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10080012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10863 NORTHFIELD SQ CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 10080012 CONDITIONING 1712 STONE AVE DATE ISSUED:08/03/2010 NER'S NAME: MAISY YOUNG PHONE NO:(408)293-4717 OWNER'S PHONE: 4082032149 SAN JOSE,CA 95125 © LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB License Class0 4 C 7" Lic.# �� �'� 7 � MECH r RESIDENTIAL I— COMMERCIAL� Contractor \G W' U ykJ"� Date JOB DESCRIPTION: INSTALL CONDENSER UNIT&220 POWER HOOK UP 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 Valuation:$4152 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APN Number:31637027.00 Occupancy Type: 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 13ERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the Ci upertmo against liabilities,judgments, t80 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may a me a ainst said City in consequence of the granting of this permit. i' rally, a applicant understands and will comply _ Date with all non- om so ce re latio per the Cupertino Municipal Code,Section Issued bYi�' � 9.18. ature -� Date 3 _ �d RE-ROOFS: OWNER-BUILDER DECLARATION All -oofs shall be inspected prior to any roofing material being installed.If a roof is Inst filled without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of insl ection. the following two reasons: Date: I,as owner of the property,or my employees with wages as their sole compensation, Sig iature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). — HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I hive read the hazardous materials requirements under Chapter 6.95 of the declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Compensation,as provided for by Section 3700 of the Labor Code,for the Sa etty Code, ect on 25532(a)should Intoe or handle hazardous Chapter 9.12 matethe rlh& material. performance of the work for which this permit is issued. Ac ditionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by co itarninants as de a by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this in. tain c ce ith the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Hi alth afe C e,Sections 25505,25533,and 25534. 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 O•�nMen, Compensation laws of California. If,after making this certificate of exemptionI become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I I tereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is L order's Name 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 L-nder's Address the above mentioned property for inspection purposes.(We)agree to save mnify and keep harmless theLper ertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses whit ay ct said City in consequence of the granting of this permi d o licant understands and will comply I inderstand my plans shall be used as public records. with all non- ' rce atiCupertino Municipal Code,Section 9.18. ,. I icensed Professional Date Signature , CITY OF CUPERTINO 4 ITEMS OF 30 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31637C27 .00 DATE ISSUED. . . . . . . : 08/03/ 2010 RECEIPT #. . . . . . . . . BS000011064 REFERENCE ID # 10080012 SITE ADDRESS 10863 NORTHFIELD SQ SUBDIVISION . . . . . . . CITY CUPERT I NO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MAISY YOUNG ADDRESS : 10863 NORTHFIELD SQ CITY/STATE/ZIP . . . : CUPERPINO, 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 AMCUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- -- 00 1BCBSC VALUATION 4, 152. 00 1 .00 0 .00 1. 00 0 • 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 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 148 . 00 0 .00 148 .00 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION __ _ -------- ---------------------------- -- ---------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISIOONREVIEwED BY: DATE: [121 ADDRESS: *VALUATION: $4,152 APN: BP#: xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair j, APPLICATION 1 RMAP2, PRIMARY SFD or Duplex ;;��r, -:°.; ; TYPE: USE: xW QO 3 � BP FEES APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY 1BREMAIFt 1 $63 A/C Units (<=10K cfm) $63.00 TOTALS: Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERWT Other Mech.Insp. 0.0 hrs $42.00 NOTE: These fees are based on the relimina in ormation available and are only an estimate. CMISC ITEMSthe Dept or addn'l in o. FEE ITEMS (Fee Resolution 09-051 Eft '-'1-'09) FEE QTY/FEE PME Plan Check: $0.00 t Y' PME Unit Fee: $63.0 PME Permit Fee: $42.00 Cc 1 Work Without Permit? Yes No $0.(10 Travel Documentation Fee: rTRavDoc $42.00 Select an Administrative Item §4 Bldg Stds Commission Fee: 1BCBSC $1.30 SUBTOTALS: $148.00 $0.00 TOTAL FEE: $148.00 Revised: 7/27/2010 CITY OF CUPERTINO FURNACE/AC CITY OF PERMIT APPLICATION FORM CUPEkT�NO Date: AP # ,,, , - r�� --- - Building Address: _- Dib 3 No r4 LA Sq q-,?f Phone #: Owner's Name: -a16 111Q ism442Phone #: 40 Contractor: Rand�,j -4-- mss ��� � � Fax #: D - 01-93 `7 - Cupertino Business License #: Contractor License #: -7&�Sl7 -- TFax e #:Ll o&-949.3 -L1 / 7 Contact: -1a(�+ T&AA) "Le { -- #: 10 3 (0 7 —7 Building Permit Info: Elect [Y Plumb Mech [✓]' Residential � Commercial ❑ Job Description: J N I /j For Residential Installations: 1St floor [1,,- 2nd floor ❑ Attic ❑ Adhere to minimum setback requirement For Commercial Installations: Additional weight (structural calcs) [:1Replacement same weight ❑ Structural Calculations required for new installatio,l ❑ New installation Planning Approval Requireyd E] construction (Usage Class): Cost of Protect: L4152 -00 On Platform Bon.led Location Replacement Strapped New Loc Project Size: Express ❑ Standard ❑ Lar c ❑ Major ❑ --- Valuation: . y r sZ ACU Building Checklist & attach it to Green Building: Please complete relevant porti in of the Green the application or if applicable, in:lude in plan set & the sheet index. -- Revised 01/07/09 1ADIflealth M.Indoor Air ual►ty and Finishes 1.Use Low/No-VOC Paint 1 1AQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 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 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 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 0 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 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 0 ' f t t Total Points Available: 1 1401 1301 57 Total Points Project Recei 1 01 0 0 G:data/progs,gr._ ildingguidelinas/remodeiers/greenpoint i 12.12.04protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 ' Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;UPEkTINO Buildin 7Deartment JOBADDRESS: AOQ$!03 Nf0 r�h-�i P lc,C 'L�* RMIT # L2 L' U X11 OWNER'S NAME: I-S-4 Vn PHONE #� GENERAL CONTRACTOR , FAX# I am not using any subcontractors: Date Signat ire Please check applicable subcontractors and complete the followin �$USINESS LICENSE # SUBCONTRACTOR BUSINESS NAME 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 M pl Shee ck -/Q Owner/ tractor Signature - Date