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12090188 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10238 CRESTON DR CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 12090188 MECHANICAL INC OWNER'S NAINIE: FLAAGAN JOI IN K AND YVONNI-11 6056 E BASELINE RD STE 155 DATE ISSUED:09202012 OWNER'S PHONE: 4086919409 MESA,AZ 85206 PIIONE NO:(866)692-5273 ❑ LICENSED CON`RAC1'OR'S DECLARATION JOBDESCRIPTION: RESIDENTIALLJ RESIDENTIALCOMMERCIAL❑ License Class Lic.N �l!` REPLACE FURNACE IN GARAGE, INCLUDES NEW DUCT YORK Contractor Dale 9' 70 �2 THROUGHOUT HOUSE (100K BTU) hereby i m 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 die Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10050 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the perf oTnnnce of the work for which this AM Number:32637050.00 Occupancy Type: permit is issued. AI'I'LIC\N'1'CISR'I'IFICA'1'ION I certify that I have read this application and state that the above information 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep hamtless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �i 2 —/'"Z granting of this permit. Additionally,the applicnn understands and will comply Issued by: lZBale: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 20" RE-ROOFS: RROOFS: nt Signu� Date G All roofs shall be inspected prior to any reading material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ O\VNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's license Lao for one of the following two reasons: ALI,ROOF COVERINGS TO ISE CLASS"A"OR BETTER 1,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 IIA'LARDOUS MATERIALS DISCLOSURE construct the project(Sce.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the fallowing three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Ilealth&Safely Code,Section 25532(a)should 1 store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally.should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Ma nagemenl District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safe",Code,Sections 25505 15533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this —2CJ f O permit is issued. wner or amhorixed agem: Date: I certify 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 laws of California. If,after making this certificate of exemption,1 CONS'IRl1C1'ION LENDING AGENCY become subject to the Worker's Compensation provisions of the labor Code,I must I hereby affirm that Were is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued(Sec.3097,Civ.C.) lender's Name APPLICANT CERTIFICATION lender's Address 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 hamhless the City of Cupertino against liabilities,judgments, ARCI11'1'F,CI"S DECLARATION 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 appliaat understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION ' MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255 I p� CUPERTINO (408)777-3228 • FAX(408)777-3333• building0cuoer;ino.orG v\ ❑PLUMBBING MMECHANICAL ❑ELECTRICAL ❑M'I/nSsC�EJLANE�OjU�S I�D�D � /8t PROJECT ADDRESS �L050 \/ OWNER NAME /J(\ V C ,(HONE-MAIL J STREET D P FAX D Z CONTACT NAME PH NE E-MAIL S ADDAE S < CITY,STATE, ffi FAX a Q �p 1. C20 ❑OWNER ❑ OWNER-BUIlDER ❑ 0w94EiAtiQfT w CDNTKACiOR ❑CONTRACTORAGENT ❑ ARCRRER ❑ENGINEER ❑ DEVEIAPER ❑ TENANT CO CTOR NAME LICENSE NUMBER LICENSE TYPE I BUS.LIC k � t]7P8AIN AME E. FAX / / I CV DRESS CRY,STATE,ZIPPH d ,7a rem / S 20 •a? 7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC p COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,PIP PHONE USE OF vDUPLFJt ❑ MULTI-FAMILY PROJECTN W11.0 D ❑ YS I PROJECTIH ❑YES I IS THE BLDG AN ❑ YES B=Na: ❑COMMERCW. URBAN INTERFACE AREA ❑ NO FLOODZONE ❑NO MCHLEit HOM ❑ NO DESCRIPTION OF WORK ,. ' /�C /1 C e= ^1C 1f I L i Jl TOTAL VALUATIO /9 0eq N: /D RECEIVED BY: / By my signature below,II certify to each of the following: 1 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 come% I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and sate laws relating In buil 9i nsmuction. I authorize representatives of Cupenino to enter the above-identified propery for inspection putposes. Signature ofAppimandAgenn Dam: 9 - 20 �2 ' P , h ORS1ATiON REQUIRED OFFICE USE ONLY yr 4a—CV15-THE-COUNTER ❑ E\PRESS 1 J ❑ STANDARD U i ❑ t-ARCE 5 ❑ MAJOR ,kEPMucApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 12 ADDRESS: 10238 creston dr. I DATE: 09/20/2012 REVIEWED BY: bobs. APN: BP#: Q SG 'VALUATION: $10,050 *PERMIT TYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration /Addition/ Repair PRIMARY PENTADIATION FURN/AC USE: SFD or Duplex PERMITTYPE: YORK re lace furnace at garage local. includes new duct work through out sfd. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air iMFR=<100 1 # $133 Heating System 1MRRAA 1 # $67 IOTA LS: F $200.00 Mech. Plan Check 0.0 hrs $0.00 Plumb. flan Check E-lec. Plan Check Mech. Permit Fee: IMPERAHT I/'limb. Permit Fee: F.lec•. Permit Fee.- Other ee:Other Mech. Insp. 0.0 hrs L$45.00 Other Plumb Insp, L1 I Other Elec. Insp. ilech. bisp. Fee: Plumb. losp. Fee: Face.Insp. Fee: NOTE: This estinmte does not include fees clue to other Departments(i.e. Planning, Public IVorks, Fire,Sanitary Sewer District,School District,etc. . These fees are baser/on the preliminan information atwilahle and are onl-an estinuae. Contact the Dept for adt/n'1 info. FEE ITEMS (Fee Resol tion 11-053 ER' 71111/1 FEE QTY/FEE MISC ITEMS Plan Check Fee: SnppL PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. lisp Fee PME Unit Fee: $200.00 PME Permit Fee: $45.00 Construction Tat-: Administrative Fee: IADXfhV $42.00 Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSFISAIICR $1.01 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $334.01 $0.00 TOTAL FEE: $334.01 Revised: 07/01/2012 Building Department City Of Cupertino „p `1`0n3000 Torre Avenue CUPERTINO C1I111_'-IIIlIl1X1_ ��' IM�1 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 0L ,7Che ✓( PERMIT# OWNER'S NAME: 76 PHONE# ' / 9 yp 9 GENERAL CONTRACTOR: / BUSINESS LICENSE # ADDRESS: p 4, L7 n �/S CITY/ZIPCODE: r/ *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) NVILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY Of CUPERTINO BUSINESS LICENSE. n am not using any subcontractors: / _ 7 — 2 0 'A? Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing 'Flooring / Carpeting Linoleum / Wood .Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting./Wallpaper Paving Plastering X Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Wner/Contractor Signature Date