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11040017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7526 FALLENLEAF LN CONTRACTOR:NORTH CAL HEATING PERMIT NO:11040017 AND AIR OWNER'S NAME: CHENG DAI 10216 PASADENA AVE DATE ISSUED:04/04/2011 C ;R'S PHONE: 4089661688 CUPERTINO,CA 95014 PHONE NO:(408)446-1702 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class C d- Lic.# J I ") 1 VS �i EJ �/y"-��� MECH 6_-_ RESIDENTIAL COMMERCIAL r Contractor I� ate ©CI���o'�"`�< I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE(HALLWAY CLOSET)AND ADD AIR (commencing with Section 7000)of Division 3 of the Business&Professions CONDITIONING 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:$7500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ( APPLICANT CERTIFICATION APN Number:35928016.00 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 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 ource regulations per the Cupertino Municipal Code,Section 9.18. 1��,Y2 w � Issued bxr Date: Signature J" Date L 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. 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, Signature of Applicant: Date: Business&Professions Code) 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 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. I 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,I Own�thorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Dater a,cw f 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 work's I certify that I 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, c -id expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g,.. ig of this permit.Additionally,the applicant understands and will comply with 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 . . . . . . . . : 35928016. 00 DATE ISSUED. . . . . . . : 04/04/2011 RECEIPT #. . . . . . . . . : BS000013083 REFERENCE ID # . . . : 11040017 SITE ADDRESS . . . . . : 7526 FALLENLEAF LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . CHENG DAI ADDRESS . . . . . . . . . . : 7526 FALLENLEAF LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NORTH CAL HEATING & CONTRACTOR . . . . . . . : SLOBODAN PLAVSIC LIC # 30551 COMPANY . . . . . . . . . . : NORTH CAL HEATING AND AIR ADDRESS . . . . . . . . . . : 10216 PASADENA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 446-1702 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 500 .00 1. 00 0. 00 1.00 0. 00 1BREMAIRHA NO.UNITS 1.00 63 . 00 0.00 63 .00 0.00 1BSEISMICR VALUATION 7, 500 .00 0.75 0. 00 0 .75 0. 00 1MFR=<100 UNITS 1 .00 126. 00 0. 00 126 .00 0. 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0.00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 274 .75 0.00 274 .75 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 .75 #1106 --------------- TOTAL RECEIPT 274 .75 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION leg ADDRESS: 7526 fallenleaf In DATE: 04/04/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: $7,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK replace furnace and add A/C unit SCOPE Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Pe;e Resolution 09-051 Elf.' 1,'10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Mechanical Suppl.PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 $126.00 IWR=<1oo Furnace,Forced-Air PME Plan Check: $0.00 0 # Mechanical Permit Fee: $0.00 $63.00 IBREMAIR A/C Units(<=10K cfm) Suppl. Insp.Fee.e Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $42.00 Acoustical Fee: 0 Yes E) No $0.00 0 Work Without Permit? 0 Yes G No $0.00 E) Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0 i Strom Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $85.75 $189.00 TOTAL FEE: 1 $274.75 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Is Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: G f A- � X ' PERMIT# OWNER'S NAME: &-tA, P41 PHONE # - 2 GENERAL CONTRACTOR: C a BUSINESS LICENSE'# ADDRESS: CITY/ZIPCODE: � T+O *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 BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: J 0(4 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 7-- '3'> Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CCIPERTINO (408)777-3228• FAX(408)777-3333•building cD.cupertino.org M 's PLUMBING Z MECHANICAL ELECTRICAL [:1MISCELLANEOUS PROJECT ADDRESS + APN# OWNER NAME 1` , C� "� IPHO y 66 _ � E MAIL STREET ADDRESS CITY,STATE,ZIP F FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER Cl OWNER-BUILDER ❑ OWNER AGENT &,CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMES �>C ` LICENSE NUMBER /.-7/ s LICE,NSr BUS.LIC COMPANY NAME Ef-ft -MAIL / FAX YC�I� fSC (4-2f -2f,(� /- STREET ADORE,CS CITY,STATE,ZIP PHONE r. S w �ti �17 S tF GCS . S u 4 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 IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK 14 C TOTAL VALUATION: S� J �� RECEIVEDBY- 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. 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 onstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent:_ _ i��l/�� Date: �`f �C7'� f r SUPPLEMENTAL INFORMATION REQUIRED 4_ 'CKUSXOo y., 4 �� " 1 r `� _ Q:sTAlvnali�Ii { u MEPMiscApp_2011.doc revised 03/16/11