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12100218 CITY OF CUPERTINO 13UILDING PERMIT BIIILDING ADDRESS: 10665 MARTINWOOD WAY CO\I'RAC'MR:ABC COOLING&HEATING PERMITNO: 12100218 OWN ER'S NADIE: VISWESWARAN SRINIVASA AND JAYA ET A 31845 1IAYMAN ST DATE ISSIJEID: 10(312012 O\\'NER'S PDONF.: 4089972185 DAYWARD,CA 94544 PIIONENO:(510)471-8181 ❑ LICENSED CONTRAM'OR`'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r1 PLUMB rJ License Class C ao Lie.Ny���� p1 p/,-�� EC11 r RRESIDENTIALr CCOMMERCIALLERC1AL r Contractor� J� Date-/—O— - '-0)- hereby affirm that I ant licensed under the provisions of Chapter JOB DESCRIPTION:RENIOVEAND REPLACE FURNACE (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 penally 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. Sy.Ft Floor Area: Valuation:$2400 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. APS Number:36936027.00 Occupancy'fypc: APPLICANTI'CIiR'1'IPICA'I'ION I certify that I have read this application and state that(he above information is correct.l agree to comply with all city and county ordinances and slate 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 ol'Cuperunoagainst 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 source regulations per the Cupertino Municipal Code,Section Issued bv: � � Tl/l� Dale: /40 '31 Ig 9.18. RF;ROOFS: ❑ O\VNER-BL111AIiR DECLARA'T'ION All roofs shall be inspected prior to any roofing material being installed If a roof is installed without fust obtaining an inspection,I agree to remove all new materials for I hereby affirm that Ian exempt from(lie Contractor's License Law for one of inspection. (lie follow'i ng Iwo reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applimnt: Dale: 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 BF CLASS"A"OR 13F,'ITF-R construct the project(Sce.7044,Business&•Professions Code). hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS 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 Ileallh&Safclp Code,Sections 25505,25533,and 25534. I 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 Ileallh& performance of the work for which this permit is issued Safely Code.Section 25.532(m)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(he work for which this contaminants as defined by(lie Bay Area Air Quality Management District I will permit is issued, maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ileulth&Safely Code.Sections.55115,25533,and 25534. 1 certify that in the performance of die work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Worker's i 1 nz Compensation laws of California. If,alter making this certificate ofexemption,I �'/ laIC:w-�r-�d- become subject to the Worker's Compensmion provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRIXXION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's .\I'I'hIC,\NI'CISR'1'IPIC.\'I'IOS for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application mid stale that the above information is Lender's Name correct.1 agree to complywilh all city and count)-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 indemnily and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCI I I'I'I?CI"s Ill?CLARA'I'ION granting of this permit.Additionally,the applicant understands and will comply 1 understand nay plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Dale CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10665 MARTINWOOD DATE: 1 013 112 0 1 2 REVIEWED BY: SEAN APN: BP#: 'VALUATION: $2,400 *PERMIT TYPE: Mechanical Permit PLAN CIIECR TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK REMOVE AND REPLACE FURNACE. 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 Ins $0.00 Plemth.Plan Check Flee. Plat Check Mech. Permit Fee: IMPERMIT Plumb.Permit Fec: race.Permit Fez: Other Mech. Insp. 0.0 hrs $45.00 other Plumb Invp. Li Other Elce.Insp. L1 I Mr.ch.Gip. Fee: Plumb. lay.Fee: Elcc.Insp.Fac: NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District, etc.). These ees are based on the prelintinan information available and are adr an estimate. Contact the Det for atldn 11.in a. FEE ITEMS (Fee Resolution 11-053 Ell' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PCFec PME Plan Check: $0.00 Pertnil Fee: Supp/. Ins? Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Con.simc ion Tar: Administrative Fee: /ADMIN $42.00 Work Without Permit? Yes Q No $0.00 Adventeetl Planning Fces: Travel Documentation Fee: ITRAI DOC $45.00 A Strong,Motion Fee: IRSEISAfICR $0.50 Select an Administrative Item 131da Sids Commission Fee: IRCRSC $1.00 SUBTOTALS: $266.50 $0.00 TOTAL FEE: 1 $266.50 Revised: 1010112012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I sc CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcuoertino.ora ❑PLUMBING • MECUANICAL �CTRICAL EIMISCELLANEOUS PROJECTADDRESS10665 MARTINWOO SSV' APN9 ,�lp ✓6 -Q(:? OWNER NAME IYER, SRIRAMAYA �� PHONE408 997 2185 E-MAIL STREET ADDRESS 10665 MARTINWOOD WY CITY.STATE-z'PCUPERTINO CA 95014 1 FAX CONTACTNAIIEMAGGIE MENDOZA I P"ONE510471 8181 E-MAILMAGGIEM@ABCCOOLING.COM SrREETADDREss3266 INVESTMENT BLVD I C'rY,S'rATE.ZIP HAYWARD CA 945451 FAX 510 471 8368 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT IT CONTRACI'OP. ❑COM'itACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO,YTRACTORNAME SCOTT LUNDAY LICENSE NUMBER 382383 LICENSE TYPE C20 BUS.LICM COMPANY NAME ABC COOLING & HEATING E-MAIL MAGGIEM@ABCCOOLING.COM FAX 510 471 8368 STREETADDRENs3266 INVESTMENT BLVD CITY.STATE,zIPHAYWARD CA 94545 PHONE 510 471 8181 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N CO%IP.W Y NAME E-MAIL FAX STREETADDRESS CRY,STATE,ZIP PHONE 011 OF FDor DUPLEI C) MULTI-FAMILYPROJECTINWILDtAND ❑ YES PROJECT IN YES IS THE BLDG AN ❑ YES BUIm"G: COMMERCIAL URBAN INTERFACE AREA .ANO FLOODZONE NO EICHLER ROMM. .'O DESCRIPTION OF WORK REPLACE FURNACE WITH 80% EFF TorALVALUATION: �O �.l RECEIVED BY:' By my Signature below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property downer's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating t ing construction. I autJl�r¢e r �Te 'vesniCupenino to enter thea ve-ide7ntified property for inspection purposes. Signature o(Applican✓AgenC � �/� Dater^JI—I Ol SUPPLEMENTAL INFORMATION REQUIRED OFFICEUSEONLY OVER-THE.COU3TEliEl - 6 EXPRESS _ z . ❑. STANDARD_- - '< :❑ LARGE ME)",11iscApp_2011.doc revised 06121/11 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 1, 3-7 Site Address: Enforcement Agency: Date: Permit tt: 10665 MARTINWOOD WAY Cupertino, CA 95014 City of Cupertino I Oct 23, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑Package Unit ®Furnace ®AFUE 80% O COP_ ®Setback I]Indoor Coil O SEER_ O HSPF_ R 6 (CZ 1, 3-5) Served by system ff not already present, must be ❑Condensing Unit ❑EER ❑Resistance O R 4.2 (CZ 6, 7) 1560 sf installed) ❑Other_ 1.Equipment Type:Choose the equipment being Installed;If more than one system,use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPF for typical residential systems. Contractor(Documentation Author's /Responsible Designer's Declaration Statement) .1 certify that this Certificate of Compliance documentation is accurate and complete. .1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. .1 certify that the energy features and performance specifications for the design Identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. .The design features identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Scott Lundy Signature: Scott Lundy Company: ABC COOLING &HEATING SERVICES INC Date: Oct 23, 2012 Address: 31845 HAYMAN STREET License: 382383 City/State/Zip: HAYWARD/CA/ 94544 Phone: (510) 471-8181 F , Reg: 212-A0059363A-000000000-0000 Registration Date/Time: 2012/10/23 19:30:93 HERS Provider: CSICERTS, Inc. 2008 Residential Compliance Forms July 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777.3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: I0(0 C ; A6gj I zo, I PERMIT# OOd OWNER'S NAME: PHONE# GENERAL CONTRACTOR: tco Lemur\ \ BUSINESS LICENSE#?j � ADDRESS: �(o 6/ CITY/ZIPCODE: 9LJ545 *Our municipal code requires all businesses working in the city to have a City of Cuper ino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I.am not using any subcontractors: C (/un�/G�G I0 5 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 BUILDING PERMIT BUILDING ADDRESS: 7508TIPTOE LN CON"fRAC7fOR:ABC COOLING&HEATING PERMITNO: 12100217 OWNER'S NAME: MUZZI CARMELLA B TRUSTEE 31845 DAYMAN SI' DATE ISSUED: 10/31/2012 OWNER'S PHONE: 4082578395 IIAYW'ARD.CA 94544 PI IONS NO:(510)471-8181 ❑ LICENSED CON"IRAC`fOR'S DECLARATION BUILDING PERMIT INFO: BLDC r ELECT r PLUMB Ci 1-iccnse Cl.1ss GAO Lic.H �I9-�, tl 3 1" C) r �, /D_ ?Y_ +� MF.CFI RESIDENTIAL COMM1IERCIAL Contractor Date hereby affirm that 1 nm licensed under(he provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE 1'URNACE (commencing with Section 7000)of Division 3 of the Business& Professions Code and that tar license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 1 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:$9000 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 APN Number:35932053.00 OccupancyType: .\PI'LIC.\N'f CER'1'IPIC,\'PION I cenify 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 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[he CityofCupertino against liabilities, judgments, 18(1 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accme against said City in consequence of the graining of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: . ���,✓ �TGCf Date: RF:ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without firs(obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the 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(Sec.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 RE;ITER construct the project(Sec.7044,Business d Professions Code), I hereby affirm under penalty of perjury one of the fallowing three DAZARDOUS MATERIALS S DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter!95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California llealth&Safery Code,Sections 255115,25533,and 25534. I 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 llealth& perfommnce of the work for%%Inch this permit is Issued Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally.should 1 use equipment or devices which emir hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Nlunicipal Code,Chapter 9.12 and the permit is issued. llealth&Safety Code.Sections 25505.25533.and 25534. 1 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 pwneyu out ar L� 1iI�Ji 2)._ Compensation laws of Califamia. If,after making this certificate of exemption,1 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. CONSTRIN-fl 3N[,ENDING AGENCY I hereby affrtn that there is a construction lending agency for the performance of work's APPLICANT CE RTI FICATION 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 consruction,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, ,\RCIII'1'F:CI"S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used to public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 1 72oI ( I GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' (408)777-3228• FAX(408)777-3333° buildino(DDcupertino.org CUPERTINO sc Ej PLUMBING *]MECHANICAL ELECTRICAL MISCELI-ANEOUS PROJECTADDRESS7508 T IPrTIOE LANE APN1 359- �a - o5 OWNER NAMEBORREGO'VA/N rnj7 VI PHONE408 257 8395 EMAIL STRCETADDRESS 7508 TRIPTOE LANE CITY, STATE,ZIPCUPERTINO CA 95014 1 FAX COM'ACF NAME MAGGIE MENDOZA I PHONE510 471 8181 I E-MAIL MAGGIEM@ABCCOOLING.COM STREET ADDRF.SS3266 INVESTMENT BLVD I CITY,STATE,ZIP HAYWARD CA 945451 FAX 510471 8368 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT E CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME SCOTT LUNDAY I LICENSENUMBER 382383 1 LICENSETYPE C20 BUS.LICd COMPANYNAME ABC COOLING & HEATING E-MAIL MAGGIEM@ABCCOOLING.COM FAX 510 471 8368 . STREETADDREss3266 INVESTMENT BLVD CITY,STATFZIP HAYWARD CA 94545 PHONE 510 471 8181 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC A CONIPANY NAME E-MAIL FAX STREETADDRESS CITY,STATE ZIP PHONE USE OF FDor DUPLEX ❑ MULTI-FMIILY PROJECT INWILDLAND ❑ YES PROIELTIN ❑ YES IS THE BLDG AN 1"ES BUIIDINO. ❑fOMAIERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER NOME? NO DESCRIPTION OF WORK REPLACE FURNACE WITH 96% EFF TOTAL VALUATION: / Oo C7 RECEIVED BY: Be 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 information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ng construction. autho`e a sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: r�r Date:_����— I SUPPLEMENTAL INFORMATION REQUIRED 'oiFTce USEbsi:Y..' F, ❑ E\PRESS .:may ❑ LARGEAiOR o'-fv:nin r J� ,4lFA%fiscApp_201 Ldoc revised 06/21/11 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 1, 3-7 Site Address: Enforcement Agency: Date: Permit#: 7508 TRIPTOE LANE Cupertino, CA 95014 City of Cupertino Oct 29, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat Ll Package Unit ® ®Furnace AFUE 96% ❑COP_ H R 6 (CZ 1, 3-5) Served by system ®Setback ❑Indoor Coil p SEER_ [3 HSPF If not already present, must p Condensing Unit ❑EER_ [3 Resistance R 4.2 (CZ 6, 7) 1200 5f be installed) ®Other > 40' Ducts 1..Equipment Type:Choose the equipment being Installed;if more than one system, use another CF-IR-AIT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.]HSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) .I certify that this Certificate of Compliance documentation Is accurate and complete. .I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design Identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. .The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Scott Lundy Signature: Scott Lundy Company: ABC COOLING &'HEATING SERVICES INC Date: Oct 29, 2012 Address: 3266 INVESTMENT BLVD I License: 382383 City/State/Zip: HAYWARD/ CA/94545 Phone: (510) 471-8181 i,l Reg: 212-A0060494A-000000000-0000 Registration Date/Time: 2012/10/29 18:36:04 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forme July 2010 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 7508 TRIPTOE LANE DATE: 10/31/2012 REVIEWED BY: SEAN APN: BP#: 'VALUATION: $9,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMPP TYPE: FURN/AC NVORK REMOVE AND REPLACE FURNACE. , SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 TOTALS: $133.00 Mech.Plan Check Fo.0 hrs $0.00 Plumb. Plan Check Cleo. Plan Check Mech. Permit Fee: IMPF.RMIT Plumb. Petwir Fee: Flec. Permit Fee: 011ier Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Other F;Iec.Insp. Ll I d•Iech.Insp.Fee: Plmuib. bccp.Fee: Flee.Insp.Fee: !TOTE: This estimate clues not includejeer clue to other Departments(i.e. Planning, Public Woos, Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelitninan information available and are only an estimate. Coact the Deyajor adtfn'I info. FEE ITEMS (Fee Resolution 11-053 EIT 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: SuppL PC Fee PME Plan Check: $0.00 Permil Fee: Suppl. /nsp Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Consitwction Tar: Administrative Fee: (ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Hid, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.90 $0.00 TOTAL FEF: $266.90 Revised: 10/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:_75O (; LO PERMIT# 1,0092 OWNER'S NAME: PHONE # GENERAL CONTRACTOR': �Go L BUSINESS LICENSE# ADDRESS:3aC (o 1Oveo rn4.t\t U\jd I CITY/ZIPCODE: CqL1614 *Our municipal code requires all businesses working in the city to have a City of Cuperti io business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. \ I am not using any subcontractors: C//_� /0 Signature Date Please check applicable subcontractors and complete the following information: t/ 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