12060171CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10270 ALPINH DR I CON'TRACI'OR: PACIFIC IIRIfB7,l'- I PERNII "f NO: 12060171
MI:CI IANICAL
OWNER'SNAME: PAULSON KIRK iTRUS-I'Iili&EfAl-
OWNER'S PHONE: 408 500 28 12.
❑ LICENSED CONTRACTOR'S DECLARATION
License Class (-20 I -ie. q '968617
Contractor ip4c -tFLG BREEZ£ Date L -27 -12
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 niv license is in full force and effect.
I herehy affirm under penalty' of perjury one of the following two declarations
I have and will maintain a cerolicate of consent to self - insure Ibr Worker's
Compensation, as provided or M Section 3700 of the Labor Code, for Elie
performance of doe work for which this permit is issued.
I have and will maintain Worker Compensation Insurance, as provided I-or by
Section 3700 of the Libor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certil) that I have rcad this application and state that the above information is
correct I agree to comply with all city and county ordinances and stale Imes 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
indcntnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which only accrue against said City in consequence of the
eranting of this permit Additionally, the applicant understands and will comply
with all 11011-point source regulations per the Cupertino Municipal Code. Section
9. I X.
S i unature Date L -Z7� i2. - --
❑ OWNER-BUILDER DECLARAJ ION
1 herehy affirm that l am exempt from the Contractor's License Ian) for one of
the following two reasons:
L us owner ul'the property, or my cnnploy'ces 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)
1, is owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044. Business & Professions Code).
1 hereby affirm under penally (if 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 Suction 3700 of the Labor Code, for the
perfi nnancc of the stork for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, M provided for by
Section 3700 of the Labor Code. for the performance of the work for which this
permit is issued.
I artily Ihat in the performance of the work for which this permit is issued, I shall
not cnnploq my person in any manner so as to beconne subject to the Worker's
C(impcnsution laws of CXlifunnia. IC aller making this certiticate of exemption. I
become subject In Elie Worker "s Compensation provisions of the Labor Code- I must
Ilmtlnscith ttnnply wills such provisions or this permit shall be deemed revoked.
APPLICANT CF,Ii "IIFICATION
I certify thin I have read Ellis application and state that the above information is
correct. I agree w ennnply with all city and county ordinances and state Imes 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
indcntnify and keep harmless Elie City of Cupertino against liabilities, judgments,
costs, and expenses which ilia) accrue against said City in consequence of the
gaining of this permit Additionally, Elie applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9,1X,
Date
1205N 51 11 S'I" STE A
SAN JOSE. CA 75112
DALE ISSIII':D:06282012
Ill IONF. NO: (411X) 834 -24X5
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
,MIECII r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: AP I' I - RF.MOVI. AND I ITLACI. I IVAC PACKAGIi UNIT
Sq. Ft Floor Area: I Valuation: 56300
APN Number: 3261iI06.00 I Occupancy'1)PC:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: S�/9 ��/�l% G� Date: - rJ��j'•f �-
RE- HOOFS:
All rook shall be inspected prior to any' tooling material bcino ins ullcd. If a roof is
installed without first obtaining an inspection. I agree to remove ill ne, mmenals li,r
inspection
Signature of Applicant: Uatc:
ALL ROOF COVERINGS'I'0 111: CLASS "A" OR ]IF I' "I "F:R
11QAICDOIIS MA I ER1.M.S DISCLOSURE
have read the hazardous materials requirements under Chapter 695 of Ihr
California IicaIth & Sit fety C oil c. See liuns 25505, 25533, :ud 25534. 1 will maintain
compliance with the Cupertino Municipal Cade, Chaplet 9.12 and the Ilealth &
Safely Code, Section 25532(x) should I store or handle hazardous material.
Additionally. should I use equipment or devices which emit hazardous air
contaminants as defined by the BaN Arca Air Qualify Management Disn'ict I will
maintain compliance with the Cupertino Municipal (role, Chapter 9.12 and the
Ileallh & SafclN' Code, Sccliuns 255115, 25533, and 25534.
Oscnrr Inrrn'zrd :ngcnl:
Doe; L_27.12
CONSTRUC "I]ON LENDING: \GF :N('M'
I hereby aflinn that there is it construction lending agency' fur the perourmincc 0l'vcork's
for schieh this permit is issued (See. 3097, Civ CJ
Lender's Name
Lender's
ARCHITE-C "1'S DECLARA'I'IO.N
I understand illy plans shall be used as public records
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Lii'i
ADDRESS: 10270 Alpine Dr (Unit #1)
DATE: 06/28/2012
REVIEWED BY: Sean
UNITS
APN:
BP #:
'VALUATION:
$6,300
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Multi - Family Dwelling
USE:
Buildina is
>3 Stories O Yes Q No
PENTAMATION FURN /AC
PERMITTYPE:
WORK
Remove and replace HVAC package unit.
SCOPE
0.0 hrs
APPLIANCE / EQUIP TYPE
FEE ID
QTY /FEE
QTY
UNITS
BP FEES
0.0 hrs
Furnace, Forced -Air
1MFR = <100
�a<•.:. 1v,,�, C1�. �6
1
#
$130
[Ph mdh. /...runt h; r:
A/C Units ( < =10K cfm)
1BREMAIR
0.0 hrs
1
#
$65
,b6:eh. ln,p. l4ar:
PME Unit Fee:
$195.00
Phmib. hop_ F�•, -:
On.. bryz
C'no.cn-m lion 1-,I%.
Administrative Fee: IADMIN
$41.00
Work Without Permit? O Yes (j) No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRAVDOC
$195.00
Strong, Motion Fee: IBSEISMICR
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept for adda7 info.
FEE ITEMS (Fcr Resolution 11 -053 Ell' 71111I)
FEE
QTY /FEE
MISC ITEMS
/'lull r_ he, k l'cr.-
Mech. Plan Check
0.0 hrs
$0.00
.y, Chad
�a<•.:. 1v,,�, C1�. �6
Mech.
Permit Fee:
I MPERMIT
[Ph mdh. /...runt h; r:
h7s, T,rrvn6 Pry -:
Other Mech. Insp.
0.0 hrs
$44.00
0rho Plumb ln.q,,
El
ud,< -, tart. lu.,t.
,b6:eh. ln,p. l4ar:
PME Unit Fee:
$195.00
Phmib. hop_ F�•, -:
On.. bryz
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept for adda7 info.
FEE ITEMS (Fcr Resolution 11 -053 Ell' 71111I)
FEE
QTY /FEE
MISC ITEMS
/'lull r_ he, k l'cr.-
Suppl_ PC I 'er
PME Plan Check:
$0.00
P4.1 mil l',:c•.
,Cupp/. hnxp I"C
PME Unit Fee:
$195.00
PME Permit Fee:
$44.00
C'no.cn-m lion 1-,I%.
Administrative Fee: IADMIN
$41.00
Work Without Permit? O Yes (j) No
$0.00
.Idr„nrCtl1'huuiim; FccS:
A
Travel Documentation Fee: ITRAVDOC
$44.00
Strong, Motion Fee: IBSEISMICR
$0.63
Select an Administrative Item
131de Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$325.63
$0.00 TOTAL FEE:
$325.63
Revised: 06/30/2012
E
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255 M I
CUPERTINO
FIvrrr. wr. - 171r,.rc Amrer I— IcrFrralrAI I-l�. Ct Trn t MIC
(408)777 -3228 •FAX (408)777 -3333 • buildinOnr. cuoertinD.D
PROJECT'ADDRESS
10270 L 1 ED tl 1 ._
APNI - l . /U /
(Cj
OWNER NAME
T BSA K
PHONE
40B!500 72
E -MAD_
STREET'ADDRESS
CRY, SLATE, ZIP
FAX
CONTACT NAME Q /�T
GO
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER- BUDDER ❑ OWNER'AGENT 'CONTRACTOR - ❑01DM CIORAGENT ❑ ARCLDIECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
UCENSENUMBER
LICENSE TYPE
BUS. LJC4
COMPANY NAME
PAe1 FIG B 62 AI
E-MAIL
FAX
SLREETT ADDRESS
1010 MURPHY 1D
CRY, STATE, ZIP
YURLO CA So
PHONE
Zo9. 656.712
ARCDTECT(ENGWEER NAME I'/ �
J
LICENSE NUMBER
BUS. uCp
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE. ZIP
PHONE
USE OF ❑SFO a DUPIFS MULTI - FAMILY'
BUDDING ❑COMMERCIAL
PROJECT IN WTDLWO ❑ YES
Diu" INTERFACE ARP[ NO
PROJECTm ❑ YES
FLOOD ZONE 0
M711MBLDGAN ❑ YFS
EICHLIMHOMET O
DESCRIPTION OF WORK
FIVAt PACY,4af 00,T CM G ou
TOTAL VALUATION: 63oo.00
RECEIVED BY
By my signature below, I certify to each of the following: .1 ana the pmpertyowner or authoriud agent m act an the property owner's behalf. I have read this
application and the information I have provided is correct' I have read the Description of Work and verify it is accurate. 1 agree m comply with all applicable local
ordinances and state laws relating m building construction. I authorim representatives of Cupertino to enter the above- idend5edpropc -� for inspection pui¢oscs.
Signature of Applica ttlAgent: Dam: 6.27 -12
SIJPpt'EMENr'AL MFORMATION REQUiR1 =D
'
-
_
OFFICE USE ONLY
M
OVER- THE -COUNTER
c
Y
❑ EXPRESS
0
W
U
❑ STANDARD
❑ LARGE
c
❑ MAJOR
h1HPMLScAppjO l I. doc revised 06121111