12030062 CITY OF CUPERTINO BUILDING PERMIT
BUILDINCADDRESS: 19472 ROSENIARIE PL CONTRACTOR:BONANZA HEATING&A/C PERDIIT N0: 12030062
OWNER'SNAME: ROSEMARIE ASSOCIATES 10981NDEPENDENCEAVE3A DATE IS';UED:03/142012
OWNER'S PHONE: 4085541818 MOUNTAIN VIEW,CA 94043 PHONE NO:(6501948.4727
❑ LICENSED CONTRA(/ R'T/O/R'S DECLARATION BUILDING PERMIT INFO: BLDG Ir— ELECT PLUMB
License Class �-2o Lic.H �j_ y /011(7
/ p1ECH r RESIDENTIAL G COMMERCIAL r
Contractor &pJA.Jz-a 3//xZia
1 hereby affirm that I am licensed under the provisions of Chapter 9 .LOB DESCRIPTION:APT 3-REPLACE FURNACE AT SAME LOCATION
(commencing with Section 7000(of Division 3 of the Business&Professions "SEE NOTES--
Code
OTES^Code and that my license is in full force and effect.
I hereby affirm under,penalty of perjury one of the(W owing 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 have and will Maintain Worker's Compensation Insurance,its provided for by Sq.Ft Floor Area: Valuation:$1795
Section 3700 of the Labor Code,for the performance of the work for which this
porno(is issued.
APN Number:37501004.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify(hon I[lave read this application and state that the above information is
correct.I agree to comply with nil city and county ordinances and stale laws relating
to building construction,mid hereby authorize representatives of this city(o enter PERMIT EXPIRES IF WORK [S NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnilyand keep harmless the City ofCupeninoagainstliabililies.judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of ore 1 g0 DAYS FROM LAST CALLED INSPECTION.
gmmingof this permit. Additionally,the applicant understands mrd will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectio
9'18' Issued by: i Date: 0-1c-f-!'z..
SignawreDate .
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material bcing insL•Uled.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Law for ore Of installed without first obtainine at inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of tine property,or my employees Willi wages as(heir sole compensatioq
will do the work.and the structure is not intended or offered for sale(Sce.7044, Signature of Applicant: Date:
Business&Professions Code)
Lie;owner of the property,an exclusively contraction Willi licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one ofthe following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
(have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 695 of the
Compensation,as provided for by Section 3700 6f the Labor Code,for the California Health&Safety Code.Sections 25.505,25533,and 25534. 1 will maintain
per of the work for which this perink is issued. compliance with Ute 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(a)should I store or handle Imzardous material.
Seclina 3700 orthe Labor Code,for doe per ormance of the work lir which this Additionally,should I use equipment or devices which trill hazardous air
permit is issued. contarninanb as defined be the Bay Area Air Quality Management Dlsta'let I will
maintain Compliance Willi the Cupertino Municipal Code.Chapter 9.12 and[he
I certify that in the perfomtance of die work,for which this permit is issued,I shall Health&Safety Code.Sections 25505,25533,and 25534.
am employ any person in arty manner so as to became subject to the Worker's /
ConnpensationlawsofCalifomia. If.affer making this certificate ofesemp(ion,I Owneror uthdpttFnc
become subject to(he Worker's Compcnsa(ion provisions of the Labar Code,I must �G✓�
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION 1-ENDING AGENCY
APPLICANT CERTI FICATION I hereby affimn that there is a construction lending agency lir(Ire performance of work's
I certify that I have read this application and state(hat the above information is for which[his permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and slide laws relating Lender's Name
to building construction,and hereby authorize representatives of(his 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,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
graving of this permit.Additionally,(happlicant understands applicaunderstands mid will comply
with all non-point source reeulmios per Ure Cupertino Municipal Code,Sectio I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signmure Date
CITY OF CUPERTINO
6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37501004 . 00
DATE ISSUED. . . . . . . : 03/14/2012
RECEIPT #. . . . . . . . . : BS000016267
REFERENCE ID # . . . : 12030062
SITE ADDRESS . . . . . : 19472 ROSEMARIE PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROSEMARIE ASSOCIATES
ADDRESS . . . . . . . . . . : 1270 S WINCHESTER BLVD STE 127
CITY/STATE/ZIP . . . : SAN JOSE, CA 95050
RECEIVED FROM . . . . : BRIAN KOSKI
CONTRACTOR . . . . . . . : SOETJE, ED LIC # 20499
COMPANY . . . . . . . . . . : BONANZA HEATING & A/C
ADDRESS . . . . . . . . . . : 1098 INDEPENDENCE AVE 3A
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
• TELEPHONE . . . . . . . . : (650) 948-4727
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1ADMIN HOURS 1 .00 41 .00 0 .00 41 .00 0 .00
1BCBSC VALUATION 1, 795 .00 1 .00 0 .00 1 .00 0 .00
1BSEISMICR VALUATION 1, 795 .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
-------- -------------------------- -------- ---------------------------
50S
-----------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19472 roseemarie pl#3 DATE: 0 3/1 412 01 2 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$1,795
*PERn1IT TYPE: Mechanical Permit PLAN.CHECK TYPE: Alteration /Addition/ Repair
USE:PRIARI' SFD or Duplex PENTAMATIOIV FURN/AC
USE: PERMIT TYPE:
WORKre lace 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.Plan Char* Flee.Plan Chee*
Mech.Permit Fee: 1,11PERMIT Plund'.Permit Fee: Fle.Permit Fee:
Other Mech. Insp. 1 0.0 hrs $44.00 Ot/ta.Phnnb hap. El
Other Flea hasp.
A/ath Ings. Fee Phnnb.Insp.Fee: Elea.Inyt.Fee.
NOTE: This edi"une does not include jeer due to other Deparintents(Le. Planning. Public Works. Fire,Sanitary Sewer District.School
District,etc.). Thew ees are based on the trelininan in orn nation available and are only an estintate. Contact the De 1 or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/b11) FEE QTY/FEE MISC ITEMS
Plan Chedr Fee:
Suppl. PC Fee
PNIE Plan Check: $0.00
Permit Fee-
,Supp/. lisp Fee
PME Unit Fee: $130.00
PME Permit Fee: $44.00 '
C enutrt/cutnt Tax:
Administrative Fee: 1dDAHN $41.00
Work Without Pennit? O Yes (j) No $0.00
AdlwttreJPlanning Fee
Travel Documentation Fee: ITRA pDOC $44.00
Strong Motion Fee: 1RSEISAIICR $0.50 Select an Administrative [tem
Bldg Stds Commission Fee: 1BCESC $1.00
SUBTOTALS: $260.501 $0.001 TOTAL FEE: 1 $260.50
Revised: 1/19/2012
z.-
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DNISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
mi
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CUPERTINO (408)777-3228 • FAX(408)777-3333• buildinO(acuoerdno.orD v\ (v-
PLUMBING CHANICAL [fr=E I TCAL /n�'n/y❑MISCCFI ANEOUS
PROJECT ADDRESS /( 1 /y�O. '�pn//V L.+, (��,4 - / / ✓ V I- 0O
OWNER NAME^ / w4 � 11'W L/ /'�l. PNONE E-MAIL /]
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SrILE'' 7'ADDRF`SS CITY,SCA7'E .
V/yf+� FAX
CONTACT NAME / PHONE E-,MAA
STREELADDRESS I - f�-/ CITY,STAM IIP FAX
❑ OWNER ElOWNER-BUILDER. 'Py WNER AGENT ❑ CONTRACTOR 11COX-rC-9RAr ❑ ARCHITECT ❑EN aNEu ❑ DEVELOPER ❑ TFNA.N;
CONTRACTOR NAME ED Som} LICENSE NUNBER tllEtrSE il'P BUS.L'C q 7 n 6
COMPANY v 1>v R-f it
E-MAIL
28 +N FAX S-_`-/w
STREET ADDRESS CITY.SATZIP 6 /S
✓^ate
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9yt? 2,9
ARC`ITECTJENOINEER NAME N LICENSE NUMBER / / BUS.LJC I
CONBA.NY NAME E-MAM V' FAX
STREET ADDRESS CITY,STATE,ZJP PHONE
USE OF ❑sFD w DIJFuDI gMt 7-FA.MD.Y PRD.=INWILD AW
II 6 THE BIDO AN ❑ym
BUILDING: ❑ OMCAL �NOO PRHM
DESCRIPTION OF WORK
TOTAL.VALUATION: //�J- 00 RECEIVED BY:
By my signature below,I certify on each of the following. I am the property awn=or authorfud agent to act oo Lie property owner's behalf I have:cad this
application and the iufbnnation I have provided is co It- have read the Description of Wark and verify it is acnsam. I agree to corrmly with all applicable local
ordinances and sate laws relating m buil can ccon. I author'representatives of Cupertino m enter the abovve-i cc�dEcq property:or inspection potitoses.
Sigtacue of AppI1=:/Ag=C Daze: 3�/9//�
SUPPLEMENTAL INFORMATION REQUIRED OFFICE use ONLY
v 8-BVER-THE-couNTER
❑ EXPRESS
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❑ MAJOR
MEPMuclpp_1011.dac revlred 06/?I/11
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