10090182 CITY OF CUPERTI vO BUILDING PERMIT
BUILDING ADDRESS: 10188 MACADAM LN CONTRACTOR:SANDIUM PERMIT NO: 10090182
OWNER'S NAME: SEAN HOU 4223 VERDIGRIS CIR DATE ISSUED:09/20/2010
1ER'S PHONE: 3233656888 SAN JOSE,CA 95134 PHONE NO:(408)894-9072
Q LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
�r�
License Class Lic.# / MECH RESIDENTIAL COMMERCIAL
Contractor sa ,m�,4 ,,,. Date i
JOB DESCRIPTION:FURNACE REPLACEMENT&A/C INSTALLATION
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:$12000
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 Occupancy
permit is issued.
,,-I I2_ arc Type:
APN Number:36901041.00 P Y YP
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 relatin:, 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
with all non-point source regulations per the Cupertino Municipal Code,Section Issued b Date4 2-
9.18. AO
Signature � DateZ
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.)f inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensatic n, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors t(
constrict 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. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shal
not employ any person in any manner so as to become subject to the Worker's O r";i�thorized ager Q 12,0
� .�(o
Compensation laws of California. If,after making this certificate of exemption,I
�.. Date: ` l
become subject to the Worker's Compensation provisions of the Labor Code,I in ist
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.I agree to comply with all city and county ordinances and state laws relat mg
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
',mnify and keep harmless the City of Cupertino against liabilities,judgments ARCHITECT'S DECLARATION
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
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 11 PERM"T RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B:.k: Lot:
APN . . . . . . . . : 36901041. 00
DATE ISSUED. . . . . . . : 0 )/20/2010
RECEIPT #. . . . . . • • • : B,3000011497
REFERENCE ID # . . . : 1)090182
SITE ADDRESS . . . . . : 1)188 MACADAM LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER SEAN HOU
ADDRESS . . . . . . . . . . : 10188 MACADAM LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : YIU-HANG LEE
CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867
COMPANY SANDIUM
ADDRESS 4223 VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE . . . . . . . . : (408) 894-9072
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----
1BCBSC VALUATION 12, 000. 00 1 .00 0 . 00 1. 00 0 . 00
1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 .00 63 . 00 0 .00
1BSEISMICR VALUATION 12, 000. 00 1 .20 0. 00 1.20 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 275 .20 0 . 00 275 .20 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- - -------- -----------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF' CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: BP#: *VALUATION: $12,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
___rPRIMARY 10I 11 I PENTAMATION 1 RMAP2
USE: SFD or Duplex Fel001� ,;1:,�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 1 hrs $0.00
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. 0.0 hrs $42.00 ')rh<�, Pb11iT,t�,_=� Of/ `Vic( ""/',
EIF-L-
NOTE. These fees are based on the preliminary in ormatio 7 available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-05I E,{f. 7`1%10} FILE QTY/FEE MISC ITEMS
Plait Check 1'e
11
supp/. PC
PME Plan Check: $0.00
Permit Fee:
strpp[ 1r1.sp 1-1v
PME Unit Fee: $189.00
PME Permit Fee: 142.00
('oiv�jrtwiion 77(n
P�:ott5ti<;ctl licit°ic'lti'I cz:':
Wor=Without Permit? 0 Yes No $0.00
1'lrzrtrFitr,tr 1't'e', :
Travel Documentation Fee: ITRA VDOC 542.00 i
Strong Motion Fee: $1.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $275.20 $0.00 TOTAL FEE $275.20
Revised: 9/14/2010
INPUT Rr-soiirrLs Energy !A]'Health
M. n oor Air Quality and Finishes
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--yes0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0
7.Seal all )gored 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
N.Flooring
1.Select FSC Certified Wood Flooring B 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
I1 b 1
Total Points Available: I 140L 130r 57
Total Points Pro'ect Received: 1 01 01 0
G:datalprogs'greenbuilcOngguidelineslremodelers/greenpointsfinal2.12.04protected.xls
CITY OF CUPERTINO
FURVACE/AC
CUPEkTiNO PERMIT APPLICATION FORM
APN # C) Date: -L O 12_z,( 0
Building Ad ress:
Owner's Name: � �__ Phone#: 32� 365 9&9
vx wok
Contractor: Phone#: / g4 Co-7 Z
Fax#:
Contractor License#: Cupertino Business License#:
Contact: Phone#: Zta<W p7 Z.
tA c�t Fax #:
Building Permit Info:
Elece
Plumb E5' Mech
Residential Commercial
Job Description: Ac ih
�w
For Residential Installations: t
Attic ❑ 1St floor El" 2"d floor EJ
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 lfl Bo:ided New Location Replacement
Project Size: Ex ress ❑ Standard ❑ Large ❑ Major❑
Valuation: IV 120"
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