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10110125 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22465 PALM AVE CONTRACTOR:AAA FURNACE& PERMIT NO: 10110125 AIR CONDITIONING WNER'S NAME: SANTOS JANICE C AND ROBERT J 1712 STONE AVE DATE ISSUED: 11/18/2010 OWNER'S PHONE: 4087258273 SAN JOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATIONr ��,, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class043 IC 2G Lic.# 7(� ' 1 //�� 1I11'14)4 11 MECH r RESIDENTIAL r COMMERCIAL Contractor t' FU f/V;C Date l 1— 14S '1 L' JOB DESCRIPTION:REMOVE AND REPLACE FURNACE IN SAME LOCATION 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:$3290 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 � ,9 , APN Number:35703068.00 Occupancy Type: ` permit is issued. �4 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 ity of Cupertino against liabilities,judgments, costs,and expenses which m cure against said City in consequence of the /�/��� granting of this perrr� Ad¢tti nally,the applicant understands and will comply Issued by: Date: /� with all non-point urrop re lations per the Cupertino Municipal Code,Section 9.18. ` RE-ROOFS: nature L Date ' '— �(J 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: 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 equipm 4t 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 Ara Air Quality Management District I 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 Co ns�l 5 5,25533,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 LENDING 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 building construction,and hereby authorize representatives of this city to enter n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .ademnify and keep harmless the City of Cupertino against liabilities,judgments, 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 5 ITEMS OF 26 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35703068 . 00 DATE ISSUED. . . . . . . : 11/18/2010 RECEIPT #. . • • . . . . . : BS000012044 REFERENCE ID # . . . : 10110125 SITE ADDRESS . . . . . : 22465 PALM AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SANTOS JANICE C AND ROBERT J ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2711 RECEIVED FROM . . . . : AAA FURNACE 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 290 .00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 3, 290 .00 0 .50 0 . 00 0 . 50 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 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211 . 50 0 .00 211 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22465 Palm Ave DATE: 11/18/2010 REVIEWED BY: jsg APN: BP#: *VALUATION: 1$3,290 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: t I UC11. i.- l_ _ PERMIT TYPE: WORK Remove existing furnace and install new one in same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 �,,,,, 1"dI ( ;.="A ;t�c "Ic<i; Mech.Permit Fee: IMPERMIT "r Other Mech.Insp. 0.0 hrs L $42.00 NOTE. Thesefees are based on the preliminary information 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 P/a/1 (Jwc:' FC(I. PME Plan Check: $0.00 slljlo[ his F(A-, PME Unit Fee: $126.00 PME Permit Fee: $42.00 Con�z trlwli()t7 7_(/A %1c:ousliccrllc Work Without Permit? 0 Yes E) No $0.00 I'lcrfrnf�r« f��es. Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg;Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $211.50 $0.00 TOTAL FEE: $211.50 Revised: 11/08/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: A14 til Z-' PERMIT# OWNER'S NAME: J 0 r1 c' PHONE# 4-C i — 72 5- - Z 3 GENERAL CONTRACTOR: e- BUSINESS LICENSE# ADDRESS: /'7 Z Qr/kV CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Roc T'Ie" Owner/Co for Signature Date CITY OF CUPERTINO FURNACE/AC 10110,25 CUPEkTINO PERMIT APPLICATION FORM APN # Date: 351 - 03 ©toS Building Address: . C,s- Pci ►-)� A u-2_ Owner's Name: �{ l + Phone#: Contractor: ; i Phone #: Fax #: Z/C-S 3- 7 7 e Contractor License#: 7 �. Cupertino Business License#: Contact: Phone #: 71 Fax #: - 7 i Building Permit Info: Elect ❑ Plumb ❑ Mech [- Residential Commercial Job Description: R co-i F Li it,,:c c,= I ci CCi I � �.ti, For Residential Installations: Attic ❑ 1St floor (] 2°d 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): Strapped On Platform Bonded New Location Replacement Project Size: Ex ress ❑ Standard ❑ Lar e ❑ 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