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11080221 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20095 LAS ONDAS WAY CONTRACTOR:A PLUS HEATING&A/C PERMIT NO: 11080221 OWNER'S NAME: ERICKSON FREDERICK W AND CANDA 244 GREAT MALL PKWY DATE ISSUED:08/31/2011 0"`VER'S PHONE: 4084464238 MILPITAS,CA 92683 PHONE NO:(408)934-0730 C� LICENSED CONTRACTOR'S DECLARATION / G I BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class -0 � D Lic.# � t c� /� � MECH f- RESIDENTIAL f- COMMERCIAL Contractor APU S Date '? 3 I I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE WITH NEW FURANCE AT SAME (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION 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 Sq.Ft Floor Area: Valuation:$3200 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36932032.00 Occupancy Type: APPLICANT 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 laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. ja Issued y:" ��"�'�� _.�... Date: f C, Signature Date b ` Ili ( OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: Business&Professions Code) 1,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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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,1 O i or a tl rized agent: 1 become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 3 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of"ork's I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, cr and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION I: ig of this permit.Additionally,the applicant understands and will comply wiw all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36932032 . 00 DATE ISSUED. . . . . . . : 08/31/2011 RECEIPT #. . . . . . . . . BS000014623 REFERENCE ID # . . . : 11080221 SITE ADDRESS . . . . . : 20095 LAS ONDAS WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ERICKSON FREDERICK W AND CANDA ADDRESS 20095 LAS ONDAS WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3132 RECEIVED FROM . . . . : APLUS HEATING&AIR-C CONTRACTOR ADAM P. PHAM LIC # 31293 COMPANY . . . . . . . . . . : A PLUS HEATING & A/C ADDRESS 244 GREAT MALL PKWY CITY/STATE/ZIP . . . : MILPITAS, CA 92683 TELEPHONE (408) 934-0730 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 3, 200. 00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 3,200 .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 260 .50 0 . 00 260 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 260.50 #1946 --------------- TOTAL RECEIPT 260 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX (408)777-3333• building(acuoertino.org MISC .I ; L1111 ING �CHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS � � APN# s'"� � C 1 OWNER AMEn O ^ PHO 6—L03 E-MAIL ✓ STREET ADDRESS / ' CITY, STATE,ZIP FAX CONTACT NAME � PHO E '„ E-MAIL( 40 STREET ADDRESS CITY,STATE, ZIP F L ^�73 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRA CTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` 1 1 /`1 �ICENSE NUMBER�(D3 LI LICENS BUS.LIC# ��j COMPANY NAME V ( 1 E-MAIL ` FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF SFD or DUPLEX ❑ MULTI-FAMII Y PROJECT IN WILDLAND ❑ YES PR07ECT Al ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO IICHLER HOME? ❑NO DESCRIPTION OF WORKrnmO v-e, 0� r A\ TOTAL VALUATION: 3 2�� RECEIVED BY: By 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. 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 Wnstruction. I authorize representatives of Cupertino to enter the above identid property for inspection pudposes. Signature of Applicant/Agent: Date: J TL I SUPPLEME AL INFORMATION REQUIRED OFFICE USE ONLY L-f OVER-THE-COUNTER c ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR 1EPMzscl4pp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20095 las ondas way DATE: 08/31/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: $3,200 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK replace furnace with new furnace at same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 1 0.0 1 hrs $44.00 Li NOTE: These fivs are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee 1?esolution 11-053 I-ff TT11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bld�z Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $219.501 $0.00 TOTAL FEE: $219.50 Revised: 07/04/2011s Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: d oQ C.\s o a PERMIT# OWNER'S NAME: 4?- Q PHONE# 96 6'/o -'I 3 GENERAL CONTRACTOR: A — BUSINESS LICENSE# ADDRESS: Zk-A Lk Gt-2Ci.�-vv cAk � V-LA�) CITY/ZIPCODE: '�5035 *Our municipal code requires all businesses working ' 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: — 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 0 ner/Contractor Signature Date