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12100097 CITY OF CUPERTINO BUILDING PERMIT RUI LDING ADDRESS: 10316 DENISON AVE CONTRACI'OR:A&11 HEATING PERMIT NO: 12100097 OWNER'S NAME: MAO QINAN AND CHANG PAO-HUNG 770 CIIES NU`r S'1' DATE ISSUED: 10/1112012 OWNF-R'S PBONF-: 4089963772 SAN.IOSE.CA 9.5110 PRONE NO:(408)2794722 ❑ LICENSED CON'1'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMBr' License Class fX� Lic.N bot-1(471— r r' r' 1 AIECFI RESIDENTIAL COMMERCIALContractor , 1PP Date o 1( I herchy affirm that I am licensed under the provisions n Chapter 9 JOB DESCRIPTION: REPLACE FORCED AIR FURNACE (commencing with Section 7000)of Dh ision 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penaky of perjury one of the following boo 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. Sq.Ft Floor Area: Valuation:$2475 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of die work for which this permit is issued. AI'N Number:31629064.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK ISNOT 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 of Cupertino against liabilities,judgments, 180 DAYS FROM 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-point sou ce regulations pe h ufC M1i' Municipal Code,Section Issued by /_ 9 Date:��2 9.18. -- Signature Date RE-ROOFS: ❑ OWNER-RUILIIER DECLARATION All roofs shall be inspected prior to any roofing material beiig installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that 1 am exempt from(he Contractor's License Law for one of inspection, the following two 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(Sce.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BE ITER construct the project(Sec,7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three DAZARDOUS MA'T'ERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Ilea 11h&Safety Code.Sections 25505,25533,and 25534. [will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilcalth& performance of the work for which this permit is issued Safety Code.Section 25532(x)should 1 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 ofthe Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will p maintain compliance with the Cupertino Municipal Cndc,Chapter 9.12 and the permit is issued. Ilcalth& fete Code.Section z 505,25533,and'25534. 1 certify that in the performance of the work for which this permit is issued,I shall - , not employ my person in any manner so as to become subject to the Worker's Own or oriz .ag t: /V /l y� Compensation laws of Cal ifomia. If,after making this certificate of exemption,I Dale: L 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPI.ICANI'CI?R'I'IFICA'1'1pN 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 laws relating to building construction,and hereby authorize representatives of this city to enter .Lender's Address 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 .y RCall'I'ECI"S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA795014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOBADDRESS: PERMIT# � OC7 OWNER'S NAME: v PHONE#('(-1.3 P &&,1 —6-1 Z, GENERAL CONTRACTOR: -i AIN BUSINESS LICENSE # �L Z- ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a Cite of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTRACrOR� OBTAINED A CITY OF.CUPERTINO BUSINESS LICENSE. � � 1, /r •�� 1 am not using any subcontractors: 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 _Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10316 Benison ave. DATE: 10111/2012 REVIEWED B\': bobs. APN: BP#: 'VALUATION: $2,475 *PERMIT TN'PE: Mechanical Permit PLAN CIIECR TYPE: Alteration /Addition / Repair PRIMARY PENTAnIATION FURN/AC USE: SFD or Duplex PERN T TYPE: i WORT: re lace forced air furnace. SCOPE APPLIANCE/EQUIP TYPE FEE ID QT\' UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 TOTALS: $133.00 Mech.Plan Check 0.0 hrs $0.00 Phunb. Plan Chcek T-F Elea. Plan Chock Mech. Permit Fee: IMPERX11T Plumb. Permit Fee: lilac.Permit Fee: Other Mech. Insp. 0.0 hrs L$45.00 Other Plumb Insp. Ej Other Elec.Insp. ,blech.hap. Fee: Plumb. Insp, Fee: Elce. Insp.Fre: NOTE: This eainrale does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School District,etc.). These fees are based on the prelitninan information available and are only an estinmte. Contact Bre De t or addn'I info. FEE ITEMS (Fee Resohnion 11-053 E(C 7/1/12) FEE QTY/FEE MISC ITEMS P1un Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction Tac: Administrative Fee: /ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.50 $0.00 TOTAL FEE: $266.50 Revised: 10/01/2012 121 c)00 '� 7 GENERAL PERMIT APPLICATION IV' rm r COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I CUPERTINO (408)777-3228• FAX(408)777-3333• building(Mcuoertino.org O PLUMBING MECI1ANICAL GLFCI'RICAL SC MISC-I,I.ANEOUS PRO1ECr AD RFS APN0 I 12 1� OWNER NAME PHONi` * 91 MAIL STRETbDCIT S � 1 iPAS /, CONTACT NAME PHONE 5TRIilT ADDRESSD fr,-e' T '✓2- CITY 'T TP ZIP 1T F Q15-11D /1 i•A�I ,-^ 1017 ❑OWNFR 11OWNCR-HUILDOt ❑ OWNERAGENT M CO�NTaACfOR ❑CO,YI'RACITOR AGENT ❑ ARCHRECr 11 1'NGINEER ❑ DDry EII.OPER ❑ TIL`AN NT C Oy,.gA ' LICENSE NUMBERl LICENSHTYPE,� HUS.LIC ; 72 F:-MAI G . 7-7 01 STREET ADDRESS�j� )rr� r, CIT`„sQ ZI 5-WD PI N 0^ �9 `722 ARCIIITECU/ENGINEER NAME 1-1 LICENSE NUMBER c HIJS.LIC 0 U COMPANY NAME E-MAIL FAX STREICIADDRFSS CITY,STAT(;zip PHONE USE OF MSFD.DUPLA ❑ MULTI-FAMILY PROJECT IN WIIJJ1.AND ❑ YEs PROJECT IN ❑ Y' ISTIiEHI1KAN ❑ YI8 HUIIDING ❑COMMERCIAL URBANLYITRFACEAREA 10 FLOODZONf NO HICHI.ER110ME7 DESCRIPTION OF WORK to rA1.VALUATION: Z47 Jc� RECEIVED fly: By my signature below',I Certify to each of the following: I am the property owner Or authorized agent to net on the property ov,nef s behalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accumle. I agree to comply with all applicable local ordinances and state laws relating building constructio . I Ihonze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicalldAgenC - Date: SUPPLEMENTAL INFORMA'T'ION REQUIRED OFF'ICEUSKONIS e-0-v,1-1 I I&COIJ.\TER 6 1' ❑ E\PRESS Y V ❑ til'AMJARD V i 9 ❑ wRcr: ❑ MAJOR