12050059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10194 BONNY DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 12050059
CONDITIONING
OWNER'S NAME: TARO OR SACHIFi ONOZAWA 1712 STONE AVE DATE ISSUED:05/042012
OWNER'S PHONE: 4083936663 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
13
License Class Lic.4 REPLACE FURNACE,AIR CONDITIONING, DUCTS AND
WATER
Contractor Dale HEATER
1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and%%ill 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.FI Floor Area: Valuation:$18695
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
APN Number:3591104600 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and stale that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and stale 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 DAY M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments. 1/ I
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: ` ^
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Dale 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:
1 hereby affirm that 1 am exempt from the Contractor's License Lew 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,mid the structure is not intended or offered for sale(Sec.7044,
Business&Prolessions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE;
construct the project(Sce.7044,Business&Professions Code). 1 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 perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: lleallh&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Cenificate of Consent to self-insure for Worker's material. Additionally,should 1 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
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 Dale:
permit is issueJ,
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 Califomia. If,after making this certificate of exemption,I CONSTRUCTION LENDING ACFNCI'
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
indemnil') and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITF,CT'S DECLARATION
costs,and expenses which ma) 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 ��
CITY OF CUPERTINO
8 ITEMS OF PERMIT RECEIPT OPERATOR: counter
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35911046 . 00
DATE ISSUED. . . . . . . : 05/04/2012
RECEIPT # . . . . . . . . . : BS000016720
REFERENCE ID # . . . : 12050059
SITE ADDRESS . . . . . : 10194 BONNY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
-IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TARO OR SACHIE ONOZAWA
ADDRESS . . . . . . . . . . : 10194 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : TARO ONOZAWA
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE (408) 293-4717
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 .00 41. 00 0 . 00 41 . 00 0 . 00
1BCBSC VALUATION 18, 695 . 00 1. 00 0 .00 1 . 00 0 . 00
1BREMAIRHA NO.UNITS 1.00 65.00 0 .00 65 . 00 0. 00
1BSEISMICR VALUATION 18, 695 .00 1 .87 0. 00 1 .87 0. 00
1MFR=<100 UNITS 1 . 00 130. 00 0.00 130 .00 0. 00
1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 .00 44 . 00 0. 00
1PRWHEATR UNITS 1 .00 26 .00 0 . 00 26 . 00 0 . 00
1TRAVDOC FLAT RATE 1 .00 44 . 00 0 . 00 44 . 00 0. 00
-------- -- ---------- ---------- ----------
TOTAL PERMIT 352 . 87 0 . 00 352 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------ ----------- --------------- --------------------
CHECK 352 . 87 2325
---------------
TOTAL RECEIPT 352 .87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO l asp 05q
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10194 Bonny Dr. I DATE: 05/04/2012 REVIEWED BY: jsg
APN: I BP#: 'VALUATION: $18,695
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK Re lace furnace replace water heater with tankless new air conditioning.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
A/C Units (<=10K cfm) 1BREMAIR 1 # $65 /
Other Appliance/Equip 1 # -Sffg�&
TOTALS: $260.00
Meeh. Plan Check FO.0 hrs $0.00 Plumb. Plan Check Flee. Plan C/u.
Mech. Permit Fee: I MPERMIT Plumb. Pel mit Fee Elec. Po mit Fe o:
LLJOther Mech. Insp. 0.0 hrs $44.00 Other Plumb Insp. Usher Elev./n+P.
Mcrh. bap. Fee.: Plumb. hrsp. Fed: lilce. Insp. Fde:
NOTE: This estimate does not includejees due to other Departments(Le. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are onlp an estimate Contact rhe Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 EIT. 7/l/111 FEE QTY/FEE MISC ITEMS
Plan Check Feu:
Suppl. PC,Fee
PME Plan Check: $0.00
Permil 1'ec:
Stgtpl. ln.ep Fee
PME Unit Fee: $260.00
PME Permit Fee: $44.00
Comm ucrion Tuc:
Administrative Fee: IADMIN $41.00'
Work Without Permit? 0 Yes 0 No $0.00
,I dve need Pluming Fees:
Travel Documentation Fee: ITRAVDOC $44.00
Strong Motion Fee: 1BSEISMICR $1.8 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $391.871 $0.00 TOTAL FEE: $391.87
Revised: 04/01/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I A
(408)777-3228• FAX(408)777-33M•buildingCc cuoertino.or0 (v'
CUPERTINO
❑PLUMBING 0MECHANICAL [1aECrotCet []MISCELLANEOUS ao
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OWNER NAM - F' O 'aPH E-MAIL
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CONTACT NAME PHONE E-MAIL
STREETADDRESS _ CITY,STATE, ZIP FAX
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CONTRACTOR NAME A/ A �,�NA < LICENSE NUMBER (og8� LICENSE TYPE/ f BUS.GCO a r�
COMPANY NAME A A � F�N Cn HC:i U I(A 1)oz AC XQ r,u e-T FAXgOSpZ 5 (099
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USE OF XS wDUPIF]I 13 MCI FAMO.Y PRIUECIINWIDIAND ❑ yES PROIELTIN 07i IS THE BLDG AN 13 YES
BUILDING: ❑COMMERCIAL URBANINTEIFACEAREA 0N FLOOD ZONE [3 NO EICHER HOME' E3 No
DESCRIPTION OF WORK
FV(',Q A C A-1 C v C-
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TOTAL VALUATION: RECEIVED BY:
By my siguatute below,I certify to etch of the fallowing. I=the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I have 'ded is eorsect have teed the Description of Work and verify it is accurate. I agree m comply with all applicable local
ardmaoces and state I g n g I sadunia representatives of Cupertino m enter the above-i property for mspecdon pu@oses.
SigoznaeofAppG t/Ag.0 Date: !:�jZ20
SUPPLEMENTAL INFORMATION REQURED OFFICE USE ONLY
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❑ srANDARD
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❑ MAJOR
MEPMtscApp_2011.doc revised 06121111