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11110128 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6367 MYRTLEWOOD DR CONTRACTOR'. _ PERMIT NO: 11110128 OWNER'S NAME: CHEN YUAN-SHIN AND HUNG WAN-YU ,S .t 4-Ae— DATE ISSUED: 11/22/2011 O NER'S PHONE: 5105997194 1 PHONE NO: LICENSED CONTRACTOR'S DECLARATION (- r r /, BUILDING PERMIT INFO: BLDG ELECT " PLUMB License Class G' 7-0 Lie.# !06098719 MECH r RESIDENTIAL r COMMERCIAL ri Contractor 45916 ///1// Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPAIR FURNACE&RELOCATE TO ATTIC REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions DUCT Code and that my license is in full force and effect., WORK 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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 Floor Area: Valuation:$6500 permit is issued. APPLICANT CERTIFICATION APN Number:36917002.00 Occupancy Type: 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 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9,18. Signature140?f Date ZZ �� Issued by: OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that l am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the fallowing two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I stare or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as de0ned by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this cenificate of exemption,I '/� become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized aggar-� forthwith comply with such provisions or this permit shall be deemed revoked. ,/� Date- APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 0allend expenses which may accrue against said City in consequence of the g of this permit Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional • CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36917002.00 DATE ISSUED. . . . . . . : 11/22/2011 RECEIPT #. . . . . . . . . : BS000015383 REFERENCE ID # . . . : 11110128 SITE ADDRESS . . . . . : 6367 MYRTLEWOOD DR SUBDIVISION . . . . . . . ' CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHEN YUAN-SHIH AND HUNG WAN-YU ADDRESS . . . . . . . . . . : 6367 MYRTLEWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ABS HEATING & AIR C CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : 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 6, 500. 00 1.00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 6, 500. 00 0.65 0. 00 0 .65 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 1MRRAA UNITS 1. 00 65. 00 0. 00 65 .00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 325.65 0 . 00 325 .65 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 325.65 VISA --------------- TOTAL RECEIPT 325 .65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION • ADDRESS: 6367 myrtlewood dr. DATE: 11/22/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $6,500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK relocate furnace add new duct work throughout sfd. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 Heating System 1MRRAA 1 # $65 TOTALS: $195.00 Meeh. Plan Check 0.0 hrs $0.00 11;nnrb_Plan Cluck tile..Plan Mech.Permit Fee: IMPERMIT Plunrb. Paro,it Pke: .Vlec. Perntiz Pere: • Other Meeh. Insp. 0.0 hrs $44.00 Other P1umh hrcp. Other E;er.. Drrn. Mach..Inv). F'ee' Phunb. Imp. Pee, Elec. Inv). Fee, El NOTE: This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelindna information available and are only an estimate. Contact the Dear for addn'l info, FEE ITEMS(Fee Resolution 11-053 Ejj 7/1111) FEE QTY/FEE MISC ITEMS 111an Check Fee: Supptl. P(.:.Fee PME Plan Check: $0.00 Perrnir 1,ce: Suppl. Insp lee PME Unit Fee: $195.00 PME Permit Fee: $44.00 Construction lits Administrative Fee: (ADMIN $41.00 Work Without Permit? Yes (E) No $0.00 A,h1Mnced Planning Fees: Travel Documentation Fee: 1TRAVDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item • Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $325.65 $0.001 TOTAL FEE: $325.65 Revised: 10/01/2011 I I i 0 zg GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 M I •CUPERTINO (408)777-3228 • FAX(408)777-3333• buildina(Gdcuoertino.org SC UMBING R<CHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS L� APNM OWNER NAME ;!/2Ste/ /9y E-MAIL IJC�` STREETADDRESS � CITY,STATE.ZIP / FAX � FA CONTACT NAME , ` PHONE C•' �/- q/f� E MALI. M• STREETADDRESS33 'T OG� \' CITY,SFATEy Z@ !D FAX OWNER ❑ OWNER-BUILDER. ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARc Enver ❑EscoNEER ❑ OEYFIDPER ❑TENANT CONTRACTOR NAME ) // LICENSE NIIMHEIt�.�. e 70 LICENSE TYPE .ZD BUS.LIC e COMPANYNAME / � _ A-G E-MAIL f7l�9 FAX STREET AnnREss JoQ cm,STATEZ23 eHGNR ARCHITECTIENGINEEINAME LICENSE NUMBER BIDS.IICN G COMPANY NAMEE-MAIL FAX STREET ADDRESS CRY,STATE.ZIP PHONE OF mOUPLEX [3 MULTI-FAMILY PROIECTINWIDIAND ❑ YTS PROJECTIN ❑YTS IS THE BLDG AN ❑YES NO: 13 COMMERCIAL URBAN INTERFACE AREA NO FLWOZONB ❑NO FICHLER HOME? 0 N OESCRIPTJON OF WORK � !i GG ✓G TOTAL VALUATION: 6,152269 RECEIVED BY: ZZ By my signature below,l certify to each of the followft. I am the property owner rn aothoriud agent to act ou the property owner's behalf i have read this application and the information I have provided is correct j have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relaring to buil ' struction. I eatbarize reptesmtatives of Cupa tmo to enter the above-identified property for inspection pullroses. Signature of App6canVAgenn' Dam: ��' SUPPLEMENTAL INFORMATION REQUIRED OFFICE Use ONLY u Ero- -TBE-COUNTeR 6 ❑ EXPRESS Y u m ❑ STANDARD x V ❑ LARCE a. ❑ MAJOR MEPMuc.4pp 2011.doc revised 06/21/11 J _ � a3 8v v ..v_. • v m O 6 - ... . N .. .. __.. _.... .. ... .. IDS C 0 aN I •l"1 p o °' QOM CD A 0 ry C � F, P a . . �. :: �. ... - - � - - - � _ }�'l' - � � - - �' 1 - - p l' — 'o 1 � 1 -- - - - - - - � - 9 - - - - - --- - _ - - - . ?k o _, (r' . . . > . , . _ - - ---. _-- _ __ _ m � � -- -- - - . . � N � �. , . . . .. , � _�.� _ ... � � � ..a � � �,��_,i��.i ,�.,:� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 4%of. PERMIT# /// l2 OWNER'S NAME: 3 PHONE# G30 /7 GENERAL CONTRACTOR: &.,,,� 1 / BUSINESS LICENSE# ADDRESS: 33V N O CITY/ZIPCODE: e2 *Our municipal code requires all businesses workin in the city to have a City of Cupertino 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: V 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 Owner/Contractor Signature Date