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13040035CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22356 RANCHO VENTURA ST CONTRACTOR: VALLEY HEATING & PERMIT NO: 13040035 COOLING OWNER'S NAME: KUAN DANNY Y AND WEN W 1171 N 4TH ST DATE ISSUED: 04/04/2013 OWNER'S PHONE: 4084620746 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] vr LICENSED CONTRACTOR'S.DECLARATION License Class L —?(j Lic. # 25850 REMOVE (E) FURNACE IN CLOSET & INSTALL (N) FURNACE Contractor V e r Date/� `� IN ATTIC AREA W/ALL DUCT WORK. ADD (N) A/C UNIT & I hereby affirm that I am licensed der the provisions of Chapter 9 UPGRADE (E) EL PANEL TO 125AMP, SAME LOCATION. (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 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 Sq. Ft Floor Area: Valuation: $20500 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 APN Number: 35703055.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. i agree to comply with all cityand county ordinances and state laws relating WITHIN 180 D PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D OM L CALLED INSPECTION. 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 sued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which'may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date. • GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ) 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 _ (408) 777-3228 •FAX (408) 777-3333 • building(cDcupertino.org V� M Isc ❑ PLUMBING MECHANICAL ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESSSCP APN # - /' (J � -J V .- o 55; , OWNER NAME ✓ - PAA A y t1441A PHONE E-MAIL STREET ADDRESS 35 Vew i.,,,—e, r CITY, STATE, ZIP L� q5G,/� FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �/ 1 N r LICENSE NUMBER Z LICENSE TYPE BUS. LIC # COMPANY NAME If r r i E-MAIL FAX Your 2gK- Y STREET ADDRESS l/71 Nr, eft CITY, STATE, ZIP /T e7511 PHONE-* A( /� l ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT 7 WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO. EICHLER HOME? ❑ NO DESCRIPTION OF WORK r^ i 45 h e 7 D -e c e is in /[� / (O oret r �d cram T 4.r /I ' ( to TOTAL VALUATION: 5D� RECE By my signature below, I certify tafeach of the following: I am the property owner or authorized agent to act on the propeflT 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 building co struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: L�"► /i3 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER TJWCOUNTER a, ❑ EXPRESS ❑ STANDARD U ❑ LARGE 0. ❑ MAJOR MEPMiscApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO TTF FCTI<MATnR _ R1141.11ING YHVISION Mech. Plan Check ro.0 I hrs $0.00 Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs . -.$0.00 Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMT Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. L. hrs $45.00 Other Elea Insp. 0.0 hrs $45.00 Allech. Inspz Fee: Pluwb. best. .Fee: I Elec. Insp, Fee: NnTF• Thic avdmato dnoc not include feet due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School These ees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) -LaiADDRESS: 22356 RANCHO VENTURA ST DATE: 04/04/2013 REVIEWED BY: MELISSA APN: 357 03 055 BP#: *VALUATION: $20,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p PENTAMATION FURN/AC PERMIT TYPE: A USE: PME Plan Check: WORK REMOVE E FURNACE IN CLOSET & INSTALL N FURNACE IN ATTIC AREA W/ALL DUCT SCOPE I WORK. ADD (N) A/C UNIT & UPGRADE (E) EL PANEL TO 125AMP, SAME LOCATION. INSTALL (Na Mech. Plan Check ro.0 I hrs $0.00 Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs . -.$0.00 Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMT Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. L. hrs $45.00 Other Elea Insp. 0.0 hrs $45.00 Allech. Inspz Fee: Pluwb. best. .Fee: I Elec. Insp, Fee: NnTF• Thic avdmato dnoc not include feet due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School These ees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $133.00 Mechanical ]MFR=<100 I Furnace, Forced -Air Suppl. PC Fee: 19 Reg. ® OT0.0 hrs $0.00 PME Plan Check: $0.00 F1 # $67.00 Mechanical 1 ]BREMAIR 7 A/C Units (<=1OK c$n) Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. ® OT 0.0 hrs $0.00F-1 __j # Plumbing $27.00 IPRWHEATR Water Heater PME Unit Fee: $0.00 PME Permit Fee: $135.00 125 amps Electrical $45.00 IBELEC200 Services Canso -fiction :Tax: Administrative Fee: lADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $2.05 Select an Administrative Item Bldg_Stds Commission Fee- IBCBSC $1.00 $225.05 $272.00 �, $497. 05 Revised: 04/01/2013 �.., a-..cn.oira:m._ m....�-a. ,__ - �::ne.....,w«.,,b._.,..M.w.w -; —.. - - .,w�...w...M.�aw. ,u<. ,muv- �nn.av�snw6 Mr..»�.a+.�,..xm.....4M sm.��,v....bro+,,.,..,nr�k..,•....,�,M.,.-,,,aw,•..w�.... tie w Ale, l4e u LA Wgy� �� LCPf4tFnir n� �. _ , rtUiC CU , r IVIIZN 171 ` A p N PERTINOID Thin �d I;/ ;i ►'Ins spn�,f cuticn M11� s m ,a, 7tr ttru� it is un!' ST be kept at the at j z u on aw;ul to mare an '.,f7o° t tame, or to Y �- Marr r rum tt deviate 3e Buil p flcatlgns SHgI L,— -)roVal Of the Vhf`` NOT .. B� Gmance or st, °L a 'i Permanent light over r ..Smice Area .;� OVA oe lkcp CbIl it li' tl {u ID m i Is�r'",�t�'•"��dm,�� `'i�y��,v�`vi„,,,y ��G..dd°m'tl�se,.io'tl - Y ..��$” 5 co Condensiate a ries r tlr• y.� � �,�, 4 q�g,• nip •}nLi��'�I4�R^ JOB ADDRESS: 35l,e &4e/to, O�e,� � PERMIT #`=a OWNER'S NAME: Da.r.t ` so PHQNE GENERAL CONTRACTOR: V, ,;t BLJS,INESS LICENSE #; � ADDRESS: NCITE'/ZIPCODE. " tease 4 5112 *Our municipal code requires all businesses working in the cio.Jo hayea City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION, -WILL-,.-, WILL ,B HE SCDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS -SHA .'OBTAINED XXITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature i 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 F Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner /Contractor Signature : Date