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13120001CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10184 VISTA DR CONTRACTOR: RAN LU & YISNQING XIA PERMIT NO: 13120001 OWNER'S NAME: RAN LU & Y*NQING XIA 10184 VISTA DR DATE ISSUED: 12/02/2013 OWNER'S PHONE: 6502881671 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL r COMMERCIAL Contractor Date r I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions JOB DESCRIPTION: Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for -die performance of the work for which this permit is issued. APPLICANT CERTIFICATION [ 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one c the following two reasons: 1. 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) y I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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. 10. I 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION [ 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. 1 r V � Date (, 7- 1 Signature REPLACE 7 (E) PICTURE WINDOWS IN LIVING ROOM (1ST FLR ONLY, HOA LETTER REC'VD) Sq. Ft Floor Area: APN Number: 31624042.00 Valuation: $2000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180D F CALLED INSPECTION. I by: Date. / Z Z //3 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: 9i ��/" Date: Z[ CONSTRUCTION LENDING AGENCY 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 Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional QO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \� (408) 777-3228 • FAX (408) 777-3333 • building(Dcupertino.org CUPER'TINO I\ ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS + 94- V-5 ` _ , r APN # I I 24 l - 0 OWNTERNAME ` RAO �-w i PHONE l b�/ `E-MAIL u T PLI G3� 2s8 -1G ran _Charid-t7e STREET ADDRESS ` CITY, STATE, ZIP C�i FAX p ¢ v1 CONTACT NAME h - pi V I PHONE / _ 2 �� ��d E-MAIL VIA- 1 d K.t [, ` Cl— v r,.tq _ C �ii ad ott e CGS STREET ADDRESS�" VMA j .f CITY, STATE, ZIP FAX �/ Y ey i (A S ( WNER \KOwNER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME S // ICENSEI�TUMBER �1 n � � � TCENSETYPE '^ f BUS. LIC # COMPANY NAME � (r (\ [404?_ EMAIL STREET ADDRESS -301 C � /VWter l �L C� / S re CITY, ST TE, ZIP `� a �0�� ^ 4 Gj / 7 PHONE _ y l tl_ 6'7 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER 7 ` ( 6 BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK iC+Wre wiµ ID eu EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATIO PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ O By my signature below, I certify to each of the following: I am the propertyner or au ed agent to act on the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED p�ECKTPI , ,�,,;iioiJTiycsiP R. _ New SFD or Multifamily dwellings: Apply for demolition permit for �I � ' M existing building(s). Demolition permit is required prior to issuance of building D ovI RToUnTER ❑ BUII DIi\GrkN REt IEw 1 � permit for new building. I xpxEss` 13PiAni\�GTI,AN REVIEW r�� _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD`' PUBLIcoRxs ` Form if any Hazardous Materials are being used as part of this project. �<, Ff � x� 09A RIG IRE EPTA _ Copy of Planning Approval Letter or Meeting with Planning prior toO © '3 submittal of Building Permit application. Joh F t s1NrrAxYSE�RnISTIucT XT Lui '=ENVIROAfiNTAIo-HEALTIi-.x. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO rrr r, CrTTAR A TlID 127T77 i17N!"_ n11V'F4QF IN Afec:h. Plan Check ,W1e(,h. PernaitFee.: Other .1fech. (rasp. t Lech. Insp. Fee: Phamb. Plan! Check Plumb, Permit Fee: Other Plumb Insp. Elec. Plan Check Elec. Permit ree: Other Elec. Insp. Plumb. lump. I-ee: I Elec, Insp. Fee: NOTE: This estimate does not inctuaejees aue to orner vepunsmen13 tae. r.urtr.t'.s, • - •• ___ -- — ---- ---„ - ran tart the Dent far addn'l info. vesrrict, etc.!. l nese L= "ru OUJGu FEE ITEMS (Fee Resolution 11-053 E . 7if 11/13) FEE --- - QT'Y/FEE - -- MISC ITEMS ADDRESS: 10184 VISTA DR DATE: 12/02/2013 REVIEWED BY: MELISSA F-7-1 # $418.00 APN: 316 24 042 BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PME Plan Check: PENTAMATION 113ENRES I PERMIT TYPE: USE: WORK REPLACE 7 E PICTURE WINDOWS IN LIVING ROOM 1ST FLR ONLY HOA LETTER RECVD $0.00 Suppl. Insp. Fee:Q Reg. ® OT SCOPE hrs Afec:h. Plan Check ,W1e(,h. PernaitFee.: Other .1fech. (rasp. t Lech. Insp. Fee: Phamb. Plan! Check Plumb, Permit Fee: Other Plumb Insp. Elec. Plan Check Elec. Permit ree: Other Elec. Insp. Plumb. lump. I-ee: I Elec, Insp. Fee: NOTE: This estimate does not inctuaejees aue to orner vepunsmen13 tae. r.urtr.t'.s, • - •• ___ -- — ---- ---„ - ran tart the Dent far addn'l info. vesrrict, etc.!. l nese L= "ru OUJGu FEE ITEMS (Fee Resolution 11-053 E . 7if 11/13) FEE --- - QT'Y/FEE - -- MISC ITEMS Plan Check Fee: $0.00 F-7-1 # $418.00 Window / Sliding Glass Door _1WINREP Replacement Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 "�4ea'�``Qm�1�i:, ientrlt�"fi _ Afec:h. Plan Check ,W1e(,h. PernaitFee.: Other .1fech. (rasp. t Lech. Insp. Fee: Phamb. Plan! Check Plumb, Permit Fee: Other Plumb Insp. Elec. Plan Check Elec. Permit ree: Other Elec. Insp. Plumb. lump. I-ee: I Elec, Insp. Fee: NOTE: This estimate does not inctuaejees aue to orner vepunsmen13 tae. r.urtr.t'.s, • - •• ___ -- — ---- ---„ - ran tart the Dent far addn'l info. vesrrict, etc.!. l nese L= "ru OUJGu FEE ITEMS (Fee Resolution 11-053 E . 7if 11/13) FEE --- - QT'Y/FEE - -- MISC ITEMS Plan Check Fee: $0.00 F-7-1 # $418.00 Window / Sliding Glass Door _1WINREP Replacement Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (:onstruction Tax: 7-1 Administrative .TLe: Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel Docturientat--ion Fees: Strong Motion Fee: 1BSEIsMICR $0.50 Select an Administrative Item Bldg�Stds Commission Fee: 1BCBSC $1.00 a } 3 $1.50 $418.00TOTAEF u kp M c' $419.50 Revised: 10/01/2013 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildino(a.cuoertino.or4 Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE TDAPN o P4 V 5+Zk �r, Cw erhiw (A 1P41 3t-24-o�Z-ov BP# OWNi//Z NAMt + \�({�L b, OWN�O(DDRESVI51!/7 DY. ( Fit Qil /1VIL, C. DESCRIPTION OF WORK: Jo t,,,6 k paytt pizit,ye We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) VY 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - wilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ,_`f". 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. YL4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �L5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" understate and federal law. _6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �(/ 1)( 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. V8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for inancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. (�1vnel BZfildel FO77n 2010.doc revised 04/14/10 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11K 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) ` Lender Name: N r Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 011'77erBuilderFoi7rt 2010.doc revised 04/14/10 12/1/13 9:41 PM Subject: Re: [Vista—Drive—HOA] Request HOA approval to replace 7 picture windows w Milgard vynal windows From: Charlotte XIA (ran-charlotte@yahoo.com) To: jsmoon(Ogmail.com; Date: Sunday, December 1, 2013 4:08 PM Hi Jay, Thanks for your approval! Enjoy the rest of the Sunday:-) C harlotte On Dec 1, 2013, at 15:48, Jay Moon <jsmoon(it,(Y nail.com> wrote: Approved Cent from my iPhone On Nov 30, 2013, at 8:33 AM, Manish Mehta <manish_r__mehta@)yahoo.com> wrote: I approve too Mas is President, Vista Drive HOA 10190 Vista Dr Cupertino, CA -95014 On Wednesday, November 27, 2013 3:54 PM, Syed Faridul Haq <sfarid@gmail.com> wrote: I approve the replacements. Syed Faridul Haq (Sec., Vista Drive HOA) 10202 Vista Drive Cupertino CA 95014 On Wed, Nov 27, 2013 at 2:50 PM, Charlotte XIA <ran.__charlotte@yahoo.com> wrote: abouttlank Page 1 of 2 Print 12/1/l ra_1i PM - iment(s) from Charlotte XIA included below] Neighbors, 'm submitting permit application at the city now to replace 7 Acture windows with Milgard vynal double pane window on the I st floor. Enclosed is a picture of drawing. Would you please mr)rove? so, would you please reply to all with your name, address and ,le at HOA? Sorry to bother you all a day before the holiday id thanks to all! harlotte, 10184 vista dr Charlotte Reply vita web post RECENT ACTIVITY: Visit Your Group Reply to sender Reply to group Start a New Topic Messages in this topic, 14} Switch to: Text -Only; Daily Digest - Unsubscribe ® Terms o`r Use n Send us Feedback about:blank Page 2 of 2 Vista Drive Home Owners Association Minutes of meeting Thursday March 15, 2011 Page 3 A33 Annual Election Nov 2010 Officers: Syed: President Jay: Treasurer Colin: Secretary Manish: President Treasurer: Charlotte Syed: Secretary Create letter head for election result Signatory change for WellsFargo Call all payees for address change Tree trimming 9/13/12: Call the same contractors (Balaji) 02/13/13: Done. (Balaji) A34 Landscaping KR and 1/20/11: discussion of front area Manish landscaping. Discussed fees for landscape design, we are estimating planning fees in addition to the actual plants and work. --discussed calling an Angie's list landscaping architect for Syed? 5/6/11: Discussed getting quotes at last meeting, were not obtained. 8/3/11: Discussed project coordinator for landscaping need 3 quotes for sprinkler and landscaping for front area such as flower beds. the stumps are a problem for putting a lawn in the area. 3/15/12: Brief meeting with John Cergioli indicated that the front bed was of limited salvage as there were 3 stumps and roots, not much else will grow there. the back flow valve in the bed now has a Code requirement to be changed— estimate is $3000-3500.the question is whether is has to be done retroactively or now vs. 9/13/12: Call top contractor from Angie's list. 02/13/13: Talk with GardenSmith. Get idea for more trees. Then fix sprinkler. A35 ,Tax return and reserve analysis Colin --discussed return requirement with information. Alan Cefalu of Nino Cefalu & Co. as the gross income is under $25,000 we ma not have a filin Thursday March 15, 2011 Page 3 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST:. JOB ADDRESS: to l r^ PERMIT # / 0 00 / OWNER'S NAME: POLA W Y1,Ut4,1ttQe�_ PHONE # ff 6 5V —2-k8 ^ 16-711; G 44'S7/' GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: / Gnfractor Signature Date ,F2-30 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical - Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving i uc Svfwfib Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Gnfractor Signature Date ,F2-30 t'�LOT PLANS CHECKED BY, 10184 Vista Dr, Cupertino, CA 95014 P NNINC DEPT. G. s'el.r�. J_— Double Pane Window Replacement Window Permit Request ApplicatigrrE 20" sFIRST Or,f-jtr. F)EPT. I I � � Garage Bath 411 ia0 U SQ 1,"f eJ 13 ���ieweaQk CC W y Cp4fA CF d o o rW&Y 6"Q J— IOU s" s v l rt 8 &V C s 14e) ,4 vv2 en r"Ce- floor CONI OUNITY DE\1-LOPMENT DEPARTMENT BUILDING uld oiON - CUPERTINO This set of plansian hen MU,41lW at the k- job .i � during construction. It is unlawful to make any dhang5a3 or alterations on same, or to deviate therefrom, without approval from the Building Official. Tho stamping of this plan and specifications SHALL NOT be held to permit or to be an a proval of the violation rtnance or State Law. BY NO. /31Zo 1 Living Roo / CY— ) 4 9.' , r �g %�`�tti'2 windauis iM liv�►� rev✓�1 L�JI s Mid CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19480 RICHWOOD CT CONTRACTOR: A & H HEATING PERMIT NO: 13120047 OWNER'S NAME: KEN KISHI 770 CHESTNUT ST DATE ISSUED: 12/04/2013 OWNER'S PHONE: 4083298265 SAN JOSE, CA 95110 PHONE NO: (408)279-0722 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION License Class <'-20 Lie. 4 3011272. REMOVE AND REPLACE FURNACE IN SAME LOCATION Contractor Ag&" !" t kDate�y �3 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 oneof 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 oftheZabor Code, for the Sq. Ft Floor Area: Valuation: $2150 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: 37501009.00 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 to comply with all city and county ordinances and state laws relating WITIIIN 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 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 Issued by: Date: �Z ' granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature 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 inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: . I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and.the structure isnot intended.or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). ', I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjuryone of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700. of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen . 1��' Date:— 7L permit is issued. I 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions .or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify 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 GENERAL PERMIT APPLICATION 'VI C r 0 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ^^ M` t l CUPERTINO (408),777-3228 • FAX (408) 777-3333 • building0-cupertino.org \ `v MISC PLUMBING OWCHANICAL DELECTRICAL MISCELLANEOUS PROJECT ADDRESS / l @0 / / I (/ oo � •I ^14 %„ O f —00 APN # 3 75 --of S! PHONE /, c 329 _g -MAIL i `,, k /T r 1 ` CO_ OWNER NAME K � KtI l `► STREET ADDRESS 112.3 77 41 . Pi= &i CONTACT NAME PHONE 090 )2_7Q-072 &Mpjj _ T,���` r f _j /5 STREETADDRESS 7?oeyPi✓%r[/�' a r 6T- � 4s//D1"277-/017!(�fw[ _ Cr3W J `/ ❑ OwNER ❑ OwNER-BUILDER ❑ OwNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR_N �i- 1'� f LICENSE NUMBER3 D q q � J T LI ENS T OBSj . LIC 17- O -7"'r^ STRE �D SSffj�F STM5!' T 1 ate• CITY ST TE ZIP s 9V I D HNFy" 77f-67 Z Z_ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIICC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX MULTI -FAMILY BUR.DING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ No DESCRIPTION OF WORK y A A _ A n ry _• q 4 -t -F, to49/ r7nme-p— TOTAL VALUATION: Z©� RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th ner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent- Date: 2 ` 3-13 SUPPLEMENTAL INFORMATION REQUIRED OFFI 4W ,ONLY w OVEWTHE COUNTER o. U a 0 EXPxFss STANDARD LARGE 0 MAJOR 60K- CITY OF CUPERTINO -+iviv 1VQrrFft4 A r1rnD — RlrTTT.11TNf_' 'nFVTCI<nN APPLIANCE / EQUIP TYPE: ADDRESS: 19.480 RICHWOOD CT DATE: 12/04/2013 REVIEWED BY: UNITS APN: BP#: *VALUATION: $2,150 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex $139 PENTAMATION FURN/AC PERMIT TYPE: USE: Suppl, Insp Fee WORK REMOVE AND REPLACE FURNACE IN SAME LOCATION SCOPE $139.00, APPLIANCE / EQUIP TYPE: FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air .1MFR=<100 1 # $139 Perinit Fee: Suppl, Insp Fee PME Unit Fee: $139.00, PME Permit Fee: $47.00 7_1 Construction :1'crx: ___T Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes, (E) No $0.00 TOTALS: i ��. ''.�>.��i�,� $139 00 Strong Motion Fee: 1BSEISMICR Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Alan Check Elec.. Plan (;heck Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee. . Other Mech. Insp. Fo.0 hrs $47.00 CJtFter Plumb Insp.EIF Offier Elec. Insp. i3ech. Imp. Fee: Plumb. Insp. Fee: J Elec. Insp. Fee: NnTF• Thic ovdmato dooe not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Th k-11 the reli»t;.a in ormation available and are only an estimate. Contact the ve t or aaan't to o. Dtstrtct etc Z. ese ees are ase FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. PC: Fee PME Plan Check: $0.00 Perinit Fee: Suppl, Insp Fee PME Unit Fee: $139.00, PME Permit Fee: $47.00 7_1 Construction :1'crx: ___T Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes, (E) No $0.00 Advanced Planning Fees i Travel Documentation Fee:ITRAYDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: _ : 1BCBSC $1.00 $278.50 $0.00 �., $278.50 Revised: 10/01/2013 Sbnolified Prescriptive Certificate of Compliance: 2008 Residential RVACAIteradons CF -IR -ALT -HVAC I Climate Zones 1 and 3 - 7 Site Address:En orcement Ag n Date. Permit #: Ct 4 Z l U i �1J 1 c o �t�cz_Z—quo <L - 3— Conditioned Duct insulation F -u meat Type' List Minimum EfficiencY2 Floor Area requirement Thermostat Packaged Unit Furnace AFUE COP Over 40 ft of ducts Setback Indoor Coil Condensing Unit Q SEER DEER HSPF _ D Resistance Served by system l f 610 sf added or replaced in unconditioned space of not already present, must be installed) R 6 (CZ 1, 3-S) Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13. SEER, 78%AFUE, 7.7HSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: () A L E- E LAS R 144 d Signature: CompanyDate: Address: „1 _ $ r License: 30 y q 7 Z City/State/Zip: s I 'C4 Z%g-�? Z ZPn 2008 Residential Compliance Forms March 2010