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09110106CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19987 TWILIGHT CT CONTRACTOR: PERFORMANCE AIR PERMIT NO: 09110106 SERVICE OV"NER'S NAME: GOGINENI, KAMAL 1805 LITTLE ORCHARD ST DATE ISSUED: 11/19/2009 G. _ ..ER'S PHONE: 4087258933 SAN JOSE, CA 95125 PHONE NO: (408)920-6170 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB ?.�� Lie. # 43 133 l f—MECH License Class RESIDENTIAL COMMERCIAL pef;)C&0,4 41- Date Contractor JOB DESCRIPTION: REPLACE FURNACE 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $5245 1 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 anc Type: Occu APN Number: 31631037.00 P Y permit is issued. 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply DatetZ11 with all non point source regulations per the Cupertino Municipal Code, Section Issued by.,_ 9.18. Signature Date RE-ROOFS: _ ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, 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). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain the Cupertino Municipal Code, Chapter 9.12 and the Health & Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with Safety Code, Section 25532(a) should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally, should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance, as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Owner orayih ie joAut:- Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct. 1 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 Lender's Address U 'he above mentioned property for inspection purposes. (We) agree to save i. aify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31631037.00 DATE ISSUED.......: 11/19/2009 RECEIPT #......... BS000009233 REFERENCE ID # 09110106 SITE ADDRESS 19987 TWILIGHT CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER GOGINENI, KAMAL ADDRESS . 19987 TWILIGHT CT CITY/STATE/ZIP CUPERTINO CA, CA 95014-2304 RECEIVED FROM PERFORMANCE AIR SVC CONTRACTOR TIM STANFORD LIC # 27768 COMPANY PERFORMANCE AIR SERVICE ADDRESS 1805 LITTLE ORCHARD ST CITY/STATE/ZIP SAN JOSE, CA 95125 TELEPHONE (408)920-6170 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 5,245.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 5,245.00 0.60 0.00 0.60 0.00 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 0.00 63.00 0.00 1MRRAA UNITS 1.00 1.00 63.00 42.00 0.00 1PPERMITFE FLAT RATE ---------- -----42_00 ------0_00 TOTAL PERMIT ---------- 190.60 0.00 190.60 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 190.60 --------------- 190.60 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #3231 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING a CITY OF UCJ CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# OU Building Address: 19 1 C0 TW'l t (, 4 Ci , Owner's Name*C, k 1. Contractor: Qe� Fci m u nN i Se+' v cc- C-, C Con Tactor icense #: Contact: Building Permit Info: Plumb Residential Job Description: �50 For Residential Installations: F-11St floor Attic Mech Commc Date: 11-1q-09 Phone #: " 7 2_5- V33 Phone #: zlc?5 Y2 U % 76 Fax #: L10,6q 2 v _ Cr 7 r Cupertino Business License #: 2714 Phone #: Llog _ yZ C -(�� 76 Fax #: 2nd floor ❑ Adhere to minimum setback requirement LJ 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): SIH IS" , Strapped H On Platform Bonded New Location L 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 CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE CUPERTINO floor mounted unit heater. 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 1PGASRES 1BPGAS 1BCBSC 1BSEISMICR MECPLNCK 1 MFR=<100 1MFRN>100 FURN/AC Residential for ea gas piping system of P 1-4 Outlets For each gas piping system of 5 or P more per outlet. Cal Bldg Standards Commission Fee B ALL PERMIT TYPES Residential Seismic B Mechanical Plan Check Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h Furnace Syst > l 00k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over Im M IW 1 EPERMITFEE 1vv,vvv i. Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1. Use LowMo-VbC Paint 2. Use Low VOC, Water -Based Wood Finishes 3. Use Liow/.No VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5, Use Engineered Sheet Goods with no added Urea Formaldehyde 6. Use Exterior Grade Plywood for Interior Uses 7. Seal al W iliw�d or MDF _ 8. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recycled -Content Trim 10. Install Whole House Vacuum System N. Flooring 1. Select FSC Certified Wood Flooring 2. Use Body BenenwaWe Flooring Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Gontent Carpet with Low VOCs 1 IAWealth pts y --yes 21AQ/Health pts y=yes 31A0/Health pts y=yes 3 Resource pts yeses 61AQ/Health pts y=yes 1 IAQ/Health pts y=yes 4 Resource pts y=yes 1 Resource pts y=yes 3 IAD/Health pts y=yes B Resource pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes 5 IAQ/Health pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes Ll Total Points Available: 1401 1301 57 Total Points Project Received: - 01 01 0 G:datalprogs/greenbuilcnngguidelineslramodelerslgreenpointsfinal212 D4proteo1ed.YJs CITY OF �UPEkTINO Buildin JOB ADDRESS: l y g e6 7 T L J >�4 �- Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 De artment PERMIT # ,dq (l U L lv OWNER'S NAME: L' -?o 10 1 •' I PHONE # GENERAL CONTRACTOR: r c rv�c�� l FAX # I am not using any subcontractors: Date Signature Date Owner/ Contractor Signature