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10060036CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: AAA FURNACE &AIR BUILDING ADDRESS: 22028 LINDY LN CONDITIONING 1712 STONE AVE ✓NER'S NAME: TONY THOMAS SAN JOSE, CA 95125 OWNER'S PHONE: 4086859573 JOB DESCRIPTION: RESIDENTIAL[] LICENSED CONTRACTOR'S DECLARATION License Class01%3 C__W c . # Contractor I hereby affirm that 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 ch accrue against said City in consequence of the granting of this p it., di onally, the applicant understands and will comply with all -p ' sourc a lations per the Cupertino Municipal Code, Section 9.18. ' Date atu rtheOWNER -BUILDER DECLARATION ereby affirm that I am exempt from the Contractor's License Law for one of following two reasons: 1, 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). PERMIT NO: 10060036 DATE ISSUED: 06/08/2010 PHONE NO: (408)293-4717 COMMERCIAL INSTALL NEW CONDENSER & COIL, 220 POWOER HOOK JP Sq. Ft door Area: Valuation: $5191 APN 1` umber: 35627007.22028 Occupancy Type: 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. 'ERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issue I by: 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 * ' -gilding construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save 1�,,,emnify 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 Date: RE -ROOFS: All ro ifs 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 inspe4:tion. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hal a read the hazardous materials requirements under Chapter 6.95 of the Cali 'ornia Health & Safety Code, Sections 25505, 25533, and 25534. 1 will main tain compliance with the Cupertino Municipal Code, Ch er 9.12 and the Hea th & Safety Code, Section 25532(a) should I store or ha hazardous mab�rial. Additionally, should I use equipment or devices2d" ch emit hazardous air contaminants as defined by the Bay Area Air Qu 'tynagement District I will maintain compliance with ertino Muni ip e, Chapter 9.12 and the 3ealth & Safety Code, ctioiy 25 5, 25533, n 534. Ow rer or authorized Date: & –k -le CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of woj k's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I u iderstand my plans shall be used as public records. Li,:cnsed Profess CITY Of �UPEINO jOB ADDRESS: as-C7Z� L.inrl-f 1.4n OWNER'S NAME: GENERAL CONTRACTOR. Buildin Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 De artment PERMIT #�v PHONE # rN Com_ FAX # — I am not using any subcontractors: Signati re Please check a licable subcontractors and colets SUBCONTRACTOR BU Cabinets & Millwork Cement Finishing Electrical Excavation Flooring: carpenn Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Septic Tank Sheet eta] Signature Date Date 4 ITEMS OF 4 CITY OF CUPERPINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35627007.22028 DATE ISSUED.......: 06/08/2010 RECEIPT #......... BS000010579 REFERENCE ID # ...: 10060036 SITE ADDRESS .....: 22028 LI9DY LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER TONY THOMAS ADDRESS ..........: 22028 LINDY LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ....: AAA FURNACE CONTRACTOR .......: RANDO, JIM LIC # 8050 COMPANY AAA FURNACE & AIR CONDITIONING ADDRESS 1712 STCNE 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 ---------- 5,191.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 0.00 1BSEISMICR VALUATION 5,191.00 C.60 0.00 0.60 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 10E.60 ---------- 0.00 106.60 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 106.60 --------------- 106.60 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 361E1 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUINO CITY OF C UPERTINO FURNACEAC PERMIT APPLICATION FORM lo6ort)30 APN # Building Address: L'rvi 14 LIR Owner's Name b mC1-- Contractor: P'Prlc� F -u r, Ja C -E! J - A -k- 1 12 S4-c/'^Q- Contractor License #: '7&&k-71 Contact: Dal l G Building Permit Info: Elect L Residential AfU,ey plumb For Residential Installations: Attic ❑ Adhere to minimum setback r, 1 St floor 9 - t Mech 1[ Commercial Date: / 1n ? / Phone #: 46_(� Phone #: 144- 3-1-1 l Fax #: `ybk -99 3 & 7 -7 1 Cupertino Business License #: Phone #: ya f '•2 �� - � y7 /7 Fax #: qo�- zq.3 - 7 -7 / 2nd floor ❑ For Commercial Installations: Additional weight (structural calcs) El Replacement same weight ❑ ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Ccnstruction (Usage Class): `/ 13 Replacement Strapped ❑ On PIattorm U Project Size: Express 2 --Standard Valuation: Bonded or New Location Up 5191 Green Building: Please complete relevant portiorof the GreenBuilding he sheet indexChecklist & attach it to the application or if applicable, include in plan set & t. Revised 01/07/09 'SIRV41-1 CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Un As <= I Ok CFM B 1 MCRAA Commercial Mech R,-pair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea g�.s piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. Comn/Resid P 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M / 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E / 1 MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation. B 1 BUSLIC Business License B 1. Use Low/No-VOC Paint 1 IAC/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAC /Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAC ]Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Re source pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts Formaldehyde is 6 IA(dHealthy_y p es 6. Use Exterior Grade Plywood for Interior Uses 1 IA(VHealth pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IAO /Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 RE source pts y=yes 10. Install Whole House Vacuum System 3 IP Q/Health pts y=yes N. Flooring 1, Select FSC Certified Wood Flooring 8 Re;ource pts y=yes/ 2. Use Rapidly Renewable Flooring Materials 4 Re;ource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Re Source pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 ]&)]Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Re source pts y=yes Total Points Available: Total Points Project Received: X1 1401 130 57 J� G:daWprogslgreenb-Jdingguidelineslremodelerslgreenpointsfinal2.12.04proiected.xls -to