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11110042
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20187 NORTHBROOK SQ CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11110042 CONDITIONING OWNER'S NAME: GRAVER NORMA L 1712 STONE AVE. DATE ISSUED: 11/08/2011 R'S PHONE: 4082557617 SAN JOSE,CA 95125 PHONE NO:(408)2974717 ❑ L C SED CO TRACTOR'S DECLARATION r r r 7 6q �Q BUILDING PERMIT 1 r0: BLDG ELECT PLUMB r License Class i Lic.q v rL, MECH RESIDENTIAL COMMERCIAL Contractor �T/1 �C��'C-� Date � �.0�( hereby affirm that 1 am licensed under the provisio s of Chapter 9 JOB DESCRIPTION: REMOVE&REPLACE FURNACE AT SAME LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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.F1 Floor Area: Valuation:$2618 1 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. APN Number:31639030.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 18ODAYSFROMLASTCALLEDINSPECTION. 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 al source regulations per the Cupertino Municipal Code,Section . Issued by _ Dater:/� 9. C/ f Signature Date RF.-ROOFS: OWNER-BUILDER DECLARATION All roofs 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 1 hereby affirm that l am exempt from the Contractor's License Law for one of inspection, the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A",OR BETTER construct the project(Sce.7044,Business&Professions Code). I hereby affirm under penalty or perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safely Code,Section 25532(x)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the e y I certify that in the performance of the work for which this perm[is issued,I shall HSafelCode,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or nth agent: Compensation laws of California, If,after making this certificate ofexempti n,I Date: 24 Ct 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. CONSTRUCTION LENDING AGENCY I hereby affirm then there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and stale laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the r„ ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31639030. 00 DATE ISSUED. . . . . . . : 11/08/2011 RECEIPT #. . . . . . . . . : BS000015262 REFERENCE ID # . . . : 11110042 SITE ADDRESS . . . . . : 20187 NORTHBROOK SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GRAVER NORMA L ADDRESS . . . . . . . . . . : 20187 NORTHBROOK SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0501 RECEIVED FROM . . . . : RANDO AAA HVAC, INC CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 293-4717 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- lADMIN HOURS 1. 00 41. 00 0.00 41. 00 0 . 00 1BCBSC VALUATION 2, 618 . 00 1 . 00 0.00 1.00 0. 00 1BSEISMICR VALUATION 2, 618 . 00 0.50 0.00 0.50 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 1TRAVDOC FLAT RATE 1. 00 44.00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260.50 0. 00 260.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 521. 00 #39331 --------------- TOTAL RECEIPT 521. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • I � lluc) '4Z �Q GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MEP uVu tl tl 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ® CUPERTINO (408)777-32288 - FAX(408) 777.3333 •buildingacupertino.Gra n LJPLUN®A'G [ MCHANTCAL ❑ELECL?2:CAL ❑MISCELLANEOUS PROJECT ADORESS c'26 43'1 North 3roulc .5'.1 OWNER NAh1E A' Je✓ PHONE SREETADORESSI aYb(01 p(44,, 13rao,<- S Lu -293-& 77/ CONTACF caro C�qr b E.MAII I STREET ADDRESS CITY.�1 a93—N)/7 9-Q-A19�1 - a STAP.v . cc� I / ,L ZIP S)riho r4�; // Sc1 oSc Ck q f7 i; FoB 29 3- 6 7-71 ❑OWNER ClOWNER-BUILDER C1 OWNER AGENT Ll CpNfR Mk ❑CONTR Mk AGENT ❑ ARCHRECr ❑ ENGNEEa ❑ OEvcLOPER ❑TENANT CONIAACTOR NAME LICENSE NIR.tEER rFva / LICENSE M�C 2 o BUS.L C q COWANY Nk� Af}'F1 1 r-A.),? e.e %L� 4AA - uY-/va . cc41 -24 -(07 7 STREET AODRFSS � CTfY,STATE• PHONE S n o ICe\ -2- -7 AAC}{rIECT/ENGINEEA NAh@ LICENSEN LhER. EUS.L:C 4 COWANY NAME E-MAIL FA S"REET ADDRESS CRY,STATE,ZIP PHONE USE OF PD or Duplex ❑ IvIulti-Faraily PROJECT IN WE.DLAND PROJECT IN MUC7URE: ❑ Corrunercial UR BAN INTERFACE AREA ❑ Yes ❑ No noon zci ❑ Yes ❑ No DESCRIFRON OF WORK vh6v)e J enc /Ns r Nu.v So " TOTAL VuUAnOri: a.�e I fj•O U nece'Di a� m' Vic', - ''" .: `• 'nom•'"- „` By my signature below,I certify t9PLENg1;ENTA : I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I t. f have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws r n. I authorize representatives of Cupertino to enter the above identified property for inspection purposes. Signuture of ApplicanUAgent. Date: S TION REQUIRED X_ ..,, unm-.r,=.,•-. ..-.. df� � ,b(EPMisr4pp_7011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION . ADDRESS: 20187 north brook square DATE: 11/08/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$2,618 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK remove and replace furnace at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Plumb. Flan Check tsler.Plau Chea, Mech.Permit Fee: 1MPERM/T Plumb. P0 Mil Fre: flee. Carnal Fee: • Other Mech.Insp. 0.0 hrs $44.00 Odwr Plumb hr p. Orher Eh.c. lucp. Heck lnvp Fee: Ptwnt:. Lrap,t-'ed: /sler.Inv). Pyre: NOTE:This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelindua Information available and are oniv an estimate. Contact the De I or addu7Into, FEE ITEMS (Fee Resolution 11-053 EII 7/1/11) FEE QTY/FEE MISC ITEMS Plan Che<;k Fee:: Suppl. 11CFcre PME Plan Check: $0.00 Pt:rmit Fee, Suppl, Lisp Fee 77 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction n7.v Administrative Fee: (ADMIN $41.00 Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fans: Travel Documentation Fee: ITRAVDOC $44.00 Shone Motion Fee: 1BSEISM1CR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.501 $0.001 TOTAL FEE: 1 $260.50 Revised: 10/01/2011 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 JOBADDRESS: SO ( g or CeoC 5 dA rt PERMIT# G 0 Ll( OWNER'S NAME: orNMA rA r PHONE# O 2 3 �( GENERAL CONTRACTOR: AJA ✓rA14C-t BUSINESS LICENSE# S of ADDRESS: 'q (2 S'{ e v e CITY/ZIPCODE: SA,--)So-7-2 CA `?S *Our municipal code requires all businesses working 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. G�l I am not using any subcontractors: ✓ 20 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20187 NORTHBROOK SQ CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11110042 CONDITIONING OWNER'S NAME: GRAVER NORMA L 1712 STONE AVE. DATE ISSUED: 11/08/2011 R'S PHONE: 4082557617 SAN JOSE,CA 95125 PHONE NO:(408)2974717 ❑ L C SED CO TRACTOR'S DECLARATION r r r 7 6q �Q BUILDING PERMIT 1 r0: BLDG ELECT PLUMB r License Class i Lic.q v rL, MECH RESIDENTIAL COMMERCIAL Contractor �T/1 �C��'C-� Date � �.0�( hereby affirm that 1 am licensed under the provisio s of Chapter 9 JOB DESCRIPTION: REMOVE&REPLACE FURNACE AT SAME LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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.F1 Floor Area: Valuation:$2618 1 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. APN Number:31639030.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 18ODAYSFROMLASTCALLEDINSPECTION. 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 al source regulations per the Cupertino Municipal Code,Section . Issued by _ Dater:/� 9. C/ f Signature Date RF.-ROOFS: OWNER-BUILDER DECLARATION All roofs 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 1 hereby affirm that l am exempt from the Contractor's License Law for one of inspection, the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A",OR BETTER construct the project(Sce.7044,Business&Professions Code). I hereby affirm under penalty or perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safely Code,Section 25532(x)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the e y I certify that in the performance of the work for which this perm[is issued,I shall HSafelCode,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or nth agent: Compensation laws of California, If,after making this certificate ofexempti n,I Date: 24 Ct 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. CONSTRUCTION LENDING AGENCY I hereby affirm then there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and stale laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the r„ ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31639030. 00 DATE ISSUED. . . . . . . : 11/08/2011 RECEIPT #. . . . . . . . . : BS000015262 REFERENCE ID # . . . : 11110042 SITE ADDRESS . . . . . : 20187 NORTHBROOK SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GRAVER NORMA L ADDRESS . . . . . . . . . . : 20187 NORTHBROOK SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0501 RECEIVED FROM . . . . : RANDO AAA HVAC, INC CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050 COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING ADDRESS . . . . . . . . . . : 1712 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 293-4717 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- lADMIN HOURS 1. 00 41. 00 0.00 41. 00 0 . 00 1BCBSC VALUATION 2, 618 . 00 1 . 00 0.00 1.00 0. 00 1BSEISMICR VALUATION 2, 618 . 00 0.50 0.00 0.50 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 1TRAVDOC FLAT RATE 1. 00 44.00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260.50 0. 00 260.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 521. 00 #39331 --------------- TOTAL RECEIPT 521. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • I � lluc) '4Z �Q GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MEP uVu tl tl 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ® CUPERTINO (408)777-32288 - FAX(408) 777.3333 •buildingacupertino.Gra n LJPLUN®A'G [ MCHANTCAL ❑ELECL?2:CAL ❑MISCELLANEOUS PROJECT ADORESS c'26 43'1 North 3roulc .5'.1 OWNER NAh1E A' Je✓ PHONE SREETADORESSI aYb(01 p(44,, 13rao,<- S Lu -293-& 77/ CONTACF caro C�qr b E.MAII I STREET ADDRESS CITY.�1 a93—N)/7 9-Q-A19�1 - a STAP.v . cc� I / ,L ZIP S)riho r4�; // Sc1 oSc Ck q f7 i; FoB 29 3- 6 7-71 ❑OWNER ClOWNER-BUILDER C1 OWNER AGENT Ll CpNfR Mk ❑CONTR Mk AGENT ❑ ARCHRECr ❑ ENGNEEa ❑ OEvcLOPER ❑TENANT CONIAACTOR NAME LICENSE NIR.tEER rFva / LICENSE M�C 2 o BUS.L C q COWANY Nk� Af}'F1 1 r-A.),? e.e %L� 4AA - uY-/va . cc41 -24 -(07 7 STREET AODRFSS � CTfY,STATE• PHONE S n o ICe\ -2- -7 AAC}{rIECT/ENGINEEA NAh@ LICENSEN LhER. EUS.L:C 4 COWANY NAME E-MAIL FA S"REET ADDRESS CRY,STATE,ZIP PHONE USE OF PD or Duplex ❑ IvIulti-Faraily PROJECT IN WE.DLAND PROJECT IN MUC7URE: ❑ Corrunercial UR BAN INTERFACE AREA ❑ Yes ❑ No noon zci ❑ Yes ❑ No DESCRIFRON OF WORK vh6v)e J enc /Ns r Nu.v So " TOTAL VuUAnOri: a.�e I fj•O U nece'Di a� m' Vic', - ''" .: `• 'nom•'"- „` By my signature below,I certify t9PLENg1;ENTA : I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I t. f have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws r n. I authorize representatives of Cupertino to enter the above identified property for inspection purposes. Signuture of ApplicanUAgent. Date: S TION REQUIRED X_ ..,, unm-.r,=.,•-. ..-.. df� � ,b(EPMisr4pp_7011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION . ADDRESS: 20187 north brook square DATE: 11/08/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$2,618 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK remove and replace furnace at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Plumb. Flan Check tsler.Plau Chea, Mech.Permit Fee: 1MPERM/T Plumb. P0 Mil Fre: flee. Carnal Fee: • Other Mech.Insp. 0.0 hrs $44.00 Odwr Plumb hr p. Orher Eh.c. lucp. Heck lnvp Fee: Ptwnt:. Lrap,t-'ed: /sler.Inv). Pyre: NOTE:This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelindua Information available and are oniv an estimate. Contact the De I or addu7Into, FEE ITEMS (Fee Resolution 11-053 EII 7/1/11) FEE QTY/FEE MISC ITEMS Plan Che<;k Fee:: Suppl. 11CFcre PME Plan Check: $0.00 Pt:rmit Fee, Suppl, Lisp Fee 77 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction n7.v Administrative Fee: (ADMIN $41.00 Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fans: Travel Documentation Fee: ITRAVDOC $44.00 Shone Motion Fee: 1BSEISM1CR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.501 $0.001 TOTAL FEE: 1 $260.50 Revised: 10/01/2011 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 JOBADDRESS: SO ( g or CeoC 5 dA rt PERMIT# G 0 Ll( OWNER'S NAME: orNMA rA r PHONE# O 2 3 �( GENERAL CONTRACTOR: AJA ✓rA14C-t BUSINESS LICENSE# S of ADDRESS: 'q (2 S'{ e v e CITY/ZIPCODE: SA,--)So-7-2 CA `?S *Our municipal code requires all businesses working 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. G�l I am not using any subcontractors: ✓ 20 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date