The URL can be used to link to this page

13030154CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10320 LOCKWOOD DR CONTRACTOR: SANDIUM PERMIT NO: 13030154 OWNER'S NAME: RAJESH SHENOY 4223 VERDIGRIS CIR DATE ISSUED: 03/28/2013 OWNER'S PHONE: 4082898448 SAN JOSE, CA 95134 PHONE NO: (408) 894-9072 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL j License Class 020 Lic. # Obi t REPLACE (E) FURNACE, SAME LOCATION. REPLACE 3Zo(3 ALL ContractorDate DUCT WORK FOR FURNACE. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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 .arca: Valuation: $9958 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: 34215053.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES W WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF 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 DAYS F 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 Z� granting of this permit. Additionally, the applicant understands and will comply Is y: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 2� ( 3 3 Z'' RE -ROOFS: Signature Date l 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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(x) 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 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 lMEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O`� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /►_ (408) 777-3228 • FAX (408) 777-3333 • building()cuoertino.org MISC �O 1 —I PT -M MTNG I—I MECHANTICAL F IELECTRICAL M MISCELLANEOUS PROJECT ADDRESS � r7 � S � APN ' OWNER NAME QT \ ��• PHONE 4y *2V 944 E MAIL STREET ADDRESS /jI v ` �j�/� CITY, STATE, ZIPU FAX CONTACT NAME . j,Z•Zt ` PHONE 90 E :M.AIL STREET ADDRESS/t n `�_ 4vi C4L I CITY, CA 4 FAX FAXElo)AwER ElowNE{R-B=ER 11O'AWERAGENT CONTRACTOR ❑ CONTRACTOR AGENT 11 ARCHITECT ARCHITECT ❑ DEVELOPER ❑ T;NANT CONTRACTOR NAME LICENSE LiEell TYPE `• BUS. LIC n COMANY NAME Lam, wt E-MAIL FAX STREET ADDRESS n i c ' N`l CITY, STATE, ZIP` A q� �� CA J ('(y PHO'N'E o \i 111 ARC\=HITECr/ENG11NAME LICENSE NUI MER BUS. LIC # COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEx ❑ MULTI-FATIILYPROJECT BUILDING: ❑ COMMERCIAL IN WILDLAN'D ❑ YEs URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE El No S THE BLDG AN ❑ YES rilICHLER HOME? ❑ NO DESCRIPTION OF WORT: TOTAL VALUATION: 5V EDB ' By my signature below, I certify to each of the following: I am the property owner or authorized ent n t e prope o";mer' b have read this application and the information I have provided is correct. I have read the Description of Wor erify it is accurate. I otnpl all applicable local ordinances and state laws relating to bu' In construction. I au rize representatives of Cu rtino to enter the above -identified e ' for inspection putposes. Signature of Applicant Agent: Date: 2 Zo SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER I" •J ❑ EXPRESS U U ❑ STANDARD < ❑ LARGE ❑ MAJOR MEPA&cApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10320 LOCKWOOD DR DATE: 03/28/2013 REVIEWED BY: MELISSA UNITS APN: 342 15 053 BP#: *VALUATION: 1$9,958 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: FURN/A WORK REPLACE E FURNACE SAME LOCATION. REPLACE ALL DUCT WORK FOR FURNACE. SCOPE ';tfpP1. Insp Fee. APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Fiec. Permit Fee: Furnace, Forced -Air 1MFR=<100 Usher Elec. Insp. Li 1 # $133 1'erinit Fee: ';tfpP1. Insp Fee. PME Unit Fee: $133.00 PME Permit Fee: $45.00 Conswitction .Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $133.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary Sewer District, school rlictrint oto 1 Ttroco Fooc oro hncod nss th0 orolirninary infnrmatian ovailahlo and aro nn1V an P.Qtinlam- Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711112) Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Plan Check cc. Plan Check Mech. Permit Fee: IMPERMIT Plumh. ; ? Fiec. Permit Fee: Other Mech. Insp. Fo.0 hrs $45.00 Other Plumb Insp,Ll I Usher Elec. Insp. Li p. /_"cv Plumb. his). Fee: Flee. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary Sewer District, school rlictrint oto 1 Ttroco Fooc oro hncod nss th0 orolirninary infnrmatian ovailahlo and aro nn1V an P.Qtinlam- Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Nan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 1'erinit Fee: ';tfpP1. Insp Fee. PME Unit Fee: $133.00 PME Permit Fee: $45.00 Conswitction .Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 -i(, vOiICed 111al-I ling Fees: A Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $267.00 $0.00 TOTAL FEE: $267.00 Revised: 01/01/2013