09110027 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:XIONG LIU PERMIT NO:09110027
BUILDING ADDRESS' 10524 S TANTAU DATE ISSUED: 11/05/2009
10524 S TANTAU
OWNER'S NAME: XIONG LIU
CUPERTINO,CA 95014 PHONE NO:
ER'S PHONE: 3108697188
BUILDING PERMIT INFO: BLDG ELECT PLUMB
0 LICENSED CONTRACTOR'S DECLARATION
License Class Lic.# MECH RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION:INSTALL FURNACE,45KBTU
I 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 Valuation:$1500
Compensation,as provided for by Section 3700 of the Labor Code,for the Sq,Ft Floor Area:
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by APN Number:37537020.00 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 1 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 RE-ROOFS:
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
U OWNER-BUILDER DECLARATION inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons:
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code).
I
I hereby affirm under penalty of perjury one of the following three have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
2 and the Health&
declarations: compliance with the Cupertino Municipal Code,Chapter 9.1
I have and will maintain a Certificate of Consent to self-insure for Worker's Safety Code,Section 25532(a)should I store or handle hazardous material.
Compensation,as provided for by Section 3700 of the Labor Code,for the Additionally,should I use equipment or devices which emit hazardous air
performance of the work for which this permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
1 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 or authorized agent: Date:
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
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.)
Lender's Name
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is Lender's Address
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 ARCHITECT'S DECLARATION
upon the above mentioned property for inspection purposes.(We)agree to save
inify and keep harmless the City of Cupertino against liabilities,judgments, I understand my plans shall be used as public records.
and expenses which may accrue against said City in consequence of the
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
6 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37537020 .00
DATE ISSUED. . . . . . . : 11/05/2009
RECEIPT #. . . . . . . . . BS000009131
REFERENCE ID # 09110027
SITE ADDRESS 10524 S TANTAU
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER XIONG LIU
ADDRESS . 10524 S TANTAU
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM XIONG LIU
CONTRACTOR LIC # *OWNER*
COMPANY XIONG LIU
ADDRESS . 10524 S TANTAU
CITY/STATE/ZIP CUPERTINO, CA 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ----------
---------- --
1BCBSC VALUATION 1, 500 . 00 1 . 00 0.00 1 . 00 0 .00
1BSEISMICR VALUATION 1, 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
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 . 50 0 . 00 190 . 50 0 . 00
METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER
----------------- ---------------
CREDIT CARD 601.50 MC
TOTAL RECEIPT 601 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
__ _ ------ ----------------------------
--
--
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505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
:,. CITY OF CUPERTINO
FURNACE/AC
CUPS OF
PERMIT APPLICATION FORM
Date:
APN #2� ,�3�0 �C ) . 0 ` )
Building Address:
CvsZ� � � u C
Owner's Name: Phone#:
�CZ6k/C7 LZa ( 3 ( o )S-65-7(k�-
Phone#:
Contractor: �
Fax#:
Contractor License#: Cupertino Business License#:
Phone#:
Contact: _
}(ON Fax #:
Building Permit Info:
Elect❑ Plumb ❑ Mech ❑
Residential Commercial ❑
Job Description:
For Residential Installations: 2nd floor ❑
Attic El
Adhere
floor ❑
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 ❑
Cost of Project: Type of Construction(Usage Class):
Strapped E] On Platform ❑ Bonded New Location Replacement
Project Size: Express Standard ❑ Large ❑ Major❑
Valuation:
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
CM OF FEE SCHEDULE
CUPEI�TINO
Quantity Fee ID Fee Description Fee Permit Type
Grou
1 MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS 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 CheckM
- IKA &W - 4 :
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
1MPERMITFEE Mechanical Permit Fee M
P
1PPERMITFEE Plumbing Permit
:T-
ITRAVDOC Travel Documentation B
B
1BUSLIC Business License
. n oor Air ua try an ruts es
1 Use WVOC Pak 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes
3.Use LowRilo VOC AdhezWes 3 IAQ/Health pts y=yes
01
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 6
7 SaW4O p, d; (MF 4IAQ/Health. pts y=yes 01
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 01
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes
d 1 01
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 01
1 i 1
Total Points Available: 140 130 57
Total Points Project Received: F01 01 0
S
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