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12110140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7440 RAINBOW DR I CONTRACTOR: HUSSEY BROS INC I PERMIT NO: 12110140 OWNER'S NAME: CHANG JAMES CIIEWEN AND LIRU ZHOU TR I903 GEORGE ST IDATE ISSUED: 1127/2012 OWNER'S Pl IONE: 4083947480 I SANTA CLARA. CA 95054 1 PUONE NO: (408)733 -6360 ❑ LICENShD CONIRACIOR'S DECLLARATION License Class u) C- Lie.# ` tP �?1_6 4 I Contractor'-. NrSS+.J $NS- Date 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 full force and effect. 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 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. APPLICANF CERTIFICATION 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 Imes 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 indemni fy,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. Additionalh•, the applicant understands and will comply with all non -point s urce regulations per the Cupertino Municipal Code, Section 9.18. Ir -L1 -(L Signature Date ❑ OWNER- BUILDER DECLARA'T'ION hereby affirm that I um exempt from the Contractor's License Law 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). hereby affirm under penalty of perjury one of the following 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 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. 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 Imes of California. 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. APPLICANI' CERT'IFICAT'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 harridess the City of Cupertino against liabilities,judgnments, costs, and expenses which may accrue against saidChy 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 BUILDING PERMIT INFO: BLDG C ELECT 0 PLUMB r NIECH C RESIDENTIAL ❑ COMMERCIAL IJ JOB DESCRIPTION: NIULTI- FAMILY APT I & 4 - REPLACE A/C AND APT 3 REPLACE FURNACE & A/C Sq. FI Fluor Area: ) Valuation: $5000 APN Number: 36619015.00 I Occupancy Type. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: lam- z RE- ROOFS: All roofs shall be inspected prior to any reading material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVF.RINGST'O BE CLASS "A" OR BETTER HAZARDOUS MATEIRIAI S DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code. Sections 255115, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Safely Code, Section 25532(a) 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 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Ilndth & Safety Code, Sections 25505, 25533, and 25534. Owner o 'zed agent: �� - /•� Uate: CONST'RUC`TION LENDING AGENCY I hereby affirm 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 ARCUITF,CI "S DECLARATION I understand my plans shall be used as public records. Licensed GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUPERTINO (408) 777- 3228 • FAX (408) 777 -3333 • buildinarcDcuoeriino.ora r PL 4 - 4Fr-4AV,,(-AT_ =T IrAl- Flymv =i f AK- -nTlc MEP m'sc PROJECT ADDRESS / 1 f ` ke { Y,-IO y O r ,- �( lJ _ l _ D r ✓ rr' / I OVJ ER NAME �I GM+iS I�Y�C�H PHOt.- DC�QL� �u�J / / 7 tNcka. ' S-R =, ADDRESS �1 s �G 1` 0 R 16A0Q r. I STA �Z7f �".v �- �0 7Sd/ . X CONTACT NAME PHONE E-M!SL Size_FT ADDRESS CTY, STA iB, II? I FAX ❑ Ow-a ❑ OWh"ti -Buaom ❑ OWNRA=— ❑ CONTRACTOR XnNTRAC'OR Af= ❑ ARC--=T, ❑-�GT''�'t- ❑ DtizLo?� ❑?_y .-T CON-lRACTORNAME t,+ �V�3e I LICE "'_.`S = 61 Llcr.zu I BUS. iIC k' COMPANYNAN° Nvsse Bros. Lam(, `MAIL I FAX YOS'23-L J'9G' STTi.c''f lDDISS 03 &c o e S � , cB IJWV P 30Nc yb F ) 4360 ARC:rr- CT/ENGlNEER NAM3 i LICENSE NUM9Z BUS. LJC9 COWANYNANCE' E -MAIL FAX ' STREETADDRESS CITY, STATE. ZIP PHOhc USE OF T1FAMD.Y BL=NG: ❑COMN.EA PROPECT N WDDLAND ❑ YES I MAN ATERFACE AREA ❑ NO PRO=D! ❑ vBs FLOOD ZONE ❑ NO t5 TF =ELDG AN ❑ YS pCH1�lHOhL'I ❑ NO =_ DSCRI'MON OF WORX ( - 1 e (ice IT — 4 j�` n K (tv)act xVr(c • �•�3 4/(- re,ektc ik A-p4* TOTAL VALUATION: Q I RECEIVED BY: �f By ©y signature below, I "niy to each o':ne I are the pmpertv owner or enl,5onzed agent w ac: on the pmpc;z+ owner's behalf. I bave : zd this appliczion and the into -zion I have provided i co-ccl 1:: =.ave --a tae Dacipdon o:'wo:1: zsd v` ::v it is acn:zte. I ag; ee,:o comply wii all applicable Iota! o: diranas znd sraa laws mlating m bedding ^ � don. I aD'Sorize:nmsn;adves of Coper;ino so enter ;he about- idcnd5�e73 pmp_:.l :or inmecdoe pet'- ,�soses. Sigrat: of Applicar:dA.g:nn Dax: ���/� 7 2- SL-PPLEM::N i AI. S1.r0 4TION REQU=D . ' ' OFFICE USEONLY e u u L z ❑ O\ cR- THE -COUNTER ❑ EXPRESS ❑ STANDARD ❑ LAROE ❑ NIAJOR AEP?luc4pp_1011.doc revved 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION AADDRESS: 7440 rainbow dr. DATE: REVIEWED BY: bobs. UNITS APN: BP #: 'VALUATION: $5,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Multi - Family Dwelling Building is >3 Stories O Yes G No PENTAMATION PERNIIT TYPE: FURN /AC NVORK re lace 3 A/C and 1 Forced air furnace. SCOPE 1 APPLIANCE/ EQUIP TYPE FEE ID Phumb. Plan Cheek QTV UNITS BP FEES Flec•. Permit Fee: A/C Units ( < =10K cfm) 1BREMAIR Other• Flec. Insp. El 3 # $201 Furnace, Forced -Air 1MFR = <100 Suppl. Insp Fee 1 # $133 PME Unit Fee: $334.00 PME Permit Fee: $45.00 Construction Tin-:: Administrative Fee: IAD,VIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 ' - TOTALS: i Travel Documentation Fee: ITRAVDOC $334.00 Strong Motion Fee: IBSEISAIICR NOTE: This eVinrnte clues trot includejees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). There feev ore hosed on the Preliminary information available and are mth, air evtintcue. Contact tire Dept for ruldn'I info. FEE ITEMS (Fee Resolution 11 -053 Eff 711112) Mech. Plan Check 0.0 1 hrs $0.00 Phumb. Plan Cheek Flee. Plan Check ' Mech. Permit Fee: I,11PER kflT Pbrmh. Permit Fec•: Flec•. Permit Fee: Other Mech. InsR 0.0 hrs $45.00 Ocher Plumb Insp. Other• Flec. Insp. El tech. heap. Fee: Plumb. htvp. Fee: Eke. Insp. Fee: NOTE: This eVinrnte clues trot includejees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). There feev ore hosed on the Preliminary information available and are mth, air evtintcue. Contact tire Dept for ruldn'I info. FEE ITEMS (Fee Resolution 11 -053 Eff 711112) FEE QTY /FEE MISC ITEMS Phin Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $334.00 PME Permit Fee: $45.00 Construction Tin-:: Administrative Fee: IAD,VIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced. Planting Fees: i Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item Bide Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $467.50 $0.00 TOTAL FEE: $467.50 Revised: 10/01/2012