The URL can be used to link to this page

12080212 CITY OF CUPERTINO BUILDING PERMIT RUILDINGADDRESS: 18771 TUGGLE AVE CON"fRACI'OR:SANIIDEI I ME[IRZAD PERMIT'NO: 12080212 OWNER'S NAME: SANIIDEII MEI IRZAD 18771 TUGGLE AVE DATE ISSUED:08120/2012 OWNER'S PHONE,; 4085904887 CUPERTINO,CA 95014 rr TONE NO: ❑ LICENSED CONI'RAC`FoR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT r PLUNIB License Class Lic.t! DIECII r RESIDENTIAL COMMERCIAL -I Contmcmr Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TO CLEAR CODE CASE,DEMOLISH NON-CODE (commencing with Section 7000)of Division 3 of the Business& Professions COMPLIANT Code and that nry license is in full force and effect. FURNACE ON ROOF,INSTALL CODE COMPLIANT FURNACE hereby affirm under penalty 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 die Labor Code,for the performance ofthe 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 fie work for which this Sq.Ft Floor Area: Valuation:$3000 permit is issued. ,V'I'LICA,NI'CIiR'I'II ICAT'ION APN Number:37527024.00 OccupancyType: 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 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 PERMIT EXPIRES IF WORK IS NOT STARTED indenmify 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 granting of this permit. Additionally,the applicant understrmds and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-paint source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: � Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that 1 am exempt from the Contractor's License Law fur one of 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,1 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 stork,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Dale: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business& Professions Code). AL1.ROOF COVERINGS TO BE CLASS"A"OR BE ITER hereby nflirnn under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's 11.\%.\RDOIIS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued California liealth&Safety Code.Sections 2.5505,25533,and 25534. 1 will maintain I have and still maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of lire work for which this Safety Code.Section 25532(u)should I store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Arca Air Quality Management District I will I certify that in the perfommnce of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in my manner so as to become subject to the Worker's Ilealth&Safety Code,S etions'_5505.25533,and 25534. Compensation law's of California. If,ruder making this certificate of exemption,I become subject to the Worker's Compensation provisions ofthe Labor Code,I must O 'acrr or a tbori'r genu forthwith comply with such provisions or this permit shall he deemed revoked ate: O CONST'RUCT'ION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is I hereby affirm that there is a construction lending agency for the perfommnce of work's correct.I agree to comply with all city and county ordinances and state laws 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 the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilitics,judgmems, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting ofthis permit.Additionally,the applicant understands and will comply ARCIIlTECI"S DECLARATION with all non-point source regulations pernhe Cupertino Municipal Code,Section 9.18. > I understand my plans shall be used as public records. Signature 7 e �/ Jp �' Licensed 1'rtdessional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 18771 Tuggle Ave. DATE: 08/20/2012 REVIEWED Bl': jsg 1724 APN: BP#: 'VALUATION: 1$3,000 *PERMIT TYPE: Mechanical Permit PLAN CIIECK"TYPE: Alteration /Addition / Repair PRIMARI' PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A (YORK To clear code case demolish non code compliant furnace on roof, install code compliant furnace SCOPE APPLIANCE/EQUIP TYPE FEE ID QTV UNITS 13P FEES Furnace, Forced-Air iMFR=<100 1 # $133 TOTALS: $133.00 b-lech. Plan Check 0.0 hrs $0.00 Phonh. Plan Check Flee. Plan Check Mech. Permit Fee: IMPFR,i11T Phnnh. Permit Fee: race. Permit rue: Other Mech. Insp. 1 0.0 hr5 L $45.00 Other Plumb Insp. 7 El Other F.lec.Insp. El Hach.htmp.Fee: Plumb. btap.ret: Elce.Insp.Few: NOTE: This estinvte roes not inchttle jets due to other Departments(i.e. Planning. Pah/ic Works, Fire,Sanitary Server District.School District, ere.). Theve feev are hosed on tire prelintinart information available and are only tits estivate. Contact the Det or addn'I info. FEE ITEMS (Fee Resolution 11-053 EB' 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: 5'nppl. PC Fee: PME Plan Check: $0.00 Permit Fee: Suppl. hisp nee. PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: �� LID,t91N $42.00 Work Without Permit? O Y E) No $0.00 Arlve ncecf Planning secs: Travel Documentation Fee: ITRA VDOC $45.00 Snong Motion Fee: 1RSE/SMICR $0.50 Select an Administrative Item Blde Stds Commission Fee: IRCeSC $1.00 r SUBTOTALS: 1 $266.50 $0.00 TOTAL FEE: *6.50 Revised:'07/01/2012 208 021 Z GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 M /� CUPERTINO (408)777-3228• FAX(408)777-3333• buildina(a amedno-org �(/ (v- ❑(jPLUMBrNo ❑NfECHAMCAL [I FT Ef;/ CELLINNEOUSS FROTECTADDRESS 18.71 �)/�- l/G QaR+a 7 7f/5p— ✓�-7�/�/Or�J�[ 7 PSP/f OWNER NANM ae-A r2(T- y(JGI'/171 (�� PHOi��O J 1�(f0 /OO E MA//I��L 11/ILN Q:/�17/ /I�Zdj n 517IFGGT ADDRESS Q.// 1 -7 1�/J JP-{P,LJ . s'1 CITY. STATE ZIP /p Ji/�✓ i{qp' CQ" 507 FNc��/7-7. CONTACT NAME tf,�V�r V (iJ �./ PHO P � vfj� Ov� I E/MAIL/ 0" , // STREET ADDRESS �/� ct� vcTr srATE x&r"�0� "C,d 71 FAX � . Cx�L a boY P-61" ❑ OWNER-BUIDER ❑ Ow AGENT ❑ CONTRACTOR ❑OUNTRACLORAGENT ❑ ARCHITECT ❑ENmvEER ❑ DEVELOPER ❑ TENANT ' CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC p COMEANY NAME E-MAIL FAX STREEFADDREM CITY,STATE,ZIP PHONE ARCHTTECOFNGLNEER NAME UT SE NUMBER BUS LTC p COMPANY NAME' E-MAII. FAX STREET ADDRESS CTTY.STATE,ZIP PHONE USE OF ❑SFO w DUPIJDt ❑ MULTT-FAAm.Y PROJECT N WI DLAND ❑ YES PROTECT N ❑ YES IS THE BLDG AN ❑YES BUILDING: ❑CDF t:IAL URBANN'TERFACEAREA NO FLOOD ZONE ❑ NO VCHIFR HOME] ❑ NO DESCRIPTION OF WORK nA /% 414 414vt-�31 54 "11W 117 TOTAL,VALUATION: . D�' Poo RECEIVEO BY: BY my signature below,I caufy to each of the:ollowing: I am the property owner or anthmi=d agent to act on the property owner's behalf. I have read chis application and the information I have provided is correct j have rea the Descripl ption of Work and verify it is accurate. I aee to comply with all applicable local ordinances and state laws relating m buildingg cc9nstrucnon: I a o' e representatives of Cupertino to enter the above-idendtled property for inspection pulposcs. Signatue of Applicant/AgentI / - Dare: �/T ��.141'e N SUPPLEN127ra INFORMATION REQUMD OFFICE USE ONLY y ❑ OYER-THE-COUNTER ❑ UFRESS Y U m ❑ STANDARD U L ❑ LARGE 3 ❑ MAJOR MEPMucApp_2011.doc revised 06/21/11