10010132 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20280 PACIFICA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10010132
CONDITIONING
TIER'S NAME: YUFEN WANG 1712 STONE AVE DATE ISSUED:01/25/2010
oWNER'S PHONE: 4082575446 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Classy q3 Lic.# $� MECH RESIDENTIAL COMMERCIAL
ContractorRC{il-C C �14 fives Date 1 +2,Y —f C
JOB DESCRIPTION:REMOVE EXISTING HEAT PUMP&INSTALL NEW HEAT
I hereby affirm that I am licensed under the provisions of Chapter 9
PUMP
(commencing with Section 7000)of Division 3 of the Business&Professions IN THE SAME LOCATION&AIR HANDLER.
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.
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.Ft Floor Area: Valuation:$6724
permit is issued.
APPLICANT CERTIFICATION APN Number:36944015.00 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 Ci Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may a e#gainst said City in consequence of the
granting of this pe ' . A ti all a applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all n ource re a' s per the Cupertino Municipal Code,Section
9.18. �£.��.�.----•�_____-------Z
��5-- Issued by:r-vJ Date/
-nature
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,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,
Signature of Applicant: Date:
Business&Professions Code)
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: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California 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&
Safety Code,Section 255 a) hould I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I se eq pment or devices which emit hazardous air
permit is issued. contaminants ed by a 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 m co plian i 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& fety ,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 Owner r a tho d agent: ^ Z
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
C /RUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby 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 which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
the above mentioned prope r inspection purposes.(We)agree to save
inify and keep harmless e C* of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses w ' h y ac a against said City in consequence of the
granting o e t. ition ly,the applicant understands and will comply ARCHITECT'S DECLARATION
with all, on-poin ource egu ions per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date / Z L� Licensed Professional
V
CITY OF CUPERTINO
7 ITEMS OF 31 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36944015. 00
DATE ISSUED. . . . . . . : 01/25/2010
RECEIPT # . . . . . . . . . : BS000009610
REFERENCE ID # . . . : 10010132
SITE ADDRESS . . . . . : 20280 PACIFICA DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER YUFEN WANG
ADDRESS . . . . . . . . . . : 20280 PACIFICA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RANDO AAA HVAC, INC
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 6, 724 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 61724 .00 0 . 70 0 . 00 0 . 70 0 . 00
1EPERMITFE FLAT RATE 1.00 42 . 00 0 . 00 42 . 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
1PPERMITFE FLAT RATE 1.00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 000 . 00 42 . 00 0 . 00
---------- ---------- ---------- ---------
TOTAL PERMIT 232 .70 0 . 00 232 . 70 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ---
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
k FURNACE/AC
CUP150
TINO PERMIT APPLICATION FORM
APN # Date:
369
Building Address: 010 -no �c-to-
Owner's
Name: 1 A n Phone #:
4a - a6 Li 4 (o
Contractor: 1'RQy-\CV 0 40A G Icy 614.- 1=U r'N(c Phone #: q o f--a_r _y
Fax #: 4d8 -o1> 3 - to -7-71
Contractor License #: -7 1 Cupertino Business License#:
Contact: q QV -Fo U--�Z-er Phone #: 46 -679 3 q 7/7
Fax #: - 9 3 7- 1
Building Permit Info:
Elect Plumb Mech
ED--
Residential Commercial LJ
Job Description: epnov e- 6V i ihc� h-eq,+ t 11
heCt+ n,i , PJ Same I o c ciJ-/'0,--j CA ir' h G r1el I-to C-
For Residential Installations:
Attic ❑ I` 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 Project: (� - a ,d c� Type of Construction (Usage Class):
V
Strapped El On Plat rm Bonded New Location Replacement
Project Size: Express Standard ❑ Lar e Major E]
Valuation: (.,--I DLI.d d
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. C"-)--
Revised 01/07/09
CITY OF CUPERTINO
FURNACEAC
CITOF
CUPEYTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 MRA.PPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace S yst <=100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace S yst > l 00k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
' IEPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit p
1 TRAVDOC Travel Documentation B
1 BUSLIC Business License B
CITY OF CUPERTINO
FURNACE/AC
COPE OF
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
A
EnergyINPUT 'ReSDUTCes 1ADIHealth
. n oor tr ua tty an ins es
1. 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%VOC AdhOves 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
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
A� 8 Ait: 4 M/Flealth. pts Ayes 0
8.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 p
1 i i
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts Ayes 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 p
1 1 1
F� Total Points vai a e: 11401 ___ 1301 57
MMMEMMMMMM� Total Points Project Received: 0 p 0
G:data/progslgreenbuildngguidelineslremodelerslgreenpants na1212.04protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
C1T1(OF Fax(408)777-3333
.,UPEkTINO
Building Department
JOB ADDRESS: 2 � Pct,c;.0-,-co- `l�Q , PERMIT # s /
OWNER'S NAME: \ 4�=,j Banc PHONE # -0,5 --? -S y ct
GENERAL CONTRACTOR: ;,,�C FAX # d-9 3 — to-7-�
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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 Metal
Sheet Roc
Tile
wn r/Contractor ature Date