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11110077
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10766 CARVER DR CON'T'RACTOR: MACAULAY MARK PERMIT No: 1 11 10077 OWNER'S NAME: MACAULAY MARK 10766 CARVER DR DATE ISSUED: 11/14/2011 OWNER'S PIONE: 4089969239 PIIONE NO: itLICENSED CONTRAC'TOR'S DECLARATION r r r BUILDING PF.I2M1'1-INFO: BLDG ELECT PLUMB License Class Lie.q r r r NIE.C11 RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 .TOB DESCRIPTION: INSTALL'rANKLESS WATI:R Iil:AI*17R&NI:W I'ORCBD (commencing with Section 7000)of Division 3 of the Business&Professions AIRFURNACE Cade and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$11000 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 ANN Number:37532007.00 Occupancy Type. permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA rr' ROM LAST CALLED INSPE TIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the A n`/ granting of this permit. Additionally,the applicant understands and will comply Issued It l Date: N with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. ]('a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: creby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALI,ROOF COVERINGSTO BE CLASS"A"012 Bh:ITER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of flic California Ilcallh&Safety Code,Sections 25505,25533,and 25534. I will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self'-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 2.5505,25533,a 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: I permit is issued. 1 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions ofthe Labor Code,1 must 1 hereby affirm that there is a constriction lending agency Im the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name API'LICAN'1'CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state Imus refiling 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, ARCIIITh:CT'S DECLARATION sts,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. ting of this permit.Additionally,the applicant understands and will comply .h all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. 2 Signature IMAs Date CITY OF CUPERTINO 6 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM • COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37532007 . 00 DATE ISSUED. . . . . . . : 11/14/2011 RECEIPT # . . . . . . . . . : BS000015312 REFERENCE ID # . . . : 11110077 SITE ADDRESS . . . . . : 10766 CARVER DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MACAULAY MARK ADDRESS . . . . . . . . . . : 10766 CARVER DR CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : M. MACAULAY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MACAULAY MARK ADDRESS . . . . . . . . . . : 10766 CARVER DR CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 11, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00 1MFR=<100 UNITS 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1PRWHEATR UNITS 1 . 00 26 . 00 0 . 00 26 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 331 . 10 0 . 00 331 . 10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 331 . 10 2814 --------------- TOTAL RECEIPT 331 . 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION • ADDRESS: 10766 Carver Dr. DATE: 11/14/2011 REVIEWED BY: jsg APN: BP#: *VALUATION: $11,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Install new tankless water heater and new forced air furnace. SCOPE Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 b7ee.Plan Check Mech.Permit Fee: IMPERMIT I Plumb.Permit Fee: IPPERMIT I Elec. Permit fce: • Other Mech. Insp. 0.0 hrs 1 $44.00 Other Plumb Insp. 0.0 hrs 1 $44.00 Or4c, LIZ o Imp. Ej :14x.6.Imp. Pee: Plumb. In"".Per: Elect,Inon. Fee: NOTE: This estimate does not Include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina information avaflable and are onb,an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 1 # Mechanical Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $130.00 IMFR=UOo I Furnace,Forced-Air PME Plan Check: $0.00 = # Plumbing Permit Fee: $0.00 $26.00 1PR ZTR Water Heater Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $88.00 Construction Tin' 777 Administrative Fee: IADMIN $41.00 O Work Without Permit? © Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential t7 Travel Documentation Fee: ITRAVDOC $44.00 Building or Structure Strong;Motion Fee: IBSEISMICR $1.10 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 g . SUBTOTALS: TOTAL F E: $175.10 $156.00 $331.10 Revise 2011 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DM510N MEP 10300 TORRE AVENUE•CUPERTINO, CA 950143255 •CUPERTINO (408)777-3228• FAX(408)777-3333• buildina(Mcuoetno.ora n M ' S f I l ( r / PLUMBING MECHANICAL ELECTRICAL MISc'FtreNr0 us PROJECT A13DRESS 10k(e) .(, ,f _. C 2 `E2 b� �P J�� W?-0U owNER NAAffi V �O A ' I l�/1 o f3C. Mcw,\t cwk Ck Q,lo- �" O ga64a3`> E.mA`XsrAP .,AI_C,Lo ,- mEEraDntFss srAtE gSb14 40 gG6 9 23 CONTACT NAME l ^ 1 /� g M'6 0 M — STAE$TADDREES 5AMC C7,STATE, ZIP-�Skvi( M FAX OWNER ❑ OWNER-BUDDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRA=RAOENT ❑ ARom= ❑EmaINSE: ❑ DEVELOPER ❑VI 1PNANr CONTRACTORNAME--t�j� ' U t10ENSE TYPE UUS.uC0 COMPANY V^u�J-' IA U= F Oi - a244-7 Lf REQ n ► sT � 1° aq� - ra 5 ARCJffT MI NGINEERNAME 110ENSE NUMBER.' BUS.LIC p COMPANY NAMEE-MAIL FAX STREET ADDRESS CrLY,STATE,ZIP PHONE OF ❑SFO wDUPLEX ❑ MUJ.R-PAMD-Y PROIECTIN WILDIAND ❑ YE9 PROIEC'rm 0 YES LS THE BLDG AN ❑YES ELRLDiNO: 13CombmcL1L URBAN WTEAFACE AREA ❑ NO FLOOD ZONE' ❑NO EI31MHOME7 ❑NO DESCRIPTION OF WORK �- L e �vc, h - C E 11 & s c TOTAL VALUATION: 1 RECEJVED BY: By my signatare below,I cm*to each of the following: I an the pmpeM owner or authorized agent to act oo the property awnees bchaZ I have rend this application and the infornadan I have proviIied is correctd have read the Description of Work end v¢ify it is acnsate. I agree to comply with al]applicable local ordinances and state laws relatingIdin consbu d I authoriz entatives of Cuperlme to enter the above- wti£cd pesty far inspection pu@oses. Signattna ofApplicanUAgena' Date: I) 1 13 1 SUPPLEMENTAL INFORMATT QU11LED OFFICE USE ONLY ❑ OYER•THE-COUNTER r ❑ IDWRFSS Y U _ ❑ STANDARD u ❑ LARCE r ❑ MAJOR MEPMuc,4pp 2011.doc revised 06121111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: U at-vs— PERMIT# OWNER'S NAME: G dti PHONE# U q �1 G GENERAL CONTRACTOR: MCS I BUSINESS LICENSE# a 62. qL ADDRESS: QjI CITY/ZIPCODE: 99 S— *Our municipal code requires all businesses working in the city to have a City of Cuperti o business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 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 —✓ �sn 2j� Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering V Plumbing a ` 'f3 AJ I e2tl L4 Roofing Septic Tank Sheet Metal Sheet Rock Tile I1 i3 I �c�O Owner/Cont act r Signature Date