10080007 CITY OF CUPERTINO BUILDING PERMIT
EBUILDINGDRESS: 20092 RODRIGUES AVE
COP�TRACTOR:AAA FURNACE&AIR
COT DITIONING PERMIT NO: 10080007
NER'S NAME: MICHELIS FAMILY LIMITED PARTNERSHIP
OWNER'S PHONE: 4083133231 1712 STONE AVE
DATE ISSUED:08/03/2010
SAN.JOSE,CA 95125 PHONE NO:(408)293 4717
LICENSED CONTRACTOR'S DECLARATION
License Classl4 C Tt BUILDING PERMIT INFO: BLDG r ELECT r
Lic.# ��%;� � � d PLUMB r
Contractor }��Cj ice: r r
Date S - _ /L% MECH RESIDENTIAL COMMERCIAL r
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB 3ESCRIPTION:ADD CONDENSER&ELECTRICAL HOOKUP
(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 Sq'Ft 17oor Area; Valuation:$3840
permit is issued.
APN Number:36932038.00
APPLICANT CERTIFICATION Occupancy Type;
I certify that I have read this application an-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
FPERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, (THIN 180 DAYS OF PE
costs,and expenses which ma ccrue against said City in consequence of the RMIT ISSUANCE OR
granting of this permi t' nally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all n -por s rc a lations per the Cupertino Municipal Code,Section
9.18.
Issued I
`
xure r Date:.=S— J
Date b" - 3 -/C,
OWNER-BUILDER DECLARATION
hereby affirm
RL-ROOFS:
All roofs s hall be inspected prior to any roofing material being installed.If a roof is
that I am exempt from the Contractor's License Law for one of installed%ithout first obtaining an inspection,I agree to remove all new materials for
he following two reasons:
as owner of the roe inspection
P P rty,or my employees with wages as their sole compensation,
rill do the work,and the stricture is not intended or offered for sale(Sec.7044,
Signature(f Applicant:
Business&Professions Code) Date:
as owner of the property,am exclusively contracting with licensed contractors to
)nstruct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
Aarations: HAZARDOUS MATERIALS DISCLOSURE
lave and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
�mpensation,as provided for by Section 3700 of the Labor Code,for the California l Iealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
rformance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
ave and will maintain Worker's Compensation Insurance,as provided for by Additionad(- should
Safety Code,Section 25532(a)should I store or handle hazardous material.
;tion 3700 of the Labor Code,for the performance of the work for which this
' equipment or devices which emit hazardous air
Mit is issued. contaminan's as de ed by the Bay Area Air
:rtify that in the performance of the work for which this permit is issued,I shall maintain r► Quality Management District I will
p ce With the Cupertino Municipal Code,Chapter 9.12 and the
Y person in an manner so as to become subject to the Worker's Health Safe ode,Sections 25505,25533,and 25534.
employan y
npensation laws of California. If,after making this certificate of exemption,I O mer
)me subject to the Worker's Compensation provisions of the Labor Code,I must onzed agent:
hwith comply with such provisions or this permit shall be deemed revoked. Date: - ? C%
"-/
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirr r that there is a construction lending agency for the performance of work's
tify that I have read this application and state that the above information is ,
V.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
iilding construction,and hereby authorize representatives of this city to enter Lender's Nan ier
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
.reify and keep harmless t ity of Cupertino against liabilities,judgments,
,and expenses w ccrue against said City in consequence of the
ing of this p t.A rt' nally,the applicant understands and will comply ARCHITECT'S DECLARATION
X11 n - urc lations per the Cupertino Municipal Code,Section I understand m. plans shall be used as public records.
.ure ,.� LicensedProfcssional
Date ^" 3'-1 C
CITY OF CUPERTIIO
OPERATOR: patg
PERMIT RECEIPT COPY # 1
4 ITEMS OF 30
: Rng: Sub: Blk: Lot:
Twp
Sec: 36932038 •00
APN
08/03/2010
DATE ISSUED. • " ; BS000011064
RECEIPT #• • • . . . . 10080007
REFERENCE ID #
SITE ADDRESS . . . . . : 20092 ROI)RIGUES AVE
SUBDIVISION CUPERTINO
CITY . . . . . . . . . . . .
IMPACT AREA • '
MICHELIS FAMILY LIMITED PARTNE
OWNER • • • • • " " 20092 RCDRIGUES AVE
ADDRESS . . . . . . . CUPERTIr(O, CA 95014
CITY/STATE/ZIP INC
RANDO AAA HVAC, 8050
RECEIVED FROM • 1�ND0 UJIM LIC #
CONTRACTOR RAN
FRNACE a AIR CONDITIONING
COMPANY " " 1712 STONE AVE
ADDRESS " " SAN JOSE, CA 95125
CITY/STATE/ZIP (408) 253-4717
TELEPHONE • • • • "
THIS REC NEW BAL
QUANTITY AMOUNT PD_TO_DT- ---- ---- ----------
UNIT ___-- ----- - 1.00 0 .00
FEE ID ------- ---------- 1 .00 0 .00 0 .00
------- - 3, 840 .00 0 .00 63 .00 0 .00
VALUATION 1. 00 63 '00 0 .00 42 .00
1BCBSC 42 .00 42 .00 0 .00
1BREMAIRHA NO.UNITS 1.00 0 .00 ----------
FLAT RATE 1.00 42 .00 --
1MPERMITFE FLAT RATE __--- ----- '--------- ----148 .00 0 .00
1TRp,VDOC =.48 .00 0 .00
TOTAL PERMIT : DESCRIPTION
VOICE ID -------------------
DESCRIPTION -__----- ---
VOICE ID__ MECHANICAL
___--- ---_-____ 303 ROUGH
301 ROUGH PLUMBING 501 FINAL ELECTRICAL ENERGY
304 ROUGH ELECTRICAL 503 FINAL MECHANICAL ENERGY
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $3,840- 1
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
.-----TPRIMARY APPLICATION 1 RMAP2
USE: SFD or Duplex �� �� TYPE:
as
O �
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 $63
TOTALS: $63.00
Mech.Plan Check 0.01 hrs 1 $0.00 ,r
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00
NOTE. Theseees are based on the preliminary in ormation available c nd are onl o.
an estimate. Contact the Dept or addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ef: 7,,'1i09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $63.00
PME Permit Fee: $42.00
Work Without Permit? Yes No $0.00
Travel Documentation Fee: ITRAVDOC $42.00 i
Select an Administrative Item
131dc;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $148.00 $0.00 Tt3TAL:FEEs $148.00
Revised: 7/27/2010
CITY OF
CIJPERTINO ��-��� �-7
=�
FURNACE/AC
CITY OF
PERMIT APPLICATION FORM
CUPEkTINO
Date:
Building Address:o,. C)O9 Z e i
�P��honeOwner's Name: p9 -3 1 3 _-
i L� I s 9
1 Phone #: �!>j -� 3 7
Contractor: y��Q� jl-t//.�- � /��" /��°.N�t c2
Fax #: 40 1? -,9
-- Cupertino Business License #'
Contractor License#: '� (� 'i' -7
Phone #: 1-1G4S-c�L Q'3 - 11
jq
Contact: _ -z e r-
Fax #: 3 X-77—/
Elect
ermit Info:
Plumb _ Mech
Commercial
Residential I pi
Job Description: R cUy\� C
For Residential Installations: 2nd floor ❑
Attic ❑ 1 S` floor [�
Adhere to minimum setback requirement -
For Commercial Installations:
f�dditional weight (structural calcs) E]Replacement same weight ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required eof❑ Con;tructi (Usage Class):
Cost of Project: 3&00-00
Wp (/
Strapped On Platform .-
Bonded New Location Replacement
Project Size: Express Standard ❑ Lar c ❑ Major ❑ --
Valuation:.>i����. _
Green Building: Please complete relevant portion c f the Green Building Checklist & attach it to the
application or if applicable, incluc a in plan set & the sheet index.
-- Revised 01/07/09
M.Indoor Air Uuality and Rinllsensn��� _
1.Use Low/No-VOC Paint F
2.Use Low VOC,Water-Based Wood Finishes 1 !AQ/Health pts y=yes
0
3.Use LowLow/No21AQ/Health is o VOC Adhesives p y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 IAQ/Health pts y=yes
5.Use Engineered Sheet Goods with no added Urea 3 Resource pts y=yes 0
Formaldehyde
6.Use Exterior Grade Plywood for Interior Uses 6 IAQ/Health pts y=yes
es=y0
7.Seal all Exposed Particleboard or MDF � 1 IAQ/Health pts y 0
8.Use FSC Certified Materials for Interior Finish 4 IAQ/Health pts y_yes
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts =yeS y_yes 0
I Resource pts y 0
10.Install Whole House Vacuum System 0
3 IAQ/Health pts y=yes
. 0
N.Flooring � � F
I.Select FSC Certified Wood Flooring
2.Use Rapidly Renewable Flooring Materials 3:3esource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 i resource pts y=yes
0
4,Install Natural Linoleum in Place of Vinyl 4 r^esource pts y-yes
0
5.Use Exposed Concrete as Finished Floor 5 I asourc'%Q/Health pts y=yeS
6.Install Recycled Content Carpet with Low VOCs 4 Fasource pts y=yes
4 Resource pts y=yeS 0
. 0
t 0
Total Points Available:
140
Total P130 57
oints Pro'ect Received:
0 0 0
G:data/progs% re dir gguidelines/remodelem/grer,,,t�fina 2.12.04profected.xls
Community Development
10300 Torre Avenue
3` Cupertino CA 95014
AL
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPERTINO
Build in Department
JOB ADDRESS: ;?OC> z Ro c,l r 5 ues A-uL PERMIT #�`\
OWNER'S NAME: ,'C h e I, PA94 n of s n ,p PHONE # - 3)3, ,323I
GENERAL CONTRACTOR: u,-iva C,-e FAX #
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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Me
Sh oc
COwner/Contr for Signature Date