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12040007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7585 KIRWIN LN CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 12040007 CONDITIONING OWNER'S NAME: OWENS NANCY E 1712 STONE AVE DATE ISSUED:04/022012 OWNER'S PHONE: 4084462983 SAN.IOSF,,CA 95125 PHONE NO:(408)2934717 ❑ LICENSED CONT'RACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �'y L Z�.ic.a AW 2/ MECH r RESIDENTIAL r COMMERCIAL r / , 1 Contractor -V, Date % —Z _ / z 1 hereby offsThal 4m licensed under the provisions of Chapter9 JOB DESCRIPTION:REMOVE AND REPLACE THE FURNACE AND m (comencin with Section 7000)of Division 3 orlhe Business&Professions NINE(9)DUCTS Code and that my license is in full force and effect. I hereby affirm under penally 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 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 Area: Valuation:$9700 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35921007.00 Occupancy Type: APPLICANT CERTIFICATION I cenify 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 laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES 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 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-poin ource regulatims per the Cupertino Municipal Code,Section 9.18. Issued by: n Date: Signalurc '//U . - Dale L 2 ❑ O\VNF.R-BUILDER DECLARATION RF:ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law for one of installed without firs[obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection, 1,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. Signature of Applicant: Dale: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby alarm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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. I 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's Compensation Insurance,as provided for by Safely Code,Section 25532(1)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should t use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the 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 Health&Safety Code,Sections 2 05,25533,end 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Cal ifomia. If,after making this certificate of exemption,I Own or uthorize ag 7 become subject to the Workers Compensation provisions of the Labor Cade,I must Dole: L/ —/C forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGF.NC\' APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read(his 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 indemnify and keep harmless the City of Cupertino against IiabihGes,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 ARCHITECT'S DECLARATION 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 Dale CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35921007.00 DATE ISSUED. . . . . . . : 04/02/2012 RECEIPT #. . . . . . . . . : BS000016426 REFERENCE ID # . . . : 12040007 SITE ADDRESS . . . . . : 7585 KIRWIN LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : OWENS NANCY E ADDRESS . . . . . . . . . . : 7585 KIRWIN LN CITY/STATE/ZIP CUPERTINO, CA 95014-4338 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 9, 700.00 1. 00 0. 00 1 .00 0 . 00 1BSEISMICR VALUATION 9, 700.00 0. 97 0 .00 0 . 97 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 .97 0.00 260. 97 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 521.47 #40086 --------------- TOTAL RECEIPT 521.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7585 Kirwin Lane DATE: 04/02/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $9,700 *PERMITTYPE: Mechanical.Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURNIAC USE: PERMIT TYPE: wORK Remove and replace the FAU and 9 ducts. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: 1 $130.00 Mech.Plan Check 0.0 hrs $0.00 Phnnb. P/on Cbcrk Ek•,. Plan Check Mech. Permit Feer IMPERMIT Plmab. Penna Fac: Bloc. Parmii Fee: —1 ET Other Mech. Insp. 0.0 hrs. $44.00 O,her Phimb Insp. Olper 1.'Irc. hrq,. ED ,bhrh. ImP. Fera Phnnb. /n.p. Fra: Eler.Insp,Fee NOTE:This estimate does nor include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the preffimWina information available and are only an estimate Contact the Dept for addrz7 info. FEE ITEMS free Resahnion I1-053 f_lL 71111/1 FEE QTY/FEE MISC ITEMS Plan Check Fee. .Supp/. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Inc/)Fee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Cons/1 uction Tie: Administrative Fee: IaDMIN $41.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees. Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0.97 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.97 $0.00 TOTAL FEE: $260.97 Revised: 1/19/2012 000 GENERAL PERMIT APPLICATION EP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE'AVENUE •CUPERTINO, CA 950143255 I /� /.� CtJPERTINO (408) 777-3228 • FAX(408)777-3333-buildinD(a�cuoertino.ora v\ (v' PLU�NMING ��/r �OiCHAMCAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS V V� Y 1 FEr V I \rel C APN I �} ' 'o O OWNER NAME CI , t� A Px 2—cl( E-MAIL STTJM7 ADDRE.SS-I I-I aW..IN VrtNE UD 14 FAX CONTACT NAME Th d,,, STREET ADDRESS i 12 — CRYrsTATE•ZIP _V ) ❑OwNBR ❑ OWNERBMLDER ❑ OWNER AGENT _; <ONTRA=R ❑CONI Mlk AGENT [3 AACNr1ElT CJ ENGINEER ❑ DEVELOPER RAfl ❑TEN.WT CONTCroitNAME UCENSE BUS.CAC a COMPANY NAME E �Gja l lv�, EET AX n��•^,r.� , STRADDRESS (��tVAV `� `/�'Q`. rl 12 �. �i�►2 P'�134�-I � AR6QIECT/EN+M'n NAME INCENSE NUMBER BUS.LIC 4 COMPANYNAME EMAIL FAX STREET ADDRESS CRY.STATE.ZIP PHONE USE OF or Duplex ❑ Multi-Family PROJECT IN WB.ULAND PROJECT IN STRUCrupz: ❑ Conn inial URBAN WrEAFACE AREA ❑ Yes -�Vo FLOOD ZONE ❑ Yw ❑ No DESCRIPMON OF WORK n re MOI CQ _ /u ct ANN TOTAL VALUATION: "'HN„ By my signature below,1 certify to each of the followingo. 1 am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I have p vided is caned [have read Dcscri don of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating m yfifldi g construction. [a rtsentadvq o o N enter the idenrified mparty for impecdon purposes. Signature of Applicant/Agen[ (� Dem: S PLEMENT INFORMATION F2QUIRED 4a r • s . MEPMLrcApp 10/1.doc revised 03/16/11