11020069 CITY OF CUPERTINO BUILDING PERMIT
BUILDING A=ESS: 10290 MORETTI DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11020069
CONDITIONING
OWNER'S NAME: NOEL&PATRICIA CLARKE 1712 STONE AVE DATE ISSUED:02/17/2011
C R'S PHONE: 4083153278 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATIONr— I
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class c Lic.# -7 to S g 7
MECH F RESIDENTIAL r— COMMERCIAL�
Contractor 4&+ Y�f%moi Date �? _1? ,//
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING WALL FURNAE&INSTALL NEW IN
(commencing with Section 7000)of Division 3 of the Business&Professions SAME
Code and that my license is in full force and effect. 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 Sq.Ft Floor Area: Valuation:$2683
permit is issued. t
APPLICANT CERTIFICATION APN Number:37515012.00 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 thg City of Cupertino against liabilities,judgments,
costs,and expenses which m crue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. A iti ally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point ource a lations per the Cupertino Municipal Code,Section
9.18.
Issued b� Date: 2
Signature Date
Lr 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,
Business&Professions Code) Signature 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: 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&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
pen-nit is issued. contaminants as rt d 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 maintain comp' nc ith 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& tL.'ons 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 ne
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION NSTRUCTION LENDING AGENCY
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
upon the above mentioned property for inspection purposes.(We)agree to save
-unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515012 . 00
DATE ISSUED. . . . . . . : 02/17/2011
RECEIPT # . . . . . . . . . BS000012732
REFERENCE ID # . . . : 11020069
SITE ADDRESS . . . . . : 10290 MORETTI DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NOEL & PATRICIA CLARKE
ADDRESS . . . . . . . . . . : 10290 MORETTI DR.
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AAA FURNACE & AIR
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 2, 683 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 683 . 00 0 . 50 0 . 00 0 .50 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 148 .50 0 .00 148 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 148 . 50 #38102
---------------
TOTAL RECEIPT 148 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Building Department
City Of Cupertino
La 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: 10290 m44i' Dove- PERMIT# 2 6 t!�
OWNER'S NAME: L 10r-K PHONE# 46 — S p " a`Z7
GENERAL CONTRACTOR: kA- & r BUSINESS LICENSE#
ADDRESS: 171Z 5bM 4W CITY/ZIPCODE: SQ.t lace, (f�'#
*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:
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/Con or Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10290 moretti dr. DATE: 02/17/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$2,683
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A;
WORK re lace exisiting wall furnace with new wall furnace at same location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Floor 1 # $63
TOTALS: $63.00
Mech.Plan Check 0.0 hrs $0.00 "r t t�a� r :�fz(`'z,°ek
FMech.Permit Fee: IMPERMIT /J�c_
Other Mech.Insp. 0.0 1 Lj
hrs $42.00
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Eff 7%7:70) FEE QTY/FEE MISC ITEMS
S711"pt P(.'1"("'
PME Plan Check: $0.00
sigj1d. hop/'n-,
PME Unit Fee: $63.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $148.50 $0.00 TOTAL FEE $148.50
Revised: 01/15/2011
�g
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # � � ��
ate:
� C� I �-is it
Building Address:
Owner's Name: �l cr r/� Phone #:
N oeZ -31S -- 3o27�
Contractor: / Phone #:�4,off�93-�f7/ 7
l Fax #: 40S-4793 - 67 - i
Contractor License#: --7 6 ft 7> Cupertino Business License#:
Contact: C-7?0p--1 7q�yt,� Phone #: SDN- x293--117/7
Fax #: Zlpi--gip _ (o7 -7i
Building Permit Info:
Elect Plumb Mech
Residential Commercial LJ
Job Description: /2e/77Otle Exl:s i rr,,� Al tL,.)
Ort `-,-> S4 /oc4fio,�, J
For Residential Installations:
Attic ❑ Is' 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: 07 b�3 d U Type of ConstructioUsage Class):
StrappedEl On Platform El Bonded New LocationEJ Replacement
Project Size: Express Standard Large 0 MajorEj
Valuation:k. z 4)0,,.,3, Ov
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