12080247 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10530 CASTIN17AVE CON 1'RACI'OR: PERMIT NO: 12080247
OWNER'SNADIE: SUNILWADIIWA ONEIIOURIiGATING&AIR DATE ISSUED:08232012
OWNER'S PHONE: PHONE NO:
ry� i LICENSED COA I'RACI'OR'S DECLARATION .LOB DESCRII'"I'ION: RESIDFN-rIA - COMMERCIAL.
PQ.1
License ClassCZD•C�G ;c,N REPLACE A/C AND FURNACE IN SAME LOCATION
LID Z
Contractor Uate�/3
hereby alftrm Ill am li ens d under the provisions of Chaplcr 9
(aumm�nci� Se on- 1111)of Dfvisinn 3 of the Business&Professions
Code nn tat my-license is in fall force and effect.
hereby affirm under penally of perjury one of the following aro declarations:
I have and will maintain it certificate of consent to sell'-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 Sq.Ft Floor Arca: Valuation:$20427
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of die work for which this AISN Number:32614040.00 Occupancy Type:
permit is issued
APPLICANT CERTIFICATION
I certify that I have read this application mid stale diet the aboveinformation 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 for inspection purposes. (We)agree to save 180 DA OM LAST CALLED INSPEC IO
indenmify and keep brainless the City of Cupertino against liabilities,Judgments,
costs,and expenses which nay accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Dale:
with all non-point source regulations per the Cupertino Municipal Code,Seetion
9.18.
(/ Z RF:ROOFS:
J
Signature Date J 2' All roofs shall be inspected prior to any roofing material being installed Ira roof is
installed without first obtaining an inspection,I agree to remove all new,materials for
inspection.
❑ O\\'N I' LDlilt DECLARATION
Signature of Applicant: Date:
1 nerdy' m that I run exempt from thLaw Contractor's License lar for one of
the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR RE ITER
1,as owner of the property,many 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 Code)
1,is owner of the property,am exclusively contracting With licensed contractors to IIA%ARDOUS\IATERL\IS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous nuleriafs requirements under Chapter ti 95 of the
California Ilcalth&Safety Code.Sections 25505.25533,and 25534. 1 will
1 hereby:rlDrm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: I lealth&Safety Code.Section 25532(x)should I store or handle hazardous
I have and will maintain a CerlfiClne'Of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which earl 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 District 1
performance of the work for which this permit is issued will maintain compliance with the Cupertino NI unici pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for die performance of the work for which this gl2-j JZ
Owner or authorized agent: Ua[c
permit is issued.
1 cenify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation Imus of California. If after making this ceniflcate of exemption,1 - N-" PION LENDING.AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be defned revoked. work's for which this pennil is issued(Sec.3097,Civ C.)
Lender's Name
AI'I'I.IC\N'I'CLR'I'IFICVI'ION Lender's Address
I certify that I have read this application mid slate that the above information is
correct. I agree to comply with all city and county ordinances and state Inns relating
to building construction,land hereby authorize representatives of this city to enter
upon die above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCI IITECI"S DECLARA'T'ION
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 mid will comply
with Ill non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
( CITY OF CUPERTiNO
FEE�ESTIMATOR- BUILDING DIVISION
ADDRESS: 10530 castine DATE: 08/23/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: . $20,427
*PERM IT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD Or Duplex PERMITTYPE: FURN/A A
WORK [replace furnace and a/c at same location.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $200.00
Mech. Plan Check 0.0 hrs $0.00 Phanb.Plan Check Elec.Plan Check
Mech. Perini t Fee: IAIPERM17- Plumb.Permit Fee: race. Permit Pee:
Other Mech. lisp. 1 0.0 firs $45.00 Other Plumb Insp. ET
Other F.(cc./asp.
,Nadi./a p.Fee: Plumb. losp.Fee: Elec.hup.Fee:
NOTE: This winune does not include jeer due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District,etc.). These eev are based on the preffininari information available and are anh'an estinttue. Contact the Den or addn'I info.
FEE ITEMS (Fee Resohnion 11-053 E2 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PML Plan Check: $0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee: $200.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fees: A
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion Fee: IBSEISAIICR $2.04 Select an Administrative item
Bide, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $335.04 $0.00 TOTAL FEE: 1 $335.04
Revised: 07/01/2012
GENERAL PERMIT APPLICATIONnn,�-� M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 U MIA
CUPERTINO (408)777-3228 • FAX(408)777-3333•buildina(a),cuoertincLora `C�,� v\
❑PLUMBING J1ECtIANICAI. 'LECTRICAL ❑fI MISCC-IELLANEOUS
PROTECT ADDRESS 10,5
O 3 0 GA 7/N APNa 2 o4-0
OWNER NAME 5 N I A P H O A p'LO - 7.71 - g�37 EMAIL.
STREET ADDRESS /Q C O CITG�J�11 n PP I WO �/^ ^ �O/ I FAX
CONTACT NAME J PHONE ` 't `' EMAIL
STREETADDRESS CITY.STATE.ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS,LICA
co"PAN\'NAME 1 E-MAIL FAX
o H -71ry o'- Al R 7 5 z3 •1 0
STREET ADDRESS CITY,STATE,ZIP PHONE
IOW PE(A VL'1A PTl! �D -5A-A,vI- 9,0SA CA- 95110 �o� SAF r , pro
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STA1IL ZIP PHONE:
USE OF ❑SFDVDUPLEX CIMULTI-FAMILYPROIECTINWIIOIAND ❑ YES PROTECT IN ❑YES ISTHESLDGAN ❑ YES
BUILDING. ❑COMMEBmr. URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME: ❑ NO
DESCRIPTION OF WORK
2E � rZRAJ A� AID c - S�-7�,C- IC
TOTALVALUATIO W q27 C-� RECEIVED BY: &6--r
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: ate: / /Z_
SUPPLEME NE12IRNIATION REQUIRED OFF .usE ONLY
❑ OVER-THE-cou.NrT:R
❑ EXPRESS
1,
❑ STANDARD
i
❑ LARGE
❑ MAJOR
AMPA1iscApp}01 Ldoc revised 0612111 l