10120139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10532 CEDAR TREE CT CONTRACTOR:AIR AND PLUMBING PERMIT NO: 10120139
SYSTEMS
OWNER'S NAME: NALINI MOHAN 285 SOBRANTE WAY STE P DATE ISSUED: 12/20/2010
OWNER'S PHONE: 4088885006 SUNNYVALE,CA 94086 PHONE NO:(408)733-2000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL rT COMMERCIAL
License Class�ZC 7- Lic.# ���2 REPLACE FURNACE AND A/C IN GARAGE
Contractor Date Z5 G !1
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:$6000
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 whicht APN Number:31634023.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPHZES 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 F LAS CALLED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 12
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source reg tions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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-BLVDER 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 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 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. 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 it Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cuperti Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent - Date
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 LED ING 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
indemnify 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 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
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10535 cedar tree ct. DATE: 12/20/2010 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$6,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex lex trr �L, PENTAMATION FURN/AC
USE: 1 t�)t)h t f t. PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 # $63
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: 1 $189.00
Mech.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 1 hrs $42.00 01; tLi
LJ I
�_
Alc'c'ir. Itt_�r> �`,.. 1"tart%�- 1r�,r1, cc
NOTE. Thesefees are based on the preliminaryl2lormation available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 Elf. 7/1,/10) FEE QTY/FEE MISC ITEMS
Plult Check [cc,"c,
PME Plan Check: $0.00
1'crinit Fcc:
.`i iE p[ 111.y
PME Unit Fee: $189.00
PME Permit Fee: $42.00
Coosa iwiiml , 7'0x
Work Without Permit? 0 Yes E) No $0.00
Ylct>trttit,�,>lctt'�:
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.60 $0.00 TOTAL FEE: $274.60
Revised: 12/07/2010
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31634023 . 00
DATE ISSUED. . . . . . . : 12/20/2010
RECEIPT #. . . . . . . . . : BS000012311
REFERENCE ID # . . . : 10120139
SITE ADDRESS . . . . . : 10532 CEDAR TREE CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NALINI MOHAN
ADDRESS . . . . . . . . . . : 10532 CEDAR TREE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AIR PLUMBING SYSTEM
CONTRACTOR . . . . . . . : AIR AND PLUMBING SYSTEMS LIC # 31732
COMPANY . . . . . . . . . . : AIR AND PLUMBING SYSTEMS
ADDRESS . . . . . . . . . . : 285 SOBRANTE WAY STE P
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 733-2000
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 000 . 00 1. 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 6, 000 . 00 0. 60 0 . 00 0 .60 0 . 00
1MFR=<100 UNITS 1 . 00 126 . 00 0 . 00 126 . 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
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 274 . 60 0 . 00 274 .60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 274 . 60 VISA
---------------
TOTAL RECEIPT 274 . 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
INPUT Resources Energy •0
M.Moor Air UMN an rmshes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 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 1 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 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring 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 5 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 4 Resource pts y=yes 0
1 1 1
Total Points Available:1 1 1401 1301 57
Total Points Project Received: 0 0 0
G:data/prog reenbuild idelines/ del greenpoints a12.12.04pmtected.xls
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # 31 LP ; o.Q3 ,�� Date: ��,�Z�Ila
Building Address: la1 31 4W?e
Owner's Name: /j / a Phone#: opl J WK
14
Cont actor: /( Phone#:
�Z_ O�41t Y� .,�"0 " Fax#:
Contractor License#: �� 1C/6 Cupertino Business License#:
Contact: Phone#:
Fax#:
Building Permit Info:
Elect [� Plumb [' Mech
Residential Commercial ❑
Job Description: Q !-t��Q / Q
For Residential Installations:
Attic F-11St floor � 2nd 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 Projece,�7,e9 Type of Construction (Usage Class):
StrappedEl On Platform Bonded ew Location 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