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11070069 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10582 ESQUIRE PL CONTRACTOR:RELIABLE AIR PERMIT NO: 11070069 MECHANICAL OWNER'S NAME: THOMAS HWANG&YAPING JOYCE LIAO 3670 D CHARTER PARK DR DATE ISSUED:07/12/2011 NNER'S PHONE: 6507148181 aAN 3.SE,CA 95136 PHONE NO:(408)266-7267 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class — U Li,.# 7 04 c(4 MECH RESIDENTIAL COMMERCIAL Contractor 11y2e Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE AT EXITING LOCATION,ADD NEW (commencing with Section 7000)of Division 3 of the Business&Professions A/C Code and that my license is in full force and effect. UNIT 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:$7500 permit is issued. APPLICANT CERTIFICATION p APN Number:32644030.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS F ALLED INSPECTION. wit non-poin rce re ulations per the Cupertino Municipal Code,Section 9.18. � Issued by: Date: Signature �� Date• OWNER-BUILDER DECLARATION RE-ROOFS: I hereby 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 1,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: 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 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 ., Heal f Cod , ections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemptio , become subject to the Worker's Compensation provisions of the Labor Code, ust Ow r o thorize forthwith comply with such provisions or this permit shall be deemed revoked. I Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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 work'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 i• -mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,nd expenses which may accrue against said City in consequence of the gru,.nrg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with 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 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: In IDS r e L PERMIT# //Lf OWNER'S NAME: 14 W4,-j PHONE# L"O GENERAL CONTRACTOR: ``q 4 t/- A R 1, BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: S S 13,i� *Our municipal code requires all businesses working in the city to have a City of Cuperti o business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND U NTR TO HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. f 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 e Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10582 esquire pl. DAVE: 07/12/2011 REVIEWED BY: APN: BP#: /�' �' -VALUATION: 1$7,500 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK re lace furnace at exiting location add new a/c unit. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 Li NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (P' e Resolution II-053f.;t': ? .-'1I1 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.75 0.5 hrs Admin./Clerical Fee 131d.g Stds Commission Fee: IBCBSC $1.00 $41.00IADMIN SUBTOTALS: $284.75 $41.00 TOTAL FEE: $325.75 Revised: 07/04/2011 C\ GENERAL PERMIT APPLICATION ^© MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION�``�.,, " 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \ (408)777-3228• FAX(408)777-3333• build'ing(d-)cupertino.org MISC CUPERTINO ❑PLUMBING 4.MECHANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS i C� '1 APN# 2'X; C) OWNER NAME V•v`A S h ,6 PHONE 6, 1' `� j� r EMAIL STREET ADDRESS �j ' `-+ CITY, STATE,ZIP (� l "L FA7C 1 U t.re- til'�C CONTACT NAMEPkf PHONE E-MAIL STREET ADDRESS Db-?C) ( _�,,Y( r /2 CITY,STATE, ZIP C� 1:1 OWNER 11A OWNER-BUIIER ❑ OWNER. / AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i r LICENSE NUMBER LICENSE E BUS.LIC# L 1 COMPANY NAME E-MAIL FAX STREET ADDRESS n G [ j CITY,STATE,ZIP r PHONE ��� ARCHITECTIENGINEER NAME 1— LICENSE NUMBER J J BUS.LIC COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ffSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES7FLOOD OJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO ZONE ❑NO EICHLER HOME? 2-150 DESCRIPTION OF WORK A&1= A C_ TOTAL VALUATION: —I Soo � RECEIVED BY: By my signature below,I certify to each of a following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the inform ave prov d 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]a relating to buildi ons c on`�I orize representatives of Cupertino to enter the above-identified property for inspection pu@oses. Signature of ApplicantlAgent: Date: 1 l 1 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w OVER-THE-COUNTER ❑ EXPRESS Y U �i ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11