09080012 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11223 LA JOLLA CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09080012
CONDITIONING
OWNER'S NAME: CANTON SALVADOR AND CARNATION 1712 STONE AVE DATE ISSUED:08/04/2009
..FR'S PHONE: 4082526643 `.AN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION IIUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class4L,
?-0 Lie.# � & i_tC 7 I /! MECH f— RESIDENTIAL T_ COMMERCIAL
Contractor� �✓A'C %nL Date ``T—0 F.
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE FURNACE,INSTALL NEW 95%
(commencing with Section 7000)of Division 3 of the Business&Professions FFICIENT FURNACE
Code and that my license is in full force and effect. 13 SEER,COIL&CONDENSER,220 POWER HOOK UP
I hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 have and will maintain Worker's Compensation Insurance,as provided for by iq,Ft Floor Area: Valuation:$10343
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
CPN Number:35621044.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnity and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may ace a against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additio ly,the applicant understands and will comply
with all - oint so e r tions per the Cupertino Municipal Code,Section
9.18. Issued by: ' �— Date:
Si—iture Date O _ / ^G� �� Q C-
0
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
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 and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a) ould 1 store or handle hazardous material.
Additionally,should 1 use uipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defin by,the Bay Area Air Quality Management District 1 will
permit is issued. maintain complianc wit¢the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,1 shall alth Saf ��ections 25505,25533,and 25534.
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 Ow er r ized agent: 7 -
become subject to the Worker's Compensation provisions of the Labor Code,I must ate:
forthwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
u 'ie above mentioned property for inspection purposes.(We)agree to save Lender's Address
ii, iify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO D OS 0 0
FURNACE/AC
CUPEkTiNO PERMIT APPLICATION FORM
Date:
Building Address:
z 3 " Ia
Owner's Name: Phone#:
Uel r n G+,o.j CG n 4cui X/69-- Z S 2- - (o 4 µ3
Contractor: H v,4C jr'C_ - Phone#: revV--,;2-9 3 �i 7
i-o e-
�q c
Sc, o5r Cry 9 3-!2 S- Fax #: vg- -_(o -7
Contractor License#: 7 6 Cupertino Business License#:
Contact: -lcie`l T CLL-) ze►2_ Phone #: qo�- - X93- L-r 7 i 7
Fax #: It&b -943-- 6,7`
Building Permit Info:
Elect Y Plumb Mech E4--
Residential Commercial
Job Description: IZ evno.re- Fu r ca c e , i N S I-a i t N f-.v (i 5 F t; J,4 ,rr1 t i=U r Na c e
13 r0,F12_ Co,•L -4 eco n e,45e/Z, 2 Zv 'Po we2 H001c OP.
For Residential Installations:
Attic ❑ 1 s` floor [4-- 2°d floor ❑
Adhere to minimum setback requirement [�
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installatior. ❑
New installation Planning Approval Required ❑
Cost of Project. /D, 3q 3,(-)u Type of Construction(Usage Class):
Strapped On Platform Bonded New Location Replacement
Project Size: Express �tandard ❑ Large Major ❑ _
Valuation: 1* 101 -2
2-,.o
Green Building: Please complete relevant portio:i 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
FURNACE/AC
—UPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Rep;iir/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,al)sorption or
evaporative cooli zg system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for t le 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 Instill/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted ur it 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 e i appliance vent
installed & not incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMIC0 Commercial Sei:;mic B
1 MRRAA Residential RepE.ir/Alteration/Add to M
ea heating appliE nce,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 InstE.11/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted u:iit heater.
CITY OF C UPERTINO
FURNACE/AC
CUPEi�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= I Ok CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ca 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 pi;)ing system of 5 or P
more per outlet. Comm/Resid
1 BREMAIRHAN Residential A/C-mits<= I Ok CFM B
1 MRRAA Residential Mech Repair/alt/add M
f 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residers-.ial B
1 EPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Penni--. P
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
INPUT Resources EnLrgy IAD/Heafth
M.Indoor Air Quality and Finishes
1.UseJaw/No-VOG Pain# 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/tio 1100 Adhesives 3 IAQ/Health 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 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all EVoud.PaWaboW or MDF 41AQ/Health. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes J7771
. 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 1 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles l 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 1 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes 0
. 1 1 Ow
Total Points Available: 1 1401 130 57
Total Points Project Received: 6 01 01 0
G:data/progs/gre:nbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: %02,9 V91Z C resf- C�t - PERMIT #0��e 2
OWNER'S NAME: a (j'a n n-c e'4 )-f �o, PHONE # V05--94?,3 el 2/7
GENERAL CONTRACTOR: kU Hv�� ,� _ FAX # o& -a g 3 --6 77/
r
I am not using any subcontractors:
Signa Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI:vESS 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
-T
Tile
Owner/Contractor Signature Date