10020112 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19700 DRAKE DR CONTRACTOR:BLUE MOUNTAIN AIR PERMIT NO: 10020112
OWNER'S NAME: I l�h J 707 ALDRIDGE RD STE B DATE ISSUED:02/19/2010
INER'S PHONE: 4083061422 VACAVILLE,CA 95688 PHONE NO:(707)451-8111
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class
L G36 3Lic.# 3-1 b 6 REPLACE GAS FURNACE IN CLOSET 80K BTU/95% AFUE
Contractor ate Z 1 b
I hereby affi r am license der the provisions of Chapter 9
(commend wi S ction 7000)of Division 3 of the Business&Professions
Code and that cense 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 Valuation:$2400
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:31632021.00 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 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 Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point s urce re ulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date _Z O 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.
O NE -BUILDER DECLARATION Date:
Signature of Applicant:
I hereby affirm th am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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. I will
I hereby affirm under penalty of perjury one 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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
the Health&Safety Code,Sections 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate: 2. �� f
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 CONSTRU LENDING AGENCY
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 mus 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
-demnify and keep harmless the City of Cupertino against liabilities,judgments,
ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
a.anting of this permit.Additionally,the applicant understands and will comply
with all non-point ource regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date 2 r
SAO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPE�TINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # y-D j06 - Z2
GENERAL CONTRACTOR: 9t ie pf w„ -wt,) ,f-1 ,2 FAX #70 7 q q6- 70 2-4
I am not using any subcontractors: Z /�A _
tZeZ
Date
Please check a licable subcontractors ocmtfollowin information:
SUBCONTRACTOR BUS ESS 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
Plleyron6act%`or`Sil Date
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CJPERTINO
PERMIT INVOICE OPERATOR: SylviaM
Sec: Twp: Rng: Sub: Blk: Lot :
APN 31632021. 00
INVOICE DATE. . . . . . : 02/19/2010
REFERENCE ID # . . . : 10020112
SITE ADDRESS 197CO DRAKE DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JICI-ENG YE
ADDRESS 197CO DRAKE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2434
CONTRACTOR GREGORY S. OWEN LIC # 29600
COMPANY BLUE; MOUNTAIN AIR
ADDRESS . . . . . . . . . . : 707 ALDRIDGE RD STE B
CITY/STATE/ZIP . . . : VACIXILLE, CA 95688
TELEPHONE (70") 451-8111
FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE
--------------------------- ----------------- ----------
CAL BLDG STAND COMMISSION F PRINTING PERMIT 1 . 00 1. 00 0 . 00
SEISMIC RESIDENTIAL PRINTING PERMIT 0 . 50 0 . 50 0 .00
ELEC PERMIT ISSUANCE PRINTING P]'sRMIT 42 . 00 42 . 00 0 .00
MECH PERMIT ISSUANCE PRINTING PERMIT 42 . 00 42 . 00 0 . 00
RES MECH REPAIR/ALT/ADD PRINTING P]3RMIT 63 . 00 63 . 00 0 .00
PLUMBNG PERMIT ISSUE PRINTING PERMIT 42 . 00 42 . 00 0 . 00
TRAVEL & DOCUMENTATION FEE PRINTING P'.ERMIT 42 . 00 42 . 00 0 .00
---------- ---------- ----------
232 .50 232 . 50 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY Or
CITY OF CUPERTINO
FURNACE/AC
CUPE TINO PERMIT APPLICATION FORM
IM2bIIL
APN# Date:
LP 2 ,
Building Address:
19700 DRAKE DRIVE
Owner's Name: Phone#:
JICHENG YE 408-306-1422
Contractor: Phone#: 707-451-8111
BLUE MOUNTAIN AIR, INC.
Fax#: 707-446-7026
Contractor License#: 398668 Cupertino Business License#:
Contact: REBECCA Phone#: 707-451-8111
Fax#:
Building Permit Info:
Elect Plumb !� Mech 0
Residential 0 Commercial ❑
Job Description: REPLACEMENT OF GAS FURNACE IN CLOSET. 80K BTU/95% AFUE
For Residential Installations:
Attic F-11St floor Q 2°a 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):
#* Z,-4C ✓ L-/f3
Strapped ❑ On Platform Bonded 0-- New Location❑ Replacement
Project Size: Ex ress ❑ Standard 0 Large ❑ Major❑
Valuation: $2400
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
FURNACT AC
-UPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repai-/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,abEorption or
evaporative cooling; system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the;repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,V AV boxes,
absorption unit or ca heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1 MCSUSHTR Commercial Instal:/Relocate ea M
suspended heater,r,-cessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas pipin;; system of 5 or P
more per outlet.
1 MCAPPVNT Commercial-for th install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
IBCBSC Cal Bldg Standard3 Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating applian:,e,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative coolir g system,incl
installation of controls regulated by
this code.
1 MRSUSHTR Residential Install Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
CITY OF C;UPERTINO
FURNACE/AC
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ inc: 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
1 BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forcf;d-air/gravity type
furnace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> i 00k BTU install or M
relocate ea forcesd-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
l EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Per-nit Fee M
1 PPERMITFEE Plumbing Perm it P
/ 1TRAVDOC Travel Documentation B
1 BUSLIC Business License B
M. n oor Air uality and Finishes - - - - - -
- 0
1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes0
3.Use Lowft VOC Adhesives 3 IAQ/Health pts y--yess0
4.Use Salvaged Materials for Interior Finishes Ir Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde E IAQ/Health pts y--yes 0
6.Use Exterior Grade Plywood for Interior Uses ' 1AQ/Health pts y--yes 7. 0
Seal al fiXPOsW4WtOab9wd or K)F IAQ/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 i Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
. 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2 Use Rapf3anewable Mooring 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 f�IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs / Resource pts y=yes 0
. . - J=1 ! 1
Total Points Available: 14W 1301-- 57
Total Points Project Received: 0 0 0
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