11110117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10525 PINEVILLE AVE CONTRACTOR:DUNRITE HEATING&AIR PERMIT NO: 11110117
INC
OWNER'S NAME: ROUTH RICHARD R AND SHEILA P 26700 SOQUEL SAN JOSE RD DATE ISSUED: 11222011
f R'S PHONE: 4086402461 LOS GATOS,CA 95033 PHONE NO:(408)3514900
LICENSED CONTRACTOR'S DECLARATION r r r.
'76
�/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class L - 2 d Lia N ( 6 � / 3 Z' r r r
MECH RESIDENTIAL COMMERCIAL
Contractor &f.4'Of %/ IZClC Date /l- 12
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: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.
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. Sq.Ft Floor Area: Valuation:$2150
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:36913027.00 Occupancy Type:
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 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, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which ay accrue against said City in consequence of the -rte
granting o this permit. dditi the Cupertino
understands and will comply / / 2Lt
with all non-po t sou ere ti s the Cupertino Municipal Code,Section Issued by: Date:
9.18.
Signature Date
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,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(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I 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. Safety Code,Section 25532(a)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I 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 I will
Join
compl ce th the Cupertino Municipal Code,Chapter 9.12 and the
main
permit is issued. Health&Saf "OF,Sections 25505,25533,and 25534.
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 O
Compensation laws of California. If,after making this certificate of exemption,I Date: !�
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 that 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 1 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 state 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
i mfy and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
d expenses which may accrue against said City in consequence of the
ng 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
a _
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913027. 00
DATE ISSUED. . . . . . . : 11/22/2011
RECEIPT 4. . . . . . . . . : BS000015374
REFERENCE ID # . . . : 11110117
SITE ADDRESS . . . . . : 10525 PINEVILLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROUTH RICHARD R AND SHEILA P
ADDRESS . . . . . . . . . . : 10525 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4528
RECEIVED FROM . . . . : DUNRITE HEATING&AIR
CONTRACTOR . . . . . . . : MICHAEL WOOD LIC # 33033
COMPANY . . . . . . . . . . : DUNRITE HEATING & AIR INC
ADDRESS . . . . . . . . . . : 26700 SOQUEL SAN JOSE RD
CITY/STATE/ZIP . . . : LOS GATOS, CA 95033
TELEPHONE . . . . . . . . : (408) 353-4900
• 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 2, 150 .00 1.00 0. 00 1 .00 0. 00
IBSEISMICR VALUATION 2, 150 .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 260.50 #1119
---------------
TOTAL RECEIPT 260. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M I
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•CUPERTINO (408)777-3228 • FAX(408)T77-3333• buildinaC�cuoertino.oro
PLUMBINGMECHANICAL EIT717CIRICAL CIMISCEIANEOUS
PAODiCf ADpRESS
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OWNER NAME q/ D O 4 PHONE
STREETADDRESS 'S CRY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREETADDRESS ,� CCIY,STATE,ZtP FAX
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INC, ❑C MMERaAL URBAN NTERFACE AREA ❑ NO IFLOOD TONE ❑NO EICHIFR HOME? ❑NO
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TOTAL VALUATION: ( c a �' RECEIVED BY: J /
By my signature below,I certify to each of the following: m I athe property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I have provided is correct.) read th&Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildiD cons on. uthori tatives of Cupertino to cater the above-iiddentif!d pro erty for inspection y4oses.
Signature ofApplicandAgcaN- Date: /L 7 �i
SUPPLEMENTAL INFORMATION REQu ED OFFIIOVER-THCE USE ONLY
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❑ MAJOR
MF-PMtrcApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10525 pineville DATE: 11/22/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $2,150
"PERMIT TYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration/Addition / Repair
PRIMARY SFD Of DU IBX PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK a lace furnace at same location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: 1 $130.00
Mech. Plan Check 0,0 hrs $0.00 Plm„Ih. Phan Check Flee.Plan Chuck
Mech.Permit Fee: IMPERMIT Plumh.Permit Fee: Elea Permlt Fev:
• Other Mech.Insp. 0.0 Ins L $44.00 Other Phtmh Inap. 011ier filer. lrpp.
Ouch.Lave. Fee: 1'Lurih. Imp. Fee: lilmr.Lwp. lee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prellmina Information available and are only an estimate. Contact the Det for tuldn'l in o.
FEE ITEMS (Fee Resolution 11-0531 . 711111) FEE QTY/FEE MISC ITEMS
1'14111 Chock. I'ue:
Supp/. PC Fee
PME Plan Check: $0.00
Permit Fee:
S'erppl. LsspFec
PME Unit Fee: $130.00
PME Permit Fee: $44.00
Construction Tax
Administrative Fee: IADMIN $41.00
Work Without Permit? O Yes (E) No $0.00
Advanced Planning/,'eeac:
Travel Documentation Fee: ITRAVDOC $44.00
Strom;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: 1 $260.501 $0.001 TOTAL FEE: $260.50
Revised: 10/01/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: /o$ r /0; 'r 0 .; e-CZPERMIT#
OWNER'SNAME: ; .04- "`7 /?cc. ! PHONE# 3S
GENERAL CONTRACTOR: Oc4 . 4,'re &cXL BUSINESS LICENSE#
ADDRESS: 2 6 c o .� c, S. T. /z CITY/ZIPCODE: Lorr%—s 9Ir=2 2
*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 SUBCO RA ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
j/ 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
Z-
Owner/ ontractor Signature Date