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12080118 CITY OF CUPERTINO BUILDING PERMIT BIJI1:UlNG ADDRESS: 7751 11UNTRIDGE LN CONTRACTOR: VALLEY HEATING& PERM TTNO: 12080118 COOLING OWNER'S NAME: CANTWELL ERVIE E AND FRANCES G 1171 N TI'll SI' DA'Z'E ISSUED:08/108012 OWNER'S PHONE: 4082528466 SAN JOSE.CA 95112 PDO\ENO:(408)291-6290 '. LICENSISD CONI'ItAC�fO�pIt'S UEuCL,ut,\'F10N BUILDING PERMIT INFO: BLDG r ELECT r PLUNIB r License class C-20 Llc.b < :J S `D MECII r RESIDEN'1'LU, r COMMERCIAL r Contractor wll(q/ ytnc r Dale ss/(a// Z JOB DESCRIPTION:REMOVE AND REPLACE HEAT PUMP AND AIR HANDIER 1 hrrcby affirm that I am licensed mWrr the provisions of Chapter') IN (connnencing with Section 7000)of Division 3 of the Business S Professions SAME LOCATION Code and that my license is in full force and effect. hereby affirm under penalty of perjury'one of the following two declarations: I have and will maintain a cenificme of consent to self-insrire for Worker's Compensation,as provided for by Section 3700 of the Labor Code.for the performance oflhe work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the perlixmanee of the work for which this Sq.Ft Floor Arta: Valuation:$8433 permit is issued. \I'1'LICANI'f.P:R'I'IFIC,\'PION APN Number:35906023.00 Occupaney'fype: I certify that I have read this application and state that the above inlbmhation is correct. I agree to comply with all city and county ordinances and state Imes relating to building construction,and hereby authorize representatives of this city to enter mentionedupon tile above i Jemnil}and keep harmlepssthe CityofCupertino a ainstliabilities.judgmens, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the WITHIN DAYS OF PERMIT ISSUANCE OR graining of this permit. Additionally,the applicant understands mid will comply "V' DAY OM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. � -4s — Issued by: — I0 �Z Date: Signaun• �r�>,;a . ��///GGG��eee�i� Dated! ❑ OWNER-RUILDER DECLARATION RE-ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one 0f All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without First obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,mid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner or the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Prol'essions Code). ALL ROOF COVERINGSTO RI,CLASS"A"OR BEI-I'ER I hereby affirm ander penalty of perjury one of the following three declarations: I have and will maintain a Certificate ofConsent to self-insure for Worker's IL\7.ARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the perfommnce of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I hive and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino NI unici pal Code.Chapter 9.12 and the Health S Section 3700 of the Labor Code,for the performance of the work for which this Safely Code.Section 25532(a)should I store or handle Immrd0us material. Additionally,should I use equipment or devices which snit h:aardous air permit is issued. contaminants az de0ned by the Bay Area Air Quality Management District l will I certify than in the perfomumce of the work tiny which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ilenith S Safety Code,Sections 25505,25533,and 25534. Compensmion laws of Cali fomia. If,atter making this certiricate of exemption.I become subject to the Worker's Compensmion provisions of the Labor Code,I mustw zr au rr d ages fonhwith comply with such provisions or this permit shall be deemed revoked. S"�' Date' LS//D//Z APPLICANTCERTI FICATION CONSTRUCr1ON LENDING %GENCV I certify that I have read this application:rad state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state Imus relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon[lie above mentioned property for inspcetion purposes.(We)agree to save indemnify and keep harnhless the City ol'Cupertino against liabilities.judgments, Lender's Address costs,and expenses which may acerae 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 ARCHITECI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7751 Huntridge Ln. DATE: 08/10/2012 REVIEWED BY: gs APN: BP#: 'VALUATION: 1$8,433 *PERbI1TT1'PE: Mechanical Permit PLAN CIIECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/A USE: PERMITTYPE: t; N'ORK Remove and replace heat pump and air handler in same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Air-Handling (<=10K cfm) 1BREMAIR 1 # $67 Heat Pump (<=10K cfm) 1BREMAIR 1 # $67 TOTALS: $134.00 Mech. Plan Check 0.0 Ins $0.00 Plumb. Plan Check Elec. Plan Check Mech. Penni t Fee: ImPER,If T Plumb.Permit Fee: F•lec.Permit Fee: Other Mech. Insp. 0.0 firs $45.00 Other Plumb Insp. 7 El Other F.fec.Insp. El -loch. Insp. Fee: Plumb. /a,I,. Fes Elce.Imp.rec: NOTE: This esd,nate does not include fees due to other Departments(i.e. Planting, Public Works, Fire,SanitarySerer District,School District,etc.). These fees are hosed on the prelintinan•information a ailahle and are on/w,an estimate. Contact the De t or adtht'I in t. FEE ITEMS (Rce ltavolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. h7sp Fee PME Unit Fee: $134.00 PML' Permit Fee: $45.00 Construction Tar: Administrative Fee: 1ADMIN $42.00 Work Without Permit? O Yes (D No $0.00 Advanced Planting Fees: Travel Documentation Fee: ITR,rnDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.84 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBT'OT'ALS: $267.841 $0.001 TOTAL FEE: $267.84 Revised: 07/01/2012 ogle GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 MI �1 /� CUPERTINO (408)777-3228 • FAX(408)777-3333•buildinclecupertino.org V\■V_ ❑PhUM131NG MIiCIlAN1GV, ❑ELIiC'I'RICAh ❑MISCEI,LANEODS .PROJECT ADDRESS 751 }}w(�/� APNa C)co _ �Z OWNER NA\IE fli 12 L��l aVC�l PIION�03-2 S-7- �� , E-NIAIL SEREIrr ADDRESS 7CITY.STATE,ZIP I FAX 75! � H I,T :,-d 2 i,L CONEACIN•NIF. PHONE. E-MAIL See c� f�uc'lor STREETADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILd1iR ❑ OWNERACENT ❑ CONI'RACIOR J�JfONTRACIORACILNT ❑ ARCHHTCI' ❑ENGINEER ❑ DEVELOPER ❑'TE.NANT CONTRACIOR NA.\IEJ /r, J (' LICENSE NUMBER LICENSF-TYPE BUS.LIC d VC(l' nee,(. l `� CLO/ -55.6,4 d G-ZCJ /W COSIPANI'NA\IE /A E.NIAIL FAX STRF.EI'ApDRPSS 1/'7/ N. 44 S-1- CITY,ST,\T�ZIP5, - /^5II� PIIONEVG� L•�,JJ�Rr p• ARCHITE(7PENGINEERNA\II: r LICE\SENUNIBER -J % BUS.LICH CO\IPANY NANIE EMAIL FAX STREET ADDRESS CITY,FI'A'rE.ZIP PHONE USE OF SIT)ar DUPLEX ❑ \IULTI-FAIIILN' PROIECTIN N'ILDLAND ❑ \'ES PROIER IN ❑)Fs I IS THE BLDG AN ❑\'ES aUll.DIN'C: ❑CONIMLRCIAI. lIROANINTF.RFACE AREA ❑ NO FLOOD%ONE. ❑80 EICHLER HOME^ ❑ NO DESCRIPTION OF WORT: 7 rI p r .I TOTAL VALUATION: RECEIVED BY: By my signature below.I cenify to each of the following: I am the propenv owner or authorized agent to act on the property ooner's behalf. I have read this application and the.information I have provided is correct. I have read the Description m'Work and verify it is accurate. I agree to comply with all applicable local ordinances and slate laws relating to building cons�w',ni¢on—I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Appliennt/Agent: 1Jnr,e,-t J�UC-� �� Date: OzOhZ SUPPLEA18NTAL INFORNIATiON REQUIRED OFFICE use ONLY OYER-1'uF COIJN1ER ❑ EXPRESS 1 ❑ STANDARD ❑ 1.,\RCE ❑ \IA.IOR ,I 1EPMiscAp1Io_20/l.doc revised 0612//1/