The URL can be used to link to this page

12010171 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22363 STEVENS CREEK BLVD CONTRACTOR: I AAA FURNACE& PERMIT NO: 12010171 AIR OWNER'S NAME: KAM LI 1712 STONEtCA VE DATE ISSUED:01/30/2012 OWNER'S PHONE: 4084832637 SAN JOSE, 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB 2c C' 43 A11315 7 ( F_License Class �" Lic.# MECH RESIDENTIAL COMMERCIAL Contractor ' w,4= Date % 3(� -17— JOB DESCRIPTION: REPLACE FURNACE IN SAME LOCATION 1 hereby affirm that I am licensed under the provisions of Chapter 9 (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 Valuation:$3000 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APN Number:32650011.00 Occupancy Type: permit is issued. ?N T APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / 3 C) — / -2— costs, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: r 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. RE-ROOFS: Signature 2� �ti Date 2 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 inspection. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will Chapter 912 and the 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Cha p declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect* ns 25505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Dater� 1G" Owner or authorized agent: �- permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: S �, "hGe U D PERMIT# 112-0[ 6/ 7/ OWNER'S NAME: t PHONE# q5 3 " 26 GENERAL CONTRA TOR: �, ,;;: w BUSINESS LICENSE# 7 C SS` ADDRESS: IZ 5 CITY/ZIPCODE: ��-'c Ls ` /z *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: ( Date ignature 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 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32650011 . 00 DATE ISSUED. . . . . . . : 01/30/2012 RECEIPT # . . . . . . . . . BS000015867 REFERENCE ID # 12010171 SITE ADDRESS 22363 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KAM LI ADDRESS 22363 STEVENS CREEK BLVD CITY/STATE/ZIP CUPERTIN, CA 95014 RECEIVED FROM AAA FURNACE 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 3 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00 1MFR=<100 UNITS 1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 44 . 00 0 . 00 44 . -- - --------1TRAVDOC FLAT RATE 1 . 00 ---------- ---------- ---------- TOTAL PERMIT : 260 . 50 0 . 00 260 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CHECK 521 . 00 39758 --------------- TOTAL RECEIPT 521 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- _ _ -- ------------- ---- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION �F ADDRESS: 22863 Stevens Crk Blvd —7=] DATE: 01/30/2012 REVIEWED BY: RDW APN: BP#: VALUATION: $3,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY, PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK Furnace Replacement SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check FO.0 hrs $0.00 Mech.Permit Fee: IMPERMIT E Li Other Mech.Insp. 0.0 hrs $44.00 Li NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public FVorks,Fire,Sanitary Sewer District,School District,etc. . These Lees are,based on the Erelininary information available and are o!&an estimate. Contact the ROW or addn'l info. FEE ITEMS r'/'`_ R'.�%'��`s'£"� 1 ' €'".3?.�1 ' I-'11� FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 ec:_ IBSELS'AWCR $0.50 Select an Administrative Item BI 1 S t�dI BCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.5 0 Revised: 1/19/2012 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 •building(a?cupertino.org misc CUPERTINO ❑PLUMBING MCHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 2 w n5 (f�� ' jI ARK N ® n Q p OWNER NAME PH 7 r r E-MAIL STREET ADDRF ,� �1 \S C/1 r of C l.�T Oua FAX CONTACT NAME �'�,�.1" j E'MAII- STREET ADD` S ,v+ l� C STAFA1C 2 (p fpAr s cam" INv ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n n �(�► \C�1 LI 1 LIS2:0 SE C BUS.LIC B COMPANY NAME E-MAOV �C �'Grip'' FU, �53y STREET ADDRESS I S . j CITY.STAj�,� �) G C"/Zl; P 0'`�/ - ARCHTTECTIENGINESR NAME ` LICENSE NUMBER ?� l�1 {' BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE of FD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: C1 Commercial URBAN INTERFACE AREA Cl Yes No FLOOD ZONE ❑ YeSX No DESCRIPTION OF WORK TOTAL VALUATION: l ► \� V V1BY'` -� Kate. _:s c��: 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 rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws vela' g to bul co on. I authorize representatives of Cupertino to enter the above-iden'led property for inspection purposes. Signature of Applicant/Agent: - Date: 2 12 SUPPN AL INFORMATION REQUIRED - ``'a 0 � NfEPMiscApp_2011.doc revised 03/16/11