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11090193 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22261 MCCLELLAN RD CONTRACTOF PERMIT NO: 11090193 OWNER'S NAME: FLYNN/MMB MORTGAGE FUND LLC �., ;� ATE ISSUED:09/27/2011 OWNER'S PHONE: 4156959024 PHONE NO: LICENSED CONTRACTOR'S DECLARATION �y BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 2 O Li,.4—J?'7 7 MECH RESIDENTIAL COMMERCIAL Contractor ^�=�'l�1 �'"//l/6"��i Date 09'10-71(( I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL DUCT WORK IN ATTIC,ONE NEW FURNACE (commencing with Section 7000)of Division 3 of the Business&Professions DOWNSTAIRS AND TWO CONDENSING UNITS OUTSIDE 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 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 Sq.Ft Floor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:35704077.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHI AYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DA OM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 9 Issued by: J /) - Date: Signatures ` Date (� e OWNER-BUILDER DECLARATION RE-ROOFS: ..,ereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sec'ons 5505,25533,and 25534. 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 Owne�j rr_ horized a forthwith comply with such provisions or this permit shall be deemed revoked. �/ Date: 2 / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35704077. 00 DATE ISSUED. . . . . . . : 09/27/2011 RECEIPT #. . . . . . . . . : BS000014873 REFERENCE ID # . . . : 11090193 SITE ADDRESS . . . . . : 22261 MCCLELLAN RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : FLYNN/MMB MORTGAGE FUND LLC ADDRESS . . . . . . . . . . : P O BOX 151559 CITY/STATE/ZIP . . . : SAN RAFAEL, CA 94915 RECEIVED FROM . . . . : KEVIN SULLIVAN HEAT CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 2 . 00 82 . 00 0. 00 82 . 00 0. 00 1BCBSC VALUATION 2, 000 .00 1. 00 0 . 00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 2 .00 130. 00 0 . 00 130. 00 0 . 00 1BSEISMICR VALUATION 2, 000 . 00 0. 50 0 . 00 0.50 0. 00 1MFR=<100 UNITS 1 . 00 130. 00 0. 00 130. 00 0. 00 1MPERMITFE FLAT RATE 1 . 00 44 . 00 0. 00 44 .00 0. 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 431.50 0. 00 431.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 431. 50 #3604 --------------- TOTAL RECEIPT 431. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL GENERAL PERMIT APPLICATION iEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333• building(a?cupertino.org MISC PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS _C-) OWNER NAME PHO E-MAIL STREET ADDRESS (/ � CITY, STATE,ZIP CC FAX ?v: CONTACT NAME E-MAIL xeG/h —e2, STREET ADDRESS CITY,STATE ZIP/lG`/ FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT I CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME, LICENSE NUMBER LICENSE TYPE BUS.LIC K C AcGSPi�lGrZk li! �j 8-77 7. C COMPANY NAME/ // E-MAIL FAX \r7 / ZIP f , STREET ADDRESS CITY,STATE,/ /i ��:�3 PHONE Cf. Sr�7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF rASFDrDUPLEX MULTI-FAMILY PROTECT INWIL DI.AND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COM3,fERCL4L URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME? NO DESCRIPTION OF WORK f TOTAL VALUATION: ze90 O RECEIVED BY: By my signature below,I certify to each ofihe 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 provide 's correct. �I v d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil 1 oristruction` a �ri representatives of Cupertino to enter the above-iden' ed prop for inspection pu{poses. Signature of Applicant/Agent: �L�L Date: o� SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER a ❑ EXPRESS Y U w ❑ STANDARD 2 U ❑ LARGE a ❑ MAJOR MEPMscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22261 McCellan Rd. DATE: 09/27/2011 REVIEWED BY: gs APN: BP#: 'VALUATION: 1$2,000 "PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 2 # $130 Furnace, Forced-Air 1 MFR=<100 1 # $130 TOTALS: 1 $260.00 T T Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 IL NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resohition 11-053Iff. 7'7/1 Ij- FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $260.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: 1BSEISMICR $0.50 =hrs Admin./Clerical Fee Bl.dQ Stds Commission Tee: IBCBSC $1.00 $41.00IADMIN SUBTOTALS: $390.50 $41.00 TOTAL FEE: 1 $431.50 Revised: 09/02/2011 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: 2Z2 e/ , �& PERMIT# OWNER'S NAME: �� ca 1u1/s Lc PHONE # GENERAL CONTRACTOR: e-1 ti, ` Ze A4BUSINESS LICENSE# ADDRESS: ��d � c �ia� c'r�: S'�.5 1 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino 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: "`�' G� 2 k 2 �� Signature Date Please check applicable subcontractors and complete the following information: V 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