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ANDREW WAN ADDRESS 20125 CEDAR TREE LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2004 RECEIVED FROM . . . . : DALE PHELPS CONTRACTOR PHELPS, DALE LIC # 12079 COMPANY A & H HEATING ADDRESS 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE (408) 279-0722 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000. 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 190 .70 0 .00 190 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 190 .70 VISA --------------- TOTAL RECEIPT 190 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN #L3t 3 If I-.- . Date: Building Address: a012- S— O 0—E0 Z • Owner's Name Phone Contractor: Phone#: Zf© g' Z 79-Z7 Z 1 zFax#: O g Z Contractor License#: J �� Cupertino Business License#: Contact: � r�--�� C Phone#:�� G Fax #: Og 2-79--= Building Permit Info: ElecttT--� Plumb Mech Residential Er Commercial ❑ Job Description: For Residential Installations: Attic F11" floor 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 Project: Type of Construction(Usage Class): t,, /B' - Strapped ❑ On Platform ❑ Bonded' New Location ❑ Replacement Project Size: Express Standard ❑ Large ❑ Major❑ Valuation: 7 Bo�-O 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 SIm� FURNACEAC CITY OF CUPERTINO 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 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 1 MECPLNCK Mechanical Plan Check M W f Ak 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 1MFRN>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 r 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B M.Indoor Air Quality and Finishes 1.UseLow/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Neater-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/.No VOC Adhesives 3 IADJHealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 5IAQ/Health pts y=yes 0 6.Use Exterior Grade PI}nvood for Interior Uses 1 IAC/Health pts y=yes 0 7.SaW aMiiilmsed Piaigotelaaard or MDF _ 0 4 IAD/Health. pts =res 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes p 1 D.Install Whole House Vacuum System 3 lAQ/Health pts y=yes p 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Benewatie 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=yes 0 S.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 id Total Points Available: 140 130 57 Total Points Project Received: 01 0 0 G:data/progslgreenbui)cHnoguidelines/ramodelers/greenpointsfina1212D4proteoied.xls Community Development sa, 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .,UPEkTINO Building Department JOB ADDRESS: _ PERMIT # zco OWNER'S NAME: 41,OQ2 - PHONE # p� Z GENERAL CONTRACTOR: �9 FAX # Z — D I am not using any subcontractors: _ l6 �� 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