12100141 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7656 NORMANDY WAY CO\TRACTOR:ABC COOLING&HEATING PERMIT NO: 12100141
OWNER'S NAME: JABRI CLARICE M TRUSTEE 31845 BATMAN SI' DATE ISSUED:10/182012
OWNER'S PHONE: 4086740705 IIAY\VARD,CA 94544 PHONE NO:(510)471-8181
❑ LICENSED CONTRA C`fOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT ID PLUMB (J
License Class e 'M Lic.# 3 8"a 3 F'3 r_ r r
A / AfECH RESIDENTIAL COMMERCIAL
Contractor A�hdrel/ AX/' GMSD,lc_IQ— LZ— I Q.
1 hereby affirm(hat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE FURNACE IN EXISTING LOCATION
(commencing with Section 7000)of Division 3 of the Business&Professions
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 ceni Ocate 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. S Ft Floor Area: Valuation:54977
I have and will maintain Worker's Compensation Insurance,as provided for by 9-
Section 3700 of the Labor Code,for die performance of die work for which this
permit is issued. APN Number:36617055.00 Occupancy Type:
APPLICANT CEBIT FICATION
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 mid stale laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City ofCupenino against liabilities,judgments, 180 HAI' M LAST CALLED INSPECTION.
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-poim source regulations per the Cupertino Municipal Code,Section Issued by: C Date:l
9.18.
Signaam_4 �� Done 1r�2
RE-ROOFS:
❑ OWNER-RUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is
installed without fim obtaining an inspection,I agree to remove all new materials for
hereby affirm that I am exempt from the Contrac(or's License Law for one of inspection,
the following Iwo reasons:
I,as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three UA'LARDOIIS AIATF RIAIS DISCLOSURE.
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate ofConsenl to self-insure for Worker's California Iladth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cu per(ino Municipal Code.Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(n)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this conOmninanl.s as defined by the Ilay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and(he
Death&Safety Cade.Sections 25505,25533,and_5534. -
I certify that in the performance of die work forwhich this permit is issued,l shall
not employ any person in any manner so as to become subject to the Worker's pwrier or authpri
Compensation laws of California. If,after making this certificate of exemption,I Date:
became 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. CONSTRUCTION LENDINGAGENCY
1 hercbv affirm film there is a construction lending agency for the performance of work's
API'LICAN"f CI?R'1'IFIG\"PION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state Imus relating
to building construction,and hereby authorize representatives of this city to cuter Lender's Address
upon the above mentioned properly 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 ARCII ITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand illy plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
12Lool41
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M
(408)777-3228• FAX(408)777-3333•building(okuoertino.org
CUPERTINO
ISIC
❑PLUMBING ' MECIIANICAL ❑IiLECTRICAL RMISCELLANEOUS
PROJECT ADDRESS7656'NORMANDY WY AP"" - L7 O5�
O";NERN'AMEJABRI, CLARICE PIIONE408 674 0705 1
E-MAIL
MEEFADDRIM7656 NORMANDY WY CITY,STATE,ZIP CUPERTINO CA 950141 FAX
CONTACT NA\IE MAGGIE MENDOZA PIIONE 510 471 8181 6NIAILMAGGIEM@ABCCOOLING.COM
FIREETADDRESS 3266 INVESTMENT BLVD CITY,SFATE,ZIP HAYWARD CA 94545 FAX 510 471 8368
❑OWNER ❑ OWNER BUILDER ❑ OWNER AGENT IN CONFRAC OR ❑CONTRACTOR AGENT ❑ ARCIIITECr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAM"SCOTT LUNDAY LICENSENUNUBER 3823837 uLICE1sSETYPEC20 BUS.LIC 0
CO\IPAX)'NA,IE ABC COOLING & HEATING E-'IA'L MAGGIEM@ABCCOOLING.COM FAN510 471 8368
ST'REE7ADDRESs3266 INVESTMENT BLVD CITY.SrATIL ZIP HAYWARD CA 94545 "ION"510 471 8181
ARCI BI'ECI IENGINEI:R NA\I F. LICF..uSE NUMBER BUS.LIC b
CO\IP,\N1'SA\IE E-.MAIL FAX
SI REM ADDRESS CITY,SLYF[ZIP PHONE
IISIi OF ❑STD or DUPLRC ❑ MULTI-FAMIt.Y PRO"C" IN N'ILDLAND ❑ NES PROTECT IN ❑ 1'FS I$TIIE BLDG AS ❑ 1'[S
BUILDING: C]COM\IERC1A1. URBAN INTERFACE AREA C] No FLOOD ZONii ❑ NO EICIILERItO,UL. ❑ NO
DESCRIPTION OF"'ORA ,
REPLACE FURNACE WITH 96% EFF
TOTAL VALUA'r10Nt4977,00 RECEIVEDBY: V J
By my signature below,I certily to each of the lidlo% ing: I am the property ovJncr or Uaduni'red ngenl to act on the property o"ner's behalf: I have read this
application and the information I have proviC:d is correct. I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and slate Imus relaune �u�ll�d/ing/c'�}^slru/c�}/Ion�. I a�j}a�jlJy�n¢.re/pmsentaticcs of Cmwrtino to enter the above-identified property for inspection purposes.
Signature of Applicunt/Agcnl; � '�U4!!' -� *Date: /D—I!/ — I ;L
SUP111,I7,NIBNITAL INFORMATION REQUIRED OFFICE USEONLY
❑
s. OVER=TBE.COUNTPai
..
❑ E.\PRESS '
❑ $i'Ap'DAND
< ❑ LARGE P i
'a
❑ )LWOR
1
,1/L7',Visc Ipp_201 Leloc revised 06'21111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7656 Normandy Way DATE: 10/18/2012 REVIEWED BY: jsg
APN: • BPH: 'VALUATION: $4,977
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYPENTAMATION
USE: SFD or Duplex PERMITTYPE: FURN/AC
WORK Re lace furnace in existing location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
Mech. Plan Check 0.0 1 hrs $0.00 P1.....b.Plan Check Flee. Plan Check
Mech.Permit Fee: 1AIPERAHT Plumb. Permit Fec: Glee.Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Etec.Insp.
�Adech.Insp.Fee: Plumb. htap.Fee: Elce.Insp.Fee:
NOTE: This estimate does trot include jeer clue to other Departments(i.e. Planning, Public Works. Fire,Sanitary Server District,School
District.etc.). These fees are based on die preliminanv information available and are onh•an estimate. Contact the Dept for addn7 into.
FEE ITEMS (Fee Resolution 11-053 Elf 7///12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Construction Tay:
Administrative Fee: (ADMIN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAI DOC $45.00 A
Strong Motion Fee: 113SEISMICR $0.50 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $266.50 $0.001 TOTAL FEE: $266.50
Revised: 10/01/2012