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12080202CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20584 & 20588 SCOFIELD DR CONTRACTOR: COLD CRAFT INC PERMIT NO: 12080202 ONVNER'S NAME: LIN STEVEN P AND CHANG LYCHIN TRUST 181 LOST LAKE LN DATE ISSUED: 08/20/2012 OWNER'S PHONE: 4088738186 CAMPBELL, CA 95008 PRONE NO: (408)374-7292 ❑ LICENSED CONTRACTOR'S DECLARATION License Class l l L. C�� p Lic. 0 7 Contractor W CL"J-+Lt L • Date 2.0 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 my license is in full force and effect. I 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 the Labor Code, for the performance of the work for which this permit is issued. 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 permit is issued. APPLICANT CERTIFICATION 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 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 permit. Additionally, the applicant understands and will comply with all not}"�Qint source regulations per the Cupertino Municipal Code, Section 9.18. / ': . t Signature VU I 6K Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: I, 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 Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the 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 the work for which this permit is issued. I certify that in the performance of die work for which this permit is issued, l shall not employ any person in any nmanner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r— COMMERCIAL r JOB DESCRIPTION: 20588 SCOFIELD DR - REMOVE AND REPLACE EXISTING FURNACE AND AC Sq. Ft Floor Area: I Valuation: $8574 APN Number: 35910012.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or authorize rent• �. 10_ �ci�Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professio CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION v ADDRESS: 20588 Scofield DATE: 08/20/2012 REVIEWED BY: jsg UNITS APN: BP#: 'VALUATION: 1$8,574 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: A WORK Remove and replace existing furnace and AC SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plun Check QTY UNITS BP FEES Elec. Permit Fee: Furnace, Forced -Air 1MFR=<100 other Elcc. Insp. Li 1 # $133 A/C Units (<=10K cfm) 1BREMAIR Suppl. Insp Fee 1 # $67 PME Unit Fee: $200.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: (ADMIN $42.00 Work Without Permit? C) Yes 0 No $0.00 TOTALS: F Travel Documentation Fee: ITRA VDOC $200.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based air the preliminary information available and are only an estimate Contact the Dept for adthr'I into. FEE ITEMS (Fee Resoh,tion 11-053 E . 7/1/11) Mech. Plan Check Rolhrs $0.00 Plumb. Plun Check Elec. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $45.00 ether Plumb Insp. other Elcc. Insp. Li Uech. insp. FeC: Plumb. htsp. Fee: Elco. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based air the preliminary information available and are only an estimate Contact the Dept for adthr'I into. FEE ITEMS (Fee Resoh,tion 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Plum Check Fee: S,tppl. PC Fee PME Plan Check: $0.00 Per,nit Fee: Suppl. Insp Fee PME Unit Fee: $200.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: (ADMIN $42.00 Work Without Permit? C) Yes 0 No $0.00 Advanced Plarn„ng lees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $0.86 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $333.861 $0.00 TOTAL FEE: $333.86 Revised: 07/01/2012 P: CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cuoetno.orD ❑PLUMBING ❑MECFAMCAL F1FLECTRICAI_ I I MTCri.7 r e XMnT tC MEP IMA ISC PROJECT ADDRESS /� , r I A.PN u uOVI • OWNER NAME L�.� P Q —� '/ -V Ee� S REETADDRES�� M ►�� FAX Jf 1 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER. ❑ OWNER AGENT x1coNTRAcToR ❑ CONTRACTOR AGENT ❑ ARCHITECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CT R L.ICE�15E NUMBER CENSE TYPE BUS. LIC C• E—MAIL � � FAXI _r'li��•� t3� L��' I:� 1 � ADD SS / ,STATE, _ G� PAONE ARCIi1TECT/ENGIN'EEIR NAME LICENSE NUMBER BUS. LIC b COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD m DUPLEX ❑ MULTI-FAMMY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES PROJECTIN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLEt HOME? ❑ NO DESCRDMON OF WORK C � TOTAL VALUATION: RECEIVED BY: 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 informati ve provided is correct ve read the Description of Work and verify it is accurate. I agree_to comply with all applicable local ordinances and state laws rel ng bu'Idi constrocti Irepresentatives of Cupertinc :c enter the above-idend5edprope.—'proper.;or inspection purposes. Sigttature ofApplicanVAg –" per: SORMATION REQUIRED OFFICE USE ONLY yyc I- ❑ OVER-THE-COUNTER ❑ EXPRESS U U ❑ STANDARD ❑ LARGE ❑ NWOR MEPMiscApp_2011.doc revised 06/21/11 2 d1ANJ a