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10100005
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10059 OAKLEAF PL CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10100005 CONDITIONING OWNER'S NAME: JHANESHWAR NAYAK 1712 STONE AVE DATE ISSUED: 10/01/2010 JWNER'S PHONE: 4089968747 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class c 2-0 Lic.# -7 L-�S__7 J REMOVE& REPLACE FURNACE&COIL IN SAME p Contractor A 14}g} Date /()—/ —/u LOCATION 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:$3825 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 thiWt APN Number:32618053.00 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 relatin; 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 h ss the City of Cupertino against liabilities,judgments, costs,and expenses w c f may accrue against said City in consequence of the � `y.� granting of this p dditionally,the applicant understands and will comply Issued by: Date: with all -po' t s r e regulations per the Cupertino Municipal Code,Section 9.18. /©�� l d RE-ROOFS: Signature Date ( 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 I hereby affirm that I am exempt from the Contractor's License Law for one c f Signature of Applicant: Date: 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 compensatiol 1, 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. I 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 g255533, or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by r Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectand 25534. Section 3700 of the Labor Code,for the performance of the work for which this �+ permit is issued. Owner or authorized agent: Date: 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 mug t 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 relatin; to building construction,and hereby authorize representatives of this city to enter non the above mentioned property for inspection purposes.(We)agree to save iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,osts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting 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 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPERTINO Building Department JOB ADDRESS: PERMIT # 100,5"I NKle 01C,eo- C 6/ a G a--r OWNER'S NAME: ng e S h u-,rx r Ma Vlk, PHONE #409 to k 7 GENERAL CONTRACTOR: p y1jo We-c . FAX # —N�I am not using any subcontractors: I Signatu 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/c)( Til OF Owner/Contract gnature Date CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$3,825 *PERMIT TYPE: Mechanical Permit PLA N CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex �� '` � PENTAMATION FURN/AC USE: PERMIT TYPE: 19 WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check0.0 hrs $0.00 ''f,Clic• Mech.Permit Fee: 1MPERMIT 1'1� P,r m"� 1'> Other Mech.Insp. 0.0 hrs $42.00 0 �'rLi NOTE. Thesefees are based on the preliminary information u vailable and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-05I & 0J FEE QTY/FEE MISC ITEMS Plan ('11(C:A 1`cc Szfppl. PC F"', PME Plan Check: $C.00 P�t-rltit f�'c�c� PME Unit Fee: $126.00 PME Permit Fee: $42.00 C"onsif iwtiotf 'a ,'I ousliczf Rc vi�,ii Fc— Work c—Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Pee: $0.50 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 9/29/2010 CITY OF CUPERTINO 5 ITEMS OF 29 PERMIT' RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot : APN . . . . . . . . : 32618053 . 00 DATE ISSUED. . . . . . . : 10/01/2010 RECEIPT #. . . . . . . . . BS000011611 REFERENCE ID # . . . 10/00005 SITE ADDRESS . . . . . : 10059 OAKLEAF PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JHANESHWAR NAYAK ADDRESS . . . . . . . . . . : 10059 OAKLEAF PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1127 RECEIVED FROM . . . . : AAA FURNACE CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 17:-2 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 3, 825 . 00 1. 00 0 .00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 825 . 00 0 . 50 0 .00 0 . 50 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 211 . 50 0 . 00 211 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL "InMiruality and Fin—ishes INPUT ReSDUTCes Energy IADIHWth 1.Use Low/No-VOC Paint 1 iAQ/Health pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2!AQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes p 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes p 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p 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 f f F N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 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 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 0 f F F Total Points Availabl� 1401 130 57 Total Points Project Receive701 0 0 I 4Li G:daWp ocs%green:iildingguidelines/remodeiers/greenpointsfinaa2.12.o4protected.xls CITY OF CUPERTINO FURNACE/AC CUPEQ INO PERMIT APPLICATION FORM APN # Date: Building Address: Gt, cc 1 U inci Place- Owner's _ Name: — Phone #: J Q n CA e. L5 lJ LA i r- - 7 y (o- 0 7 y 7 Contractor: ''JQ0 nd. H \JA C i N C -1A A 4 }-u rrN0 CQ Phone #: q09- 29 3 -t/71 -- Fax #: 409-a 53 - 6 - -7 Contractor License #: .7 (9�� / Cupertino Business License #: Contact: C--,G 9-y Tu W 2 P r- O f Phone #: 1/d� -� Cl 3 "Cf 7/ 7 -bo Fax #:140i-J'43 — 0-7 —7 l Building Permit Info: Elect Plumb ❑ _ Mech ["Y Residential Commercial Job Description: ZemC)vQ 1r��rNa� q- /v e-ko FUrN6 co- -A- C0 1Ni S ryNoi 0cg4+j'v..� . For Residential Installations: Attic ❑ I" 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 Required [] Cost of Project: •3 a;s, 6 G Type cf Construction (Usage Class): Strapped On Platform Banded Replacement Project Size: Express Standard D Large 0 MajorEJ Valuation: Green Building: Please complete relevant pori ion of the Green Building Checklist & attach it to the — application or if applicable, include in plan set & the sheet index. Revised 01/07/09