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11010162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21203 OROGRANDE PL CONTRACTOR:A&H HEATING PERMIT NO: 11010162 OWNER'S NAME: YUKI NAGANO 770 CHESTNUT ST DATE ISSUED:01/31/2011 r1WNER'S PHONE: 4087758180 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class 6- Z-4' Lic.# 3'49 Cf 7Z REMOVE AND REPLACE FURNACE IN SAME LOCATION REPLACE DUCT SYSTEM,MOVE CONDENSER Contractor Date — f"" 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:$10000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the workf w�is APN Number:36217018.00 Occupancy Type: permit is issued. 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 the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued --Date: i with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. C^ !v/� RE-ROOFS: Signature �te / 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) 1,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. 1 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 equipment 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 Area 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 Code,S ctions 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 2/�f Owner or authorized agent:_ Date: 1 •—�� .1 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, fists,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. nting 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 .:UPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 'z, t ZB Pb PERMIT# OWNER'S NAME: PHONE# 7 GENERAL CONTRACTOR: g- BUSINESS LICENSE# ADDRESS: 7d CITY/ZIPCODE: OfAC *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 Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36217018 .00 DATE ISSUED. . . . . . . : 01/31/2011 RECEIPT #. . . . . . . . . : BS000012618 REFERENCE ID # . . . : 11010162 SITE ADDRESS . . . . . : 21203 OROGRANDE PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER YUKI NAGANO ADDRESS 21203 OROGRANDE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : A & H HEATING CONTRACTOR PHELPS, DALE LIC # 12079 COMPANY A & H HEATING ADDRESS 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE (408) 279-0722 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 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 10, 000 . 00 1. 00 0 .00 1 . 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 1MRRAA UNITS 1. 00 63 . 00 0 . 00 63 . 00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 .00 0 . 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 338 . 00 0 . 00 338 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 338 . 00 VISA --------------- TOTAL RECEIPT 338 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# C) Date: Building Address: If residential, is house an Eichler? Yes ❑ No [ If yes, needs planning approval. Owner's Name: VU441 © Phone#: 7 7 --F/50 1 ( Contractor: 1 d fPhone #: ze2 7V-4)7 Fax#: 2-749—A9 Contractor License#: Cupertino Business License#: dCf(4?2_ Contact: Phone#: Lf pg' Fax/e-mail: 2 ? lD l Building Permit Info: Elect C Plumb 1 �r Mech Residential Commercial Job Description: 113E-f•G( For Residential Installations: Attic 1-11 sc 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 Re uired ❑ Cost of Project: 060Type of Constructi nl.LUsage Class): fl9f ?f Strapped H On Platform Bonded New Location Replacement Project Size: Counter B—Ex ress ❑ Standard ❑ Large ❑ 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 12/06/10