The URL can be used to link to this page

10080081 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22303 REGNART RD CONTRACTOR:AIR SOLUTIONS INC PERMIT NO: 10080081 OWNER'S NAME: RAY&KYLIE BANKS 3517 LA GRANDE BLVD DATE ISSUED:08/11/2010 NER'S PHONE: 4085686920 SACRAMENTO,CA 95823 PHONE NO:(916)392-2444 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB r License Class t! ZG j t3 Li,.# -75-7-10 (- MECH F RESIDENTIAL[- COMMERCIAL Contractor Sof �S Date t7 E6 / " t t I hereby affirm that I am licensed under the provisions of Chapter 9 JO 3 DESCRIPTION:REMOVING GAS FURNACE AND INSTALLING AIR (commencing with Section 7000)of Division 3 of the Business&Professions HANDLER, Code and that my license is in full force and effect. SA1 IE LOCATION 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. at Floor Area: Valuation:$2575 permit is issued. APPLICANT CERTIFICATION APP Number:36602043.00 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 .HERMIT EXPIRES IF WORD IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. f Signature � '"' Date O I? 1 m Issue Date:&' LJ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: insta 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, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sign:Lure 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 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Calif►rnia Health&Safety Code,Sections 25505,25533,and 25534. I 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. permit is issued. Addis Tonally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall main ain compliance 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&Safety Code,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 Ownt r nr nu rued a forthwith comply with such provisions or this permit shall be deemed revoked. � Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I here)y 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 Lendt is Name upon the above mentioned property for inspection purposes.(We)agree to save 'Pmnify and keep harmless the City of Cupertino against liabilities,judgments, Lendt is Address cs,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 unde-stand my plans shall be used as public records. Signature Date Licen-ed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RF;CEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: lot: APN 36602C43 . 00 DATE ISSUED. . . . . . . : 08/11/2010 RECEIPT #. . . . . . . . . : BS000011157 REFERENCE ID # . . . : 10080081 SITE ADDRESS 22303 REGNART RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RAY & KYLIE BANKS ADDRESS 22303 REGNART RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM TOMMY 3IMKINS CONTRACTOR TOM SIAKINS LIC # 31373 COMPANY AIR SO.�UTIONS INC ADDRESS 3517 LA GRANDE BLVD CITY/STATE/ZIP SACRAM:�',NTO, CA 95823 TELEPHONE (916) 392-2444 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 2, 575. 00 1 . 00 0 .00 1. 00 0. 00 1MFR=<100 UNITS 1 . 00 1::6 .00 0 .00 126 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 1:2 . 00 0. 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 2:2 . 00 0. 00 42 . 00 0 .00 ---------- TOTAL PERMIT 2--.1 . 00 0 .00 211. 00 0. 00 METHOD OF PAYMENT AMOUNT I.EFERENCE NUMBER --- --------------- --- ----------------- CREDIT CARD 211. 00 63E155 --------------- TOTAL RECEIPT 211 .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 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTL'i FURNACE/AC l alo CU PEkT1N0 PERMIT APPLICATION FORM APN # �G .� Date: U f 1 f zd r Building Address: 2-- -3 0 3 1LeTrekr t Phone#: O� 5 G,6 � 9 2 o Owner's Name: ��LJ + k y ��t 4�a►.1�S Phone#: Contractor: Q f 6 41qJ -706 Fax#: Contractor License#: Cupertino Business License#: Phone#: 9 I (o 25 1 3 Contact: Tovrri.l �. � � r S Fax#: CUk r,0 Building Permit Info: Elect Plumb ❑/ Mech Ell' LJ Residential Commercial Job Description: a,,.;r& Gas For Residential Installations: 2nd floor ❑ Attic ❑ 1 S`floor ['� Adhere to minimum setback requirement ❑ For Commercial Installations: Add tional weight(structural calcs) ❑ Replacement same weight ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Constru:,tion age ass): 100- tform Bonded New Location Replacement Strapped On Pla Project Size: Express �tandard ❑ Large ❑ rQajor❑ Valuation: Green Building: Please complete relevant portion of tb a Green Building Checklist & attach it to the application or if applicable, include ir. plan set & the sheet index Revised 01/07/09 CITY OF CUP ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$2,575 *PERMIT TYPE: Mechanical Permit PLAN CHLCK TYPE: Alteration/Addition / Repair PRIMARY 17lY,ir. APPLICATION 1RMAP6 USE: SFD or Duplex J J x 1t� i J,J TYPE 777rS 3a xW C a 00 3U APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Furnace, Forced-Air 1MFR=<100 1 $126 TOTALS: r $126.00 w" Mech.Plan Check 0.0 hrs $0.00 'innib Ph,;: C:Ir�,�;; J'J�� Nail ChccA Mech.Permit Fee: IMPERMIT h;•:... I Other Mech.Insp. FO.0 Thrs $42.00 ,u,, , t'hr,;,;: '„ t,. Cir,,<, ,`:,' . J,,:,;.,. T--1 __j NOTE: Thesefees are based on the preliminairy in ormation availal le and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 F.T: 74 0.1) FEE QTY/FEE MISC ITEMS 71 P/'or C`hc c)"' SarJ,J,I. P(- /.,, PME Plan Check: $0.00 F-1 Si r;'l�f. r1aJ.' 1•c'c' PME Unit Fee: $126.00 PME Permit Fee: $42.00 -T-T .1, F � i irrr •cr: Work Without Permit? Q Yes (F) No $0.00 l'lur±,rrrt,1 c�, . Travel Documentation Fee: ITRA VDOC $42.00 , i Select an Administrative Item Bldg St ds Commission Fee: IBCBSC $1.00 1"T $211.001 F `,` $211.00 SUBOTALS: $211.00 Revised: 8/06/2010 illy M.Indoor Air Quality and Finishes 1.Use LOWINo-Y&P91 1 IAD-'Health pts Y--Yes 0 2.Use Lolro VOC,Water-Based Wood Finishes 2 IAQ'Health pts yeses 0 3.Use Lt�u4 VOC Adhesives 31AQ'Health pts Y--Yes0 4.Use Salvaged Materials for Interior Finishes 3 Rw ource pts yeses D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IACIHealth pts y--yes0 S.Use Exterior Grade Plywood for Interior Uses 1 !AC IHealth pts y--yes 0 4IAC IHealth A - es B.Use FSC Certified Materials for Interior Finish 4 Re source pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 7 Re source pts Y--yes 0 10.Install Whole House Vacuum System 3(AilHealth pts y--yes 0 . 1 r- 0 D N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts Y--yes 0 2.1l5a Rap fl e flMafen* 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts Y--yessD 4.Install Natural Linoleum in Place of Vinyl 5 IACdHealth pts y--yes 0 5.Use Exposed Concrete as Finished Floor 4 Re*oiurce pts y=Yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Re<ource.pts y-yes D 1 D r Total Points Available: U 140 130 57 Total Points Project Received: 0 0 0 G:datalprogs/gn:enhill•Gngguidelines/n:modelerslgn:enp6intsfinal21204proteDled.zl9 Building Department ILI 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: 2Z3o 3 g ►ur+ 2 of PERMIT# OWNER'S NAME: 6A'a" PHONE# 409 56 g X042" GENERAL CONTRACTOR: 4 it- So t��'o-.-S BUSINESS LICENSE# ADDRESS: IS' "? C-, ,� 131,r� �a� �� gsSZ3 l7 CITY/ZIPCODE: i4- c k '7"? *Our municipal code requires all businesses working in the cily to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPF CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ._ �`.� V-s019 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NA ME 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 Rock Tile Owner/Contractor Signature Date