Loading...
12100182CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 10720 NIARTINWOOD WAY OW'NF,R'S NANIE: CARLSON ERIC R TRUSTEE OWNER'S PHONE: 4082572597 ❑ LICENSED CONTRACPORS DECLARATION License Class �7—lig Z19 Lie. # ��73s Contractor / 2Date 10 Zai 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 fill force and effect. herebyaffirm 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. 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. APPLIC\NI' CERTIFICA'T'ION 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. Signature ,Date Zr�L ❑ OWNER-I3111LDER DIiCLARA_h0N hereby affirm that I am exempt from the Contractor's License Lmv 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business &• Professions Code). I hereby affirmunder penalty of perjury one of the fullowing 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 perfommnce 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 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, 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. 1 agree to comply with all city and county ordinarmes 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 acerae 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. Date City Of Cupertino I 10300 Torte Avenue Cupertino, CA 95014-3255 CONTRACTOR: TFF I3EA'IING AND AIR PERNIIT NO: 12100182 CONDITIONING 299 CORNING AVE DATE ISSUED: 10252012 M ILPITAS. CA 95035 PHONE NO: (408) 786-8120 BUILDING PERMIT INFO: BLDG r ELECT (_ PLUMB r NIECII r RESIDENTIAL r COMMERCIAL .1013 DESCRIPTION: R17NIOVE AND REPLACE (8)SUPPLY DUCTS IN CRAWLSPACE AND REPLACE(I)RETURN DUCT AT ATTIC Sq. Ft Floor Area: I Valuation: $2770 APN Number: 36935032.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CAL/LED INSPECTION. Issued by: ��A/v ��'%rill Date: le �5 ��- RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BF; I-FER I IAZARDOUS MATERIA1S DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safe(y Code. Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Ilealth & Safety Code. Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255115, 25533, and 25534. Owner or authorized agent: Date' CONSTRUCTION LENDING AGENCY I hereby affurn 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. Licensed ix x CUPERTINO (2.i��IgZ GENERAL PERMIT APPLICATION M E f COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 A I (408) 777-3228 • FAX (408) 777-3333 • buildinOOCUDer�`v('ino.ora va nnu'LNci W�SCI-L4NICAL n-LECIRICA.L nNJSC-LLkY.-0US PROicCT ADDRESSW© / /—� l%�v`"-c..!/ GJA-y •/P�Nc 1 C0 �� — /G/• ONER NAME GAI {' ^ , W ! ^J �%0 �7 PHONE ZS / I (zSGS EA�'rilt`r.�i� STREc7 ADDRESS / CITY, SiG�1 FAX CDNTACT NAME PHONE STa2F<ADDRESS Cn, STAiS ZIP F.AX ❑ O` Na- ❑OWNS-BUTDE ❑ OWh A vCEN7 COMP =R ❑ CONTRACTOR AOFT. ❑ ARCM,= ❑ NGiT=L ❑ DY`cAP.-- ❑ ,1 ANT CONTRACTOR NAME ,T G , 1' - � - ' LICENSE WE I T r�A U=- E TIE�� BUS. LC C CDN.?ANY NAME ^ �s��O.J�o1..,e+Yl1- 7 S!`��- =-M.,,,L ri�H-V, fbiQ7 -A" '75 STRE:-TADDRESS A-✓4 CRY, STAI�ZIPLG P-E'�s CA 2263 PHOh= dS '796,-Y/270 ARCiLT. MENG11�EENAME LICENSE NUMBS BUS. LIC C COMPANY NAME' I E -MAB. FAX STREET ADDRESS I CITY, STATE. ZIP I PHONE USE. OF DUP1 =Y ❑ MULTHFAMILY BL1I3-D'NG t COMAffRC PRO=T IN WBDL ❑ YES I URBAN ATiAFACE AREA ❑ NO PROT� IN FLOOD ZONE ❑ Y. s ❑ NO IS TF BLDG AN ❑ YS I EICHL1t HONCI ❑ NO DESCR!IrnON OF WORK ' ft_W,f- TOTA.LvALUATION:*'/ {�, /O 1�� ' RECEDED BY: v Hy my signzTtre below, I eerd'• to tach of Lha following: f z.^N the properly oWntr o: z_LSorzed egenL ;o act on fie propcy owner's behalf. I have : ad ;his application aid the imormation I have provided is comet 1 have read the Descrptioa of Work and very it is acct -ate. I agrc- zo comply with all applicable local ordinances and sate laws relating to'onilding consrxd vthorze r-_ 'w_s of Cupertino to enter the above-identi5edprone;,y `or inspecion pofposes. Signannt of Aoph ant/Agent:Date: _ 5 Z SUPPLE. Al- IRFORMATION REQUTRED / ' OFFICE USE ONLY v V n U Z OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARCE ❑ MAJOR hfdP.VucApp_201 Ldocrevised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10720 Martinwood Way DATE: 10/25/2012 REVIFIVED BY: Sean UNITS APN: BP#: -VALUATION: $2,770 *PERMIT TYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $67 PENTAAIATION 1RMAP1 PERMIT TYPE: WORK Remove'and replace S supply ducts in crawls ace and replace 1 return duct at attic. SCOPE APPLIANCE / EQUIP TYPE FEE ID Phattb. Plan Check QTY UNITS BP FEES Elee. Permit Fee: Other Appliance/Equip 1BAPPLOT Other Eire. htsp. E37- 1 # $67 Permit Fee: SuppL Insp Fee PME Unit Fee: $67.00 PME Permit Fee:. $45.00 Conswilction Tax: Administrative Fee: (ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $67.00 Strong Motion Fee: IBSEISMICR NOTF_: This animate does not inchudejees due to otter Departments (i.e. Planning, Public Narks. Fire, Sanitary Seiner District, School District, etc.). These feev are based at lite preliminary information available and are anh, an estimate. Contact the Dent for addn'I info. FEE ITEMS. (Fee Resolution 11-053 Ell' 7/1/13) Mech. Plan Check 0.0 1 hrs $0.00 Phattb. Plan Check Flee. Plat Check Mech. Permit Fee: ImPERMIT Plumb. Permit Fee: Elee. Permit Fee: Other Mech. Insp.0.0 hrs L$45.00 Other Plumb Insp. Other Eire. htsp. E37- Me.ch. Insp. Fee: Planth. Insp. Fee: Dec. bu'p. Fee: NOTF_: This animate does not inchudejees due to otter Departments (i.e. Planning, Public Narks. Fire, Sanitary Seiner District, School District, etc.). These feev are based at lite preliminary information available and are anh, an estimate. Contact the Dent for addn'I info. FEE ITEMS. (Fee Resolution 11-053 Ell' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Snppl. PC Fee PME Plan Check: $0.00 Permit Fee: SuppL Insp Fee PME Unit Fee: $67.00 PME Permit Fee:. $45.00 Conswilction Tax: Administrative Fee: (ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planting Pees: A Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131de, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $200.50 $0.00 TOTAL FEE: 1 $200.50 Revised: 10/01/2012