12050191 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20083 WI IEATON DR CONTRACTOR:ABC COOLING& PERMIT NO: 12050191
HEATING
OWNER'S NAME: I IINMERS KI-NNETH 1 AND RAE M TR 31845 11AYMAN ST DATE ISSUED:05/25/2012
OWNER'S PHONE: 4082535012 HAYWARD.CA 94544 PHONE NO:(510)471-8181
❑ LICENSED CONTRACTOR'S DECLARATION JOBDESCRIPTION_ RESIDENTIAL COMMERCIAL
License Class/ IY.spp�� Zu Lic.4 3BZ3$3 REMOVE AND REPLACE A/C-4TON
Contmctor/T �tA�lna�HLa�1/IN Date c7—�"�Z
1 hereby a rm IhaI I am Iimnsed under the provisions of Chapler 9
(commencing xtth Section 7000)of Division 3 of the Business&Professions
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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$6900
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
.\PN Number:31623056,00 Occupancy'I'ypr:
permit is issued.
APPLICANT CERTIFICATION
I certifythat I have read this application and slate 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 far inspection purposes. (We)agree to save 180 DAY FROM LAST CALLED INSPECTIO
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 of this pennit. Additionally,the applicant understands and will comply Issued by: 7 G Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Rb:ROOFS:
Signature . Date .5-25,-12 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
Signature of Applicant: Date:
1 hereby affirm that 1 am exempt from the Contractor's License Lew for one of
the following two reasons: ALI,ROOF COVERINGS TO IIF-CLASS"A"OR BE'1"fF,R
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,
Business& Professions Cade)
I,as owner of the proper)',am exclusively contracting with licensed contractors to HAZARDOUS\L\TERIALS DISCLOSURE;
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%ill
1 hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 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 x'hich 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 Dislric(l
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the/health&Safely Code,Sections 225505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this .(/mo —i_/� Dete: —ZS�Z
permit is issued Owner or authorized agent: ,Xs'--
1 certify that in the perforrnanhce of the work for which this permit is issued.I shall
not employ any person man),manner so as to become subject to the Worker's
Compensation Imes ol'Calilbrnia. If,after making this certificate of exemption.I CONSTRUCTION LENDING AGENCY
become subject up the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the perfommence of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and stale 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
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 Prolessional
9.18.
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31623056.00
DATE ISSUED. ... . , . . : 05/25/2012
RECEIPT #. . . . . . . . . : BS000016913
REFERENCE ID # . . . : 12050191
SITE ADDRESS . . . . . : 20083 WHEATON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . .
OWNER . . . . . . . . . . . . : HINMERS KENNETH J AND RAE M TR
ADDRESS . . . . . . . . . . : 20083 WHEATON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2339
RECEIVED FROM . . . . : ABC COOLING
CONTRACTOR. . . . . . . . : GERALD UNRUH LIC # 24643
COMPANY . . . . . . . . . . : ABC COOLING & HEATING
ADDRESS . . . . . . . . . . : 31845 HAYMAN ST
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510)471-8181
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----7-------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 900 .00 1. 00 0. 00 1 . 00 0 .00
1BSEISMICR VALUATION 6, 900 . 00 0. 69 0. 00 0 .69 0 . 00
1MPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0. 00
1MRAIRHAN UNITS 1 .00 130 . 00 0. 00 130 .00 .0. 00
1TRAVDOC FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 219.69 0. 00 219.69 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 219.69 chk
---------------
TOTAL RECEIPT 219. 69
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20083 WHEATON DR DATE: 05/25/2012 REVIEWED BY: SEAN
APN: BP1h 'VALUATION: $6,900
*PERMIT TYPE: Mechanical I Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REMOVE AND REPLACE A/C 4 TON).
SCOPE
APPLIANCE/EQUIP TYPE- FEE ID QTY UNITS BP FEES
A/C Units (>10K cfm) 1MRAIRHA 1 # $65
TOTALS: $65.00
Mech.Plan Check 0.0 hrs $0.00 /'11,16. Plan Check Elec. Plan Check
Mech. Permit Fee: IMPERM/T Plumb. Parrnic P,:r: tiler. Penn6 Fry:
Other Mech. Insp. 0.0 hrs L$44.00 Ochry Plumb Insp. Cider Eley. Insp. Li I
Jireh. Imp. Pre: Plumb. hmp. Fed: Eler.Insp.Fec:
NOTE: This estimate does not includejees due to other Departments(Le Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the vreliminafi information available and are onlp an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Re,sohnion 11-053 ER 7/1/I1) FEE QTY/FEE MISC ITEMS
Plan Chcck Fru:
.Supp/. PC Fre
PME Plan Check: $0.00
Penna Fee-
suppl. hisp Fe•c
PME Unit Fee: $65.00
PME Permit Fee: $44.00
Consnvrciou Tcer:
Administrative Fee: (ADMIN $41.00
Work Without Permit? O Yes 0 No $0.00
Advanced Maiming F'ees:
Travel Documentation Fee: ITRA VDOC $44.00
Strong Motion Fee: /BSEISMICR $0.69 Select an Administrative Item
13ldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $195.69 $0.00 TOTAL FEE: 1 $195.69
Revised: 05/01/2012