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12040009 CITY OF CUPERTINO BUILDING PERMIT BUH.DIN'GADDRESS: 10892 LEAVESLEY PL CON"1"RAC I'OR: SERVICE EXPERTS PERMI'I'NO: 12040009 HEATING & AIR OWNER'S NAME: FOSTER JEFFREY RAND MARY H 6984 SIERRA CT DATE ISSUED:04/02/2012 OWNER'S PHONE: 4082579931 DUBLIN, CA 94568 PHONE NO:(92i)400-6024 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING I'F:RMI'I'INFO: BLDG el.e.(:'f PLUMB License Chas (_i 2,C) tic-q 31 l)5-7 � r r r �pp� I,�� IJ ?IECII RESIDEN'I'L\I, COMMERCIAL Contractor It A Date. -`� Z-1 Z .LOB DFSCRII''TION': Rlil'LACIi FURNACE,ADD NC,K ADDCAS I'll'p, 1 hereby affirm that 1 am licensed under the provisions of Chnpler 9 REPLACE (commencing with Section 7000)of Division 3 of the Business& Professions DUC I" 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 Connpensmion,as provided for by Section 3700 of the Labor Code,for the perliirmance oflhe work for which this permit is issued. Sq.Ft Fluor Area: Valuation:S 13029 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code.for die perlbnnanee of the work for which this APN Number:35615031.00 Occupancy"I)pe: permit is issued. APPLICANT CERTIFICATION I ccnify that l have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct l agree to comply with all cityand 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 D7 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting oflhis permit. Additionally,the applicant understands and will comply Issued by: Date: _ withall non- oillsource regulations per the Cupertino Municipal Code,Section 9.18. // Rt:-ROOFS: Sitananoc Dale. I Z��Z Au roofs shall be inspected prior to any roofing materia l being installed, If a roof is installed without first obtaining an inspection. I agree In remove all new'materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applic;unL Uatc: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS 10 BE CLASS"A"OR BE 1-1 FIR Las owner of the propcny,or my employees with wages as(heir sole compensation, will do the work,and the structure is not intended or offered for sale(See.7044, Business&Professions Code) 1,as owner of the propcny.am exclusively contracting with licensed contractors to 11:\%ARDOUS MA I ER1ALS DISCLOSURE construct the project(Sec.7044.Business R Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilenith&Safcty Code,Sections 25505,25533,and 25534. I will I hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Cade.Chapter 9.12 and the declarations: Ileallh&Safety Code,Section 25532(a)should l 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 haz irdous 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 1 performance of the work for which this permit is issued- will maintain compliance will,the Cupertino.Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ileallh&Safety Code,Secclllpn 25505.25533,and 25534. Section 3700 ollhe Labor Code,lot the performance of the work for which this 0%,net or authorized agent: ° Date: permit is issued, I ccnify that in the performance of the work for which Nis permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONS'I'1(liC'IION LENDING.\GF;NC1' 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 pertittmance of forthwith comply ss'ith such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sea 3097.Civ C.) Lender's Name APPLICANT CERTIFICATIO\ Lender's Address 1 ccnify that I have read this application and stale that the above information is correct. I agree In comply with all city and county ordinances and state Imvs relating to building construction,and hereby authorize representatives of this city hn enter upon the above mentioned property for inspection purposes.(We)agree to save Alt('III'TEC 1"S DECLARA'1lON indenmiN and keep harmless the City of Cupertino against habilifles.judgmnus, costs,and expenses which may accrue against said City in consequence of the I understand Illy plans shall be used is public records. granting of this permit Additionally,the applicant understands and twill comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18, Signature Date. CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec:. Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35615031 . 00 DATE ISSUED. . . . . . . : 04/02/2012 RECEIPT 4 . . . . . . . . . : BS000016428 REFERENCE ID # . . . : 12040009 SITE ADDRESS . . . : 10892 LEAVESLEY PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER FOSTER JEFFREY R AND MARY H ADDRESS . . . . . . . . . . : 10892 LEAVESLEY PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4747 RECEIVED FROM . . . . : !E INC CONTRACTOR . . . . . . . : TROY THOMAS LIC # 32138 COMPANY . . . . . . . . . . : SERVICE EXPERTS HEATING & AIR ADDRESS . . . . . . . . . . : 6984 SIERRA CT CITY/STATE/ZIP . . . : DUBLIN, CA 94568 TELEPHONE . . . . . . . . : (925) 400-6024 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL ------------- ---------- ---------- ---- ------ -- ----- --- --- - -- - --- -ADMIN HOURS 1 .00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 13, 029 ..00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 .00 65 . 00 0 . 00 65 . 00 0 . 00 1BSEISMICR VALUATION 13, 029 . 00 1 . 30 0 . 00 1 . 30 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 326 . 30 0 . 00 326 . 30 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------- -- --------- CHECK 326 .30 14102 --------------- TOTAL RECEIPT 326 . 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---r------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL , 4`U2 . CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10892 Leavesley PI DATE: 04/02/2012 REVIEWED BY: jsg APN: BP#: 'VALUATION: $13,029 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK a lace furnace add AC add gas pipe, replace duct SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 A/C Units (<=10K cfm) 1BREMAIR 1 # $65 TOTALS: $195.00 Meeh. Plan Cheek 0.0 hrs $0.00 Plrrn,h. Pk...C'hreA Ele,. P/on C11n6 Mech. Permit Fee: 1 IMPERMIT /'hnnh. !'e,vnit F,'rr ICIr. I'ennii 1, Other Mech. Insp. 0.0 hrs $44.00 Odrtv'Phrmh ln.q,. Odle, is tor. ln.,p. 11,<h, M,p_ Fir: Pluwh. ln,p. For: - 1.1c'. /nip. I 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 prefinndna information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution /1-053 Eff 7/1.i/1) FEE QTY/FEE MISC ITEMS flan Check I...... PME Plan Check: $0.00 Pcrm it 1,cw. SuPpl. hasp (Cr PME Unit Fee: $195.00 PME Permit Fee: $44.00 Gmsn onion T<l1': Administrative Fee: InOM/N $41.00 Work Without Permit? O Yes 0 No $0.00 ,Irl"nn e(I1'1111111ing I ec.s: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Pce: IBSEISMICR $1.30 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $326.30 $0.00 TOTAL FEE: $326.30 Revised: 1/19/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 CUPERTINO Telephone: 408-777-3228 Fax: 409-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOBADDRESS: 10 Z L-iP-aUesiN Pt PERMIT# OWNER'S NAME: reg r PHONE # Yo-3 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: IpQTd SLet U— Cl"]-Y/ZIPCODE: lXubl°'n �O *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: 6/ 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 950143255 I (408)7T-3228• FAX(408)777-3333•building(cDcuoerlino.org i CUPERTINO sc SPLUMBING ®MWH[AMCAr �ELECCRICAI. D, 19()!q600 PROJECT ADDRETVsa z . I-eaUL'Steq APNI �. j5-7_ r1 I,' E-AtAtI. OWNERNAIaE j42 J; Fos"Cp,r srRFETADDREss CITY,STATE re 7 c,t 9SZ/ FAX ►o��z Lectt,esl� �l rui-wo CONTACT NAME PHONE E-MAIL STREECADDRM CITY,SLATE ffi FAX ❑ow ❑ owNFxau m ❑ OWNM A� O3NntACTOR ❑rnrmucroRAt ❑ AM3QIFLT ❑wmtm ❑ DEVEromz ❑ rdANr EOFNI R NAAfE � LICEtSENM:STA u � RLIS LICA �onc.er10M�ULT�T-FAXIaLy - MESC&I0/' � ESFAX MONE KESS n (I ISN StE�plly ('rn �iv��s qQa(JOJEER NAME ICEb[M MBBUS UC p AME. E-MAFAX RESS Cr[YPHONE SFD mrRIP= FRQn=w wamlANDPRDIFLT DJ Q T£S MTHEBLDGAN ❑YES BUBDING: OCOWWUMALURBAN WTERFACE AREFr�OD-- ❑N➢ t10II.FR NONE± ❑No oEs RimaN OF WORK ►ave ��r��� add mu-) p r✓ � ('u�l o E(R�trl�a�l �e (ace Il S �� i �etur>1 a add 50 Pt Cls ExrevlsYon TOTAL VALUATION: i36aq .0o ABY By my sipamce below.I cadfy to each of dm f➢Bawmg:—1=the pmperty owns nr mahonzed agent to Ret oa the pmperty o eYs behalf I have lead this application aad rhe infotmaooa I have pmvided is cDOeeL j have rad the Description of Work and va-ify it is accutatn I agree to wc:Pl7 with all applicable local o[dmatttts and state laws relating tabtPdiag 'oo. I amhorze reptesatatives of capertmo to eater the above-idmv5d property for i SpeWM pnf'poses. Sigtlatme of AppG®VAgeat' Date' , Z J ► SUppLE VMgTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ MRFM Y U ❑ STANDARD U Z ❑ IARCE J L ❑ MAJOR 1,NPMwc4pp_ 011.doc revised 061-71/11