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12010153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10447 VIS•I'A KNOLL BLVD CONTRACTOR:NOR CAL MLC]IANICAL PERMIT NO: 12010153 OWNER'S NAME: CHEN.JIM J AND,JILI.IAN K 6558 HIDDEN CREEK DR DATE ISSUED:01/25/2012 OWNER'S PHONE: 4082178792 SAN JOSE,CA 95120 PHONE NO:(408)361-8080 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMI.1' INFO: BLDG � ELECT z PLUMB License Class IULE� MEC11 RESIDENTIAL COMMERCIAL Contractor �� Z.� /Z_ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RITLACEVIFN t OF HEATING AND AIR CONDtfIONFR SYSTF•M (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 ofconsent 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 Sq. Ft Floor Arra. Valuation:$9100 Section 3700 of the Labor Code,for the performance of the wort: for which this permit is issued. .UPN Number:32613032.00 Occupancy"hype: APPLICANT CF,R'I'IFICA'I'ION I certify that 1 have read this application and state that the above inlornnation 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 EX 'IBES 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 H )AYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City'in consequence of the 180 DAY M LASTCALLED INSPECTION. granting of this permit. Add"'ona the applicant understands and will comply _ with all non-point source regal s per the Cupertino Municipal Code,Section �� 9.18. Issued by: !� Date: Sign• arc 14 Z ❑ OWNER-Bt ILDER DECLARATION RE-ROOFS: All roof,shall be inspected prior to am roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection_I agree to remove all new materials for the following two reasons: inspection. I,as owner of the 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.704.4. Signature of Applicant_ __ Date: Business&Professions Code) — 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTERconstruct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ILkZARDOI'S VIATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self=insure for Worker's I 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',Compensation Insurance,as provided for by Safety Code,Section 25532(a)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 contaminants as defined by the Bay Area:fir Quality y1anagement District 1 will permit is issued. maintain compliance nvith e 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 I lealth&Safch Code, tions 255 5,25533,and 25531. not employ any person in any, manner so as to become subject to the Workers Compensation laws of California. If after making this certificate of exemption. Ont[lei- tori" ager become subject to the Worker's Connpensatiim provisions of the Labor('ode.I n st _ __-- -- __- _-- ate'_ forthwith comply with such provisions or this permit shall be deemed revoked. coNs•rRVC rloN LENDING AGENCY APPLICANT CERTI FIC;ITI0N I hcrebv 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 indemnity and keep harmless the City of Cupertino against liabilities,judgments_ costs,and expenses which may accrue against said City in consequence of the ARCI It'114AJ'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-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 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32613032 . 00 DATE ISSUED. . . . . . . : 01/25/2012 RECEIPT # . . . . . . . . . BS000015836 REFERENCE ID # . . . : 12010153 SITE ADDRESS . . . . . : 10447 VISTA KNOLL BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CHEN JIM J AND JILLIAN K ADDRESS 10447 VISTA KNOLL BLVD CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM . . . . : NOR CAL MECHANICAL CONTRACTOR JAMES COSTELLO LIC # 30818 COMPANY NOR CAL MECHANICAL ADDRESS 6558 HIDDEN CREEK DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE (408) 361-8080 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 13CBSC VALUATION 9, 100 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 . 00 65 . 00 0 . 00 1BSEISMICR VALUATION 9, 100 . 00 0 . 91 0 . 00 0 . 91 0 . 00 1BUSLIC FLAT RATE 1 . 00 119 . 00 0 . 00 119 . 00 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 444 . 91 0 . 00 444 . 91 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ---- ----------- ------------ -------- CHECK 444 . 91 1438 --------------- TOTAL RECEIPT 444 . 91 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10447 Vista Knoll DATE: 01/25/2012 REVIEWED BY: GS APN: BP#: VALUATION: 1$9,100 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced-Air 1 MFR=<100 1 # $130 TOTALS: 1 $195.00 Mech.Platt Check Elhrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00ELI NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc: . These ees are,based on the grefinina information available and are o2lE an estimate. Contact the De t or addn't info. FEE ITEMS ' -< f, %€at t,> ,'1-0 ' ij -" I], FEE QTY/FEE MISC ITEMS Lj PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Administrative Fee: 1 ADMIN $41.00 Work Without Permit? 0 Yes `L.! No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 jom Fe- 1BSEISMICR $0.91 Select an Administrative Item j'orim issjon Fee: IBCBSC $1.00 SUBTOTALS: $325.911 $0.00 TOTAL FEE: 1 $325.91 �--� Revised: 1/19/2012 t Z4C Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: `7 'S � VD t/C1 PERMIT# Q/C' OWNER'S NAME: PHONE# GENERAL CONTRACTOR: tNar Cc CC BUSINESS LICENSE# VZv ADDRESS: ` t&(4 Gtr Q.e r C4 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY IN ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT C RS HAVE OBTAINED A CITY F CUP RTINO BUSINESS LICENSE. 1 I am not using any subcontractors: J / �— ('Agnature Da/to 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 Owner/Contractor Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINp (408)777-3228• FAX(408) 777-3333•buildin <c gcartino ora misc Lj PLUMBING MSCI IANICAI_ ELECTRICAL MISCELLANEOUS PROJECT ADDRESS //)�/C`7 `/� / J In APNz OWNtiRNAMF (/i•.1/J ./� /��0h� E-'�tAIL a STrSTREET XE)DRESS 1 (J,IY, S7'A'iF_ZII> CT NAME /1 1 PHONT �1Q �� © S can C a AAe ti Ct n c�. • •..� ADD 1,� -{I- CtI'STATE_ 7B' �G'�K�✓ 1Cl►� G1 �G. �t� C`� ( i1jL FAX `t, ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHI'IT.0"t' ❑ENGINEER ❑ DEVF,I,OPF.R ❑ 'TENANT CONI' ACTOR N?avfI / I,I(`ENSE ylc4 fil � 9 LICENTe-'11'F� BUS.I.IC H 1G COMPANY NAS 1 I.& FAX 4_1eF Olt STREET ADDRESS / C'I]'Y,STATE,zip f7Gt ��� S'G�n r4� N/G�/ice ✓�J U IONF sar ARCHHITECT FNGLNEFR NAME LICENSE NtibBER Bus.Llc x COMPANY N,"IF E-MAIL FAX S'IREET ADDRESS CITY.STATIi,Z[P PHONE USE OF SFD or IJUPI_EX ❑ MULTI-FAI LILY PROJF('T IN WILDLAND ❑ IES PROJECT IN ❑ YES IS THE BLDG AN IL BUDING: COMMERCIAL. ❑ YES b URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO E[CHLEiR[ iV1 -i0E^ ❑ No DF,SCRIP'rION OF WORD � 1 TOTAL VALUATION: 5"/ 00 C vv RECENED BY: i By my signature below,I certify to each of the following: I am the 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 corre ve read the I �cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin ing const 10 7au\th//orize re se fives oT Cupertino to enter the atx�v dentit'e<t property for inspection purposes. Signature of Applicant/Agent: '✓GZ – - Date: % Z— SUPPLEMENTAL INFORMATION REQUIRED OFITCE USE ONLY pW OVER-THE-COUNTER ❑ EXPRESS v w r STANDARDLARGE MAJOR MFPMiscApp 2011.doc revised 0621,11