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10090004I CITY OF CUPERTIN O BUILDING PERMIT I BUILDING ADDRESS: 22667 SILVER OAK LN r —4ER'S NAME: JOANNE POGGI Ov*NER'S PHONE: 4085075970 ❑ LICENSED CONTRACTOR'S DECLARATION License Class �� W Lic. #,,�,}�� Contractor 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. 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 permit is issued. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. S' ^!ure Date 0,1t '%o ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 'he above mentioned property for inspection purposes. (We) agree to save .ufy 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONTRACTOR: RESIDENTIAL HEATING PERMIT NO: 10090004 AND A/C INC 65 CRISTICH LN DATE ISSUED: 09/01/2010 CAMPBELL, CA 95008 PHONE NO: 4083774073 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECH r— RESIDENTIAL [— COMMERCIAL JOB DESCRIPTION: REPLACE EXISTING FURNACE AND EXISTING A/C Sq. Ft Floor Area: Valuation: $7280 APN Number: 34249010.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date.,V- fid RE -ROOFS: 411 roofs shall be inspected prior to any roofing material being installed. If a roof is nstalled without first obtaining an inspection, I agree to remove all new materials for .nspection. signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain -ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. 4dditionally, should I use equipment or devices which emit hazardous air .ontaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. !wne • r thorized agent: Date Q l t d CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's ,or which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34249010.00 DATE ISSUED.......: 09/01/2010 RECEIPT #.........: BS000011350 REFERENCE ID # ...: 10090004 SITE ADDRESS .....: 22667 SILVER OAK LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER JOANNE POGGI ADDRESS ..........: 22667 SILVER OAK LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5634 RECEIVED FROM ....: RESIDENTIAL HEATING CONTRACTOR .......: CATHY HAIRE LIC # 21161 COMPANY RESIDENTIAL HEATING AND A/C IN ADDRESS 65 --RISTICH LN CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: 4083774073 FEE ID ---------- UNIT ------------- QUANTITY AKOUNT PD -TO -DT THIS REC NEW BAL 1BCBSC VALUATION ---------- 7,280.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 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 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 TOTAL PERMIT ---------- 274.00 ---------- 0.00 ---------- 274.00 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 274.00 --------------- 274.00 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING REFERENCE NUMBER -------------------- #30276 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 502 FINAL PLUMBING ENERGY 503 505 FINAL ELECTRICAL 507 508 FINAL MECHANICAL FINAL ELECTRICAL ENERGY FINAL MECHANICAL ENERGY FINAL PLUMBING 1. Use LowlNo-VOC Paint 2. Use Low VOC, Water -Based Wood Finishes 3. Use LowNo VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde S. Use Exterior Grade Plywood for Interior Uses 7. Seal A j hoard flr MDF B. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recycled -Content Trim 10. Install Vdhole House Vacuum System N. Flooring 1. Select FSC Certified Wood Flooring 2. Use Body Renewable Flooring. Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs 1 IADJHealth pts y=yes 21AOJHsalth pts y --yes 3IAOJHealth pts y --yes 3 Resource pts y=yes 6IAQ/Health pts y=yes 1 IAQ/Health pts y=yes 4 Resource pts y=yes 1 Resource pts y=yes 3 IAQ/Health pts y --yes B Resource pts y --yes 4 Resource pts y=yes 4 Resource pts y=yes 5 IAQ/Health pts y=yes 4 Resource pts y=yes 4 Resource pts y --yes Total Points Available: Total Points Project Recelved: 1401 1301 57 0 0 0 Mdatalprogsl ireenbuilcOngguidelineslremodslerslgreenpointsfinal212D4pmtee1ed.xis CITY OF -UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: c olo-1 Sl WCC 00L iL �-n PERMIT # OWNER'S NAME: �, j PHONE # 50-1.5-lQ GENERAL CONTRACTOR: ) FAX # 3-11 — Crc6H I am not using any subcontractors: Signature Please check annlicable subcontractors and comt)lete the following information: Date q . I . keC) Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical i 2�p 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 Rock Tile q . I . keC) Owner/ Contractor Signature Date � k CI OF CUPEkTINO CITY 017 CUPERTINO FUIViACE/AC PERMIT APPLJICATION FORM APN #Date. �,-5 1 1 1", /111 0/ Q Building Address: � cam—► s, 1ver Da kc- LA _ Owner's Name: � Phone #: 4C)46-� . 5�-?b G�,� psi � 1 Contractor: �.S i deny �►-�-e.�� rv►� `t. tic � � h � = . Phone #: L}� • "3'1'7 •-(�j,3 Fax #: S Contractor License #:--I(Dy- .-. Cupertino Business License #: Contact: Phone #: AC -370- . -3-1-1. t-�3 Fax #: Building Permit Info: Elect Plumb Mech OF ResidentialCommercial El Job Description: S4� r" L For Residential Installations: Attic F-1I"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: Type of Construction (Usage Class): �Z�J u --1 a -M . (-50 zzy kWStrapped F1 On Platform H Bonc ed New Location Replacement Project Size: Express ❑ 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 01/07/09