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11120029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22392 ST ANDREWS AVE CONTRACTOR:RESCUE AIR SERVICE PERMIT NO: 11120029 OWNER'S NAME: SMITH STEPHEN M AND SUSIE H 6007 MAJORCA CT DATE ISSUED: 12/05/2011 AQ&NER'S PHONE: 9253723046 SAN JOSE,CA 95120 PHONE NO:(408)655-9916 IF LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class�C Lic.# a'Z.�oZ.a 1 �-•�� C MECH r RESIDENTIAL r COMMERCIAL r Contractorr`—CS�u{+ FC(� Dale �Z�S� � � 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 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. I haveand will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$2000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35603007.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by�y Date• / SignatureDate • OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that l am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for the following two reasons: I,es owner of the roe inspection.p 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec,7044,Business&Professions Cade). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of The work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25.534. 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,I Owner or authorized agent: 1i / ,` become subject to the Worker's Compensation provisions of the Labor Code,I must �'�`s 6.` Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, ccddl n expenses which may accme against said City in consequence of the ARCHITECT'S DECLARATION L g of this permit.Additionally,the applicant understands and will comply wt on-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35603007.00 DATE ISSUED. . . . . . . : 12/05/2011 RECEIPT #. . . . . . . . . : BS000015486 REFERENCE ID # . . . : 11120029 SITE ADDRESS . . . . . : 22392 ST ANDREWS AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SMITH STEPHEN M AND SUSIE H ADDRESS . . . . . . . . . . : 11810 10TH AVE CT NW CITY/STATE/ZIP . . . : GIG HARBOR, WA 98332 RECEIVED FROM . . . . : RESCUE AIR SERVICE CONTRACTOR . . . . . . . : CHUNG H. KIM LIC # 29150 COMPANY . . . . . . . . . . : RESCUE AIR SERVICE ADDRESS 6007 MAJORCA CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (408) 655-9916 • 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, 000 . 00 1. 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 2, 000 . 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • I 1 i Zo CDZ"--( GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 / • CUPERTINO (408)777-322;8- FAX 408)777-3333• buildin cu B ' .o MIs C ; PLMECLHJ.LANICAL EpLECTRICAL.�r MISCELLANEOUS PROJECT ADDRESS r,L^ r �l. APN� r I�2— OO� OWNER NAME 51 V�` R Z.. ��Z � �P-JMAIL STREETADDRESS CITY, STATE,ZIP `J•J� FA% Z_z c C S CONTACT NAME `Ze PHONE E-MAIL STREET ADDRESS�C1 r C[TY STATE.ffi C1�` FAX 323--�5 ❑OwNER ❑ OwNSF.BUDDER ❑ OwNER,mrr CDNTRACJOR ❑CONTRACTOR AGENT ❑ Altair C7 ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r�e C n LICENSE ER LICENSE TYPE BUS.LIC k C 1 Q COMPANYNAME ,C^�G E-MAIL FAX ` J STREET ADDRESS J \ CITY,STATE,Z-? 0'�Sk PHONE—Coss— t+ SS— ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.DC p COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF ❑sm.Dupt.EX [3 MULTI-FAMdY PROJECT IN WEDIAND ❑ YES P0.OIELTIN ❑YES IS THE BLDG AN ❑ YES BURDING: ❑COFNEERCAL URBAN INTERFACE AREA ONO FLOOD ZONE 0N EICHLER.HOMED [3 No DESCRIPTION OF WORK U C ` ` `- ee- TOTAL VALUATION: Z•O 0� Gb RECEIVED BY; By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pmp&rty owner's behalf. I have read this application and the information I have provided is correct have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build�in con/stru�ction. I authorize represenmtives of Cupertino to enter the above-identified property for inspection pul�oses. Signature of Applicant/Agent: c--oi._ Qui Date: 1 2—( S 1 SUPPLEMENTAL INFORMATION REQUIRED OFFICE U E ONLY W OVER-THE-COUNTER 6 ❑ EXPRESS Y V S ❑ STANDARD V 3 ❑ L&RCE e, ❑ AWOR MEPMacApp_2011.dac revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 22392 saint andrews ave. DATE: 12/05/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK install furnace at same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Meeh.Plan Check 0.0 Ins $0.00 PluurG. Plan("beck Elea.Plan C'hcck Mech.Permit Fee: I MPERMIT 111"" . Permit Fee' traac. Pernur Fre: • Other Mech. Insp. Fo.o hrs $44.00 ntlre.Mund;h:p. ONrer Flcr.. Insp. Hoch.Insp. Fee: Plumb. Mvp.Fee: Estee.Insp. Fee: NOTE: This estimate does not Include fees due to other Departments(le.Planning,Public Works,Fire,Sanitary Sewer D1s1ric4 School District,etc. . These fees are based on therelinina information available and are only an estimate. Contact the Dept for addn'I Info. FEE ITEMS(lee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS plan Check Fee: St+ppl. PC'.Fe�e PME Plan Check: $0.00 Permit Fere' suppl. lusp Fee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction 7'c1.v Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes (!) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE: 1 $260.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 !U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: Z PERMIT# OWNER'S NAME: 5 PHONE# _ 31 — GENERAL CONTRACTOR: h BUSINESS LICENSE# Z ADDRESS: (. 0 1 C CITY/ZIPCODE: 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. 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 Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date