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12040005CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7720 OAK MEADOW CT CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 12040005 CONDITIONING OWNER'S NAME: CHEN SWAN AND MIRANDA 1712 STONE AVE DATE ISSUED: 04/022012 OWNER'S PHONE-: 4082181459 SAN JOSE, CA 95125 PHONE NO: (4 0 8)2 93-17 1 7 ❑ LICENSED[ CONTRACTOR'S DECLARATION License Class -2u L' / - '7 Lie. 0_ / 66t 7 Contractor. dM ' Z/ 4(1a Dale �-2 Z 1 hereby aMrm that 1 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. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a cerlificate 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. 1 have and will maintain Workers Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 stale 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 indemnify and keep hamtless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. / n Dale ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sce.7044, Business & Professions Code). 1 hereby nlfirm under penally of perjury one of the following three 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, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Permit is issued. I 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and stale Iha1 the above information is correct. I agree to comply with all city and county ordinances and state laws rel ling to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabil ities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH f RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REMOVE AND REPLACE THE FURNACE Sq. Ft Floor Area: I Valuation: $3000 APN Number: 36626013.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS - All roofs shall be inspected prior to any roofing material bong installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for Inspection. Signature of Apphctrht: Dale: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOI IS MATERIALS DISCLOSURE, I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25573, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapler 9.12 and the Health & Safety Code, Section 25532(x) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth & Safely Code, Sections 25505, 25533, and 25534. Owneyo outhrrrned- T:-- Date:V-2—ZZ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wmrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCIIITEC.T'S DECLARATION I understand my plans shall be used as public records. I Licensed Dale �� CITY OF CUPERTINO 11' FEE ESTIMATOR—BUILDING DIVISION IMNI ADDRESS: 7720 Oak Meadow Ct DATE: 04/02/2012 APN: BP#: REVIEWED BY: Sean 'VALUATION: $3,000 *PERMIT TYPE: Mechanical Permit UNITS PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Furnace, Forced -Air PENTAMATION FURN/AC PERMIT TYPE: WORK Remove and replace the FAU. 1 SCOPE $130 APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES FO.0 hrs Furnace, Forced -Air 1MFR=<100 lJee. 1'/,ur Chrak 1 # $130 Mand'. Po"Ur F, „r Fl.:r. 11",,,h 14. Other Mech. Insp. 0.0 hrs $44.00 n//.... hunt Imp. U1/;... (rr. A,r y+. ,IA, h. ln+p. rl n: PME Unit Fee: $130.00 Pluroh. Lrop. I("'. ICl.r. bz,P_ F�x•r Cneururtion Tru: Administrative Fee: IADMIN $41.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $130.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitay Sewer District, School District, etc). Thesefees are based on the Prelindna information available and are only an estimate Contact lite De t or addn'l info. FEE ITEMS (Fce Rcsohrlion 11-051 F.27/1/I1) FEE QTY/FEE MISC ITEMS I'l,rn Check 1 cc. Mech. Plan Check FO.0 hrs $0.00 I'lu,r,h. Plop ChrteA lJee. 1'/,ur Chrak Mech. Permit Fee: IMPERMIT Mand'. Po"Ur F, „r Fl.:r. 11",,,h 14. Other Mech. Insp. 0.0 hrs $44.00 n//.... hunt Imp. U1/;... (rr. A,r y+. ,IA, h. ln+p. rl n: PME Unit Fee: $130.00 Pluroh. Lrop. I("'. ICl.r. bz,P_ F�x•r NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitay Sewer District, School District, etc). Thesefees are based on the Prelindna information available and are only an estimate Contact lite De t or addn'l info. FEE ITEMS (Fce Rcsohrlion 11-051 F.27/1/I1) FEE QTY/FEE MISC ITEMS I'l,rn Check 1 cc. PME Plan Check: $0.00 l'cr snit l•::r.- Sn1'p1 hcp Fcc PME Unit Fee: $130.00 PME Permit Fee: $44.00 Cneururtion Tru: Administrative Fee: IADMIN $41.00 Work Without Permit? 0 Yes 0 No $0.00 rl,/1"I C,r Ple rrrnmg /irac: Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $260.501 $0.001 TOTAL FEE: $260.50 Revised: 1/19/2012 6 ITEMS OF 12 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg COPY # : 1 DATE ISSUED.......: 04/02/2012 RECEIPT,'# .......... BS000016426 REFERENCE ID # ...: 12040005 SITE ADDRESS .....: 7720 OAK MEADOW CT SUBDIVISION ....... CITY,, .............: CUPERTINO IMPACT:AREA ....... OWNER ............: CHEN SWAN AND MIRANDA Sec: AM Twp::Rng: ........: Sub: Blk: Lot: 36626013.00 DATE ISSUED.......: 04/02/2012 RECEIPT,'# .......... BS000016426 REFERENCE ID # ...: 12040005 SITE ADDRESS .....: 7720 OAK MEADOW CT SUBDIVISION ....... CITY,, .............: CUPERTINO IMPACT:AREA ....... VOICE ID DESCRIPTION -- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL VOICE ID DESCRIPTION ----- ---------------------------- 507 FINAL PLUMBING OWNER ............: CHEN SWAN AND MIRANDA ADDRESS'...........: 7720 OAK MEADOW CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: AAA FURNACE &AIR CO 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 ---------- -ADMIN ------------------------ 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 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 -- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL VOICE ID DESCRIPTION ----- ---------------------------- 507 FINAL PLUMBING CUPERTINO GENERAL,PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255 1408) 777-3228 - FAX (408) 777-3333 • buildingecuoertino.ora ❑PLUN0IING D:CHAMCAL . ❑ELECTRICAL ❑MISCELLANEOUS MEP MISC PROJECT ADORES '-] 22 GI V WC0 -t. VV X1111..\,,'/►•W-2 / / — 0/ �' A/j0 OWNER NAME('// Ii aCA V1 ��(�o 'r'aPN 12M. �J✓`� E-MAIL p��'1 STREET � K I 1 1 W I d W `J l/t �a.//� . `� ` v-%� FAX CONTACT NAME w 3'�- 57REET ADORESs I� I L A (r• A,. I 'V❑G �( q V❑1CONTRACTOR PIC • (']� 7F❑ �/ ❑ OwNER Cl OWNER -BUILDER OWNER AGENT /C�OwrEAR0R AGENT ❑ AVROETECT ❑ pOavaaR DEVELOPER ❑TENANT CONTRACTOR NAME A� + , ^ ,a � e '/�� I ITIA LICENSfy I BUS. LIC A�'/� COMPANYNAAff M/•`0 EI �j �7 �r {/�'�M/�/�� T0� L(/I-✓-1-rT STREET ADDRESS— -r `/r _`+V� . 12 s--TWE 4LIMSENUMBE'R n �e q •�- . Bus. IDC A ARCHO'ECUENOINEER NAA9 COWANYNAME E-MAIL FAX STREET ADDRESS Crry, STATE, Z@ PHONE USE OF XSFD Or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WBDLAND URBAN OTIFRFACE AREA ❑ Yes ❑ No PROJECT N FLOODZONE ❑ Yes Cl No OESCIInMON OF WOR% su. TOTAL VALUATION: .� K[��8"�{•A• l --{r�••..�._ x By my signature below. I certify to each of the following: I= the property owner or authorized agent to act On the property owner's behalf. I have read this application mold, infannadon i have rovidcd is Correa (have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and mots laws relating to uilding const a OCCuperdna W enter the abo a -ice tified property for inspection purposes. Signature OfApplicanVAgent_ l-1 Date: rPOT FR.fT.TT rnrrnDa.rAT'rnArvrnrrrDr„ ��_ AYEFWuMpp_7011.doc revised 03/16/11 ij