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10080008 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1049 PENNINGTON LN C014TRACTOR:AAA FURNACE&AIR PERMIT NO: 10080008 CONDITIONING NER'S NAME: CAROLYN REED 171.,STONE AVE DATE ISSUED:08/03/2010 OWNER'S PHONE: 4082558929 SAr JOSE,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB License Class .k4 -tu Lic.# 7 7 / Contractor�(�rt P(d i�U f-C' Date c5 _ �` � CMECH r- RESIDENTIAL r COMMERCIAL� I hereby affirm that I am licensed under the provisions of Chapter 9 JOII DESCRIPTION:REMOVE EXISTING FURNACE&REPLACE,ADD (commencing with Section 7000)of Division 3 of the Business&Professions CON DENSER Code and that my license is in full force and effect. 22011OWER HOOKUP 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. 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 Sq.I't Floor Area: Valuation:$8380 permit is issued. APPLICANT CERTIFICATION API\Number:36204032.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the of Cupertino against liabilities,judgments, costs,and expenses which in P eaccrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR grantinff-vointourc on 'y,the applicant understands and will comply 1 HO DAYS FROM LAST CALLED INSPECTION. with all ons per the Cupertino Municipal Code,Section9.18. natu -3 /C Issued b Date:�� '--(" Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All r ofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: instal led without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspe-tion. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) SignE ture of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I hav!read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Califrrnia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safet✓Code,Section 25532(a)should I store or handle hazardous material. Addii ionally,shout a equipment or devices which emit hazardous air permit is issued. contaminants fin d b the Ba Area Air y y Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maim air c c with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health a ty, de,Sections 25505,25533,and 25534. 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 O c or orized agent: �1 forthwith comply with such provisions or this permit shall be deemed revoked. Date: 3 APPLICANT CERTIFICATION CO STRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I here ry affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for wl ich this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lendc is Name the above mentioned property for inspection purposes.(We)agree to save mnify and keep harmless the City of Cupertino against liabilities,judgments, Lend4 is Address 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 ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licen;ed Professional CITY OF CUFERTINO 5 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: lot: APN . . . . . . . . : 36204C32 .00 DATE ISSUED. . . . . . . : 08/03/2010 RECEIPT #. . . . . . . . . : BSOOOC11064 REFERENCE ID # . . . : 10080008 SITE ADDRESS . . . . . : 1049 FENNINGTON LN SUBDIVISION . . . . . . CITY CUPERZINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CAROL'�N REED ADDRESS . . . . . . . . . . : 1049 FENNINGTON LN CITY/STATE/ZIP . . . : CUPERZINO CA, CA 95014-4929 RECEIVED FROM . . . . : RANDO AAA HVAC, INC CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FLRNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 ETONE AVE CITY/STATE/ZIP . . . : SAN JCSE, CA 95125 TELEPHONE . . . . . . . . : (408) 293-4717 FEE ID UNIT QUANTITY AMOLNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 8, 380. 00 1 .00 0 .00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 .00 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 X74 .00 0. 00 274 . 00 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 C]UPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$8,380 R�PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex APPLICATION 1 RMAP2 USE• TYPE: as O O 3U APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 $63 Furnace, Forced-Air 1MFR=<1,)0 1 $126 TOTALS: $189.00 Mech.Plan Check Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 ,,, r r r , NOTE. Thesefees are based on the preliminary information available and are onl an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-051 E{f 7%1;09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 r Work Without Permit? Q Yes (E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 i Select an Administrative Item Bld�_) Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.00 $0.00 TOTAL FEE: $274.00 Revised: 7/27/2010 J CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # 23 ' �i CJ`l (,1. ,,� Date: , Building Add ... ress: - (��P n n,n��v Loi►c Owner's Name: Phone #: CrG re0yv �� --- Contractor: �j} �' �-,v a Phone #: --- Fax #: Zf0� -lD2�3 - `77 Contractor License #: �& 9-6 7/ Cupertino Business License #: Contact: --- ----- -1/ �/ 2 Phone #: �-o2c13 -4<7/1 Fax #: �0 _ o�9,3 - �i `7 EBuildingermit Info: -� -Plumb '� Mech Residential Commercial ❑ Job Description: J?e r-"v✓e -N r - - ✓` � qcr �vn eK S e r- For Residential Installations: - Attic ❑ 1 sc floor [7. ' 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: 8- Z>,;,0. U Type of Construction (Usage Class): - Strapped Li On Platform Bonded New Location Replacement Project Size: Express ❑ Standard ❑ Lar e ❑ Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the , application or if applicable, includ-� in plan set & the sheet index. Revised 01/07/09 INPUT M.Indoor Air Quality and Finishes ]ADWealth 1.Use Low/No-VOC Paint 1 iAQ/Healthis Y=Yes 2 2.Use Low VOC,Water-Based Wood Finishes P yy 0 ,AQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health ises 4.Use Salvaged Materials for Interior Finishes yy 0 3 Resource pts y=yesp 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health is y=yes 6.Use Exterior Grade Plywood for Interior Uses p y=y 0 1 IAQ/Health pts yyes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health is y=yes 8.Use FSC Certified Materials for Interior Finish P y=y 0 4 Resource pts yyes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Healthis y=yes, P Y—Y 0 N.Flooring I E 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes p 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 5.Use Exposed Concrete as Finished Floor 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 4 Resource pts y=yes p MENEM ' 0 t 0 Total Points Available: 140 1311 57 Total Points Project Received: 01 -01 p� 7111X1l� G:data/pr,pr an�uildingguidelinas/remodalers/ oint Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEI�TINO Building Department JOB ADDRESS: �acl �P�a/I,rl L,Ad PERMIT# l OWNER'S NAME:Ctj r-o JXv e e c/ PHONE # ga GENERAL CONTRACTOR: ` # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Met Sheet ck Ne er/Contractor S' afore Date