10050074 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19717 LA MAR DR CONTRACTOR:KESTER HEATING AND PERMIT NO: 10050074
AIR CONDITIONING
671 ALDO AVE STE 19 DATE ISSUED:05!07/2010
,)WNER'S NAME: TOSH YOKI PHONE NO:(408)265-1103
SANT a CLARA,CA 95054
-oWNER'S PHONE: 4084891744
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
���L� REMOVE AND REPLACE FURNACE AND A/C UNIT
License Class 0——2 CR Lic.#
Contractor l��'J� " Date--51-7— —LCO
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:$7100
performance of the work for which this permit is issued.
Sq.F t Floor Area:
I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type:
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36910021.00
permit is issued.
APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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
N.
upon the above mentioned property for inspection purposes.against liabilities judgments, 180 DAYS FROM LAST CALLED INSPECTIO
indemnify and keep harmless the City of Cupertino Date:
costs,and expenses which may accrue against said City in consequence of the Isst ed by:
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. RE-ROOFS:
- Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
move all new materials for
Signatureinstilled without first obtaining an inspection,I agree to re
inspection.
❑ OWNER-BUILDER DECLARATION Sig iature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to Chapter
construct the project(Sec.7044,Business&Professions Code). Ci hforn a Health&Safety Code,aSections 25505,ls 2553 ,and 25534.9he
ave read the hazardous m
1 will
al
er 9.12
I hereby affirm under penalty of perjury one of the following three mAntarn compliance with the Cupertino&Safety Code,Section 25532(a)should Istore oor handle thazardoud the
H4!althwhich
declarations:
I have and will maintain a CertificateSection 3lLaborrCodeVfor the s ai-contain nants as defined by the Bay uAr ipmaeAir Quality ManagementDistrict I
Compensation,as provided 700 of the
y w II maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued. the Health&Safety Code,Sections 2 O5,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by Date: r!
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
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 v ork b for which thirm that s permit is issued(Sec.309ere is a construction 7,Civ C.)
for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. I coder's Name
APPLICANT CERTIFICATION bender'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 relating
to building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION
,on the above mentioned property for inspection purposes.(We)agree to save
emnify and keep harmless the City of Cupertino against liabilities,judgments,
�,osts,and expenses which may accrue against said City in consequence of the 1 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 .icensed Professional
9.18.
Signature
Date
CITY OF CUPERTINO
8 ITEMS OF 16 PERMIT REC]?,IPT OPERATOR: SylviaM
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lo-_:
APN 3691002L. 00
DATE ISSUED. . . . . . . : 05/07/2D10
RECEIPT # . . . . . . . . . BS000013350
REFERENCE ID # 10050074
SITE ADDRESS 19717 LA MAR DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER TOSH YCKI
ADDRESS 19717 LA MAR DR
CITY/STATE/ZIP CUPERTINO, CA 95014-3308
RECEIVED FROM . . . . : DAVID RESTER
CONTRACTOR KESTER, DAVID M LIC # 22101
COMPANY KESTER HEATING AND AIR CONDITI
ADDRESS 671 ALLO AVE STE 19
CITY/STATE/ZIP . . . : SANTA C'LARA, CA 95054
TELEPHONE (408) 2( 5-1103
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ------ ---- --------
1BCBSC VALUATION 7, 100 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BREMAIRHA NO.UNITS 1 . 00 (.3 . 00 0 . 00 63 . 00 0 . 00
1BSEISMICR VALUATION 7, 100 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1EPERMITFE FLAT RATE 1 .00 <<2 . 00 0 . 00 42 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00
1PPERMITFE FLAT RATE 1 .00 62 . 00 0 .00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 0042 . 00 0_00
---- - ---
TOTAL PERMIT
2 )5 . 80 0 . 00 295 . 80 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
CUPEI�T
T INO PERMIT APPLICATION FORM
lil
6 1 Date:
Building Address:
Phone#:
Owner's Name:_
�t 4 C V-- Phone#: 01 ►2.z
Contractor:
Fax Z
Cupertino Business License#:
Contractor License#:
Phone#: Cw=12-
Contact:
Fax#: �
Building Permit Info:
Elect❑ Plumb Mech 8—
Residential ❑ Commercial ❑
Job Description: _ �,
For Residential Installations:
1 S` floor 2 n floor ElAttic ❑ -
Adhere to minimum setback requirement El-
For
For Commercial Installations:
Ac.ditional weight(structural calcs)
Replacement same weight ❑ ❑
Structural Calculations required for new installation []
New installation Planning Approval RequireedEl
pe0 Const action (Usage Class):
Cost of Project:
Strapped ❑ On Platform Bonded ] New Location LJ Replacement ❑
Project Size: Express ❑ Standard❑ Lar e ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
E.
or if applicable, include in plan set & the sheet index.
Revised 01/07/09
CITY OF CUPERTINO
V
'` FURNACE,'AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repair/Alt,-ration/Add to M
ea heating appliance,ref igeration unit,
cooling unit,absorption anit,or ea
heating,cooling,absorpti on or
evaporative cooling sys;em,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,relhgeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporati-ve cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping sy.,tem of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appl.ance vent
installed ¬ incl in yin appliance
permit.
1BC13SC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/Alt,-ration/Add to _ M
ea heating appliance,re:frigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit he,,Lter.
CITY OF CU PERTINO
;�SIM
FURNA(�E/AC
CITY Of
CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
IMRAPPVNT Residential for the install/relocate/or M
replacement of ea a?pliance vent
install & not incl in an appl permit.
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas pipi:ig system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Residential Seismic, B
1MECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace Syst<=1 C Ok BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 B tu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, inclducts/vents '
attached to such appliance over
100,000 Btu/h
j IEPERMITFEE Electric Permit Fee E
i 1MPERMITFEE Mechanical Permit Fee - M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
CITY OF CUPE,RTINO
a FURNACE/AC
OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units 10k CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. CommiResid
1BREMAIRHAN Residential A/C units<= IOk CFM B
1MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
M.Indoor Air Ouallity and Finishes
1.Use LowiND-VOC Paint 1 IAQ/HE alth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/HE alth pts y=yes 0
3.Use Low/14o VOC Adhesives 3 IAQ/HE alth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resou-ce pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/HE:alth pts y=yes 0
0
7.Seal all EVosed Parficleboard or MDF 4 IAQ/Hl:alth. pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Hoalth pts y=yes
8.Use FSC Certified Materials for Interior Finish 4 Resou,ce 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/f-ealth pts y=yes 1 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resour;e pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resour;e pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resour;e pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HE.alth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resour;e pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resour,-e pts y=yes 0
i 1 1
Total Points Available: 1 140 130 57
Total Points Project Received: 01 01 0
G:data/progs/greenbuildingg jidelines/remodelers/greenpointsfmal2.12.D4protected.xls
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: t"Lk\ l PERMIT# C C cJ �7
OWNER'S NAME: b }N2-t)Ft
• ,;t„��,�,p_. PHONE# '� �
GENERAL CONTRACTOR: ? S`'r,�2 )J 4 �-- BUSINESS LICENSE#
ADDRESS: �7 i�om 19 `�C �A 55��`t CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
EULED UNTIL THE
NO BUILDING FINAL OR FINAL OCCUPANCY
ION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS
BUSINESS LICENSE. —10
I am not using any subcontractors: ' Date
Signature
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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
--73caner/ ontractor Signature Date