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10030055 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10109 RIDGEWAY DR CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 10030055 OWNER'S NAME: IGOR&LILYA GODZDANKER 244 GREAT MALL PKWY DATE ISSUED:03/10/2010 NER'S PHONE: 4082572460 MILPITAS,CA 92683 PHONE NO:(408)934-0730 ❑ /LICENSED CONTRACTOR'S DEC,[LARATION BUILDING PERMIT INFO: BLDG[— ELECT r— PLUMB License Class C oC Lic.# -1631ST MECH RESIDENTIAL� COMMERCIAL Contractor �� 7" �!!( Date .3 lco I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE IN SAME LOCATION,ADD IN NEW (commencing with Section 7000)of Division 3 of the Business&Professions A/C 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$7800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34241023.00 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued b-y: Date: o Signature i({YGb��r Date 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,I 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 I 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. I 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)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air 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 I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 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 Owner or thoriz e� / become subject to the Worker's Compensation provisions of the Labor Code,I mustDate: 3/ �D/G forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 'nnify and keep harmless the City of Cupertino against liabilities,judgments, 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. SignatureDate 3 l0 4D Licensed Professional ��l��'�ut CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34241023 . 00 DATE ISSUED. . . . . . . : 03/10/2010 RECEIPT # . . . . . . . . . BS000009905 REFERENCE ID # . . . : 10030055 SITE ADDRESS 10109 RIDGEWAY DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER IGOR & LILYA GODZDANKER ADDRESS 10109 RIDGEWAY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : APLUS HEATING & AIR CONTRACTOR ADAM P. PHAM LIC # 31293 COMPANY A PLUS HEATING & A/C ADDRESS 244 GREAT MALL PKWY CITY/STATE/ZIP . . . : MILPITAS, CA 92683 TELEPHONE . . . . . . . . : (408) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- -------- 1BCBSC VALUATION 7, 800 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 .00 63 . 00 0 . 00 63 . 00 0 . 00 1BSEISMICR VALUATION 7, 800 . 00 0 . 80 0 . 00 0 . 80 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 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 295 . 80 0 . 00 295 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 295 . 80 #1235 --------------- TOTAL RECEIPT 295 . 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FURNACE/AC CITY INO PERMIT APPLICATION FORM cu �.,T < -- Dater rN �ddress: —xL4460 ame: � _ o2s�]Phone#: 4�� _cl y —C 7LA� � �- � Fax#: �� -`� 3 -��'y`License#: Cupertino Business License#: 7 6 3 I SSI Phone#: o�30 Contact: 1 Ccs Fax#: 4 a g D7 Building Permit Info: Elect❑ Plumb Mech [� Residential Commercial Job �q Description: _� �� QQ�� j��X.� ��+� i � X►�� I �C�n'�b Yl � � �Yl 1r12►� For Residential Installations: � p� � 2°d floor El Attic ❑ 1St floor ] Cwt Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Struct al Calculations required for new installation ❑ New tallation Planning Approval RequTeydpe❑of Construction (Usage Class): Cost of Project: Re lacement Strapped On Platform ❑ Bonded New Location P Project Size: Express 10-- Standard ❑ Large ❑ Major❑ Valuation: -T 7 t 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 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. 1MCREPALT 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 1 BPGAS 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 ermit. 1BCBSC 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. 4,10 CITY OF CUPERTINO FURNACE/AC 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 1PGASRES 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 ITYPES 1BSEISMICR Residential Seismic B 1 MECPLNCK 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 BTT 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 ' 1 MPERMITFEE Mechanical Permit Fee - M 1PPERMITFEE Plumbing Permit P I / 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO 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 <= l Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l0k CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BCBSC + Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue . a Cupertino CA 95014 Telephone(408)777-3228 k; Fax(408)777-3333 CITY OF "UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # logo t2id a Dr - 'ao3O�� OWNER'S NAME: PHONE # 40$ - -257 — A ko GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 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