The URL can be used to link to this page

11060056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22324 CARTA BLANCA ST CONTRACTOR:ABC COOLING&HEATING PERMIT NO: 11060056 OWNER'S NAME: LARRY STEIN 31845 HAYMAN ST DATE ISSUED:06/08/2011 r'R'S PHONE: 4083984371 HAYWARD,CA 94544 PHONE NO:(510)471-8181 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Classn"'�rz/(J Li/c�# �-77 -2 3,9, 7 �J_/ r— MECH RESIDENTIAL COMMERCIAL Contractor �[,C� C�S��1'u�/J' Date ` d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL NEW FURNACE AND THERMOSTAT IN 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:$3773 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32613043.00 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. / Issued by: Date: Signature,W Date 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) 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. 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 permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will 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 Owne2ar Sze age become subject to the Worker's Compensation provisions of the Labor Code,I mustDate: 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, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ing 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 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32613043 . 00 DATE ISSUED. . . . . . . : 06/08/2011 RECEIPT #. . . . . . . . . : BS000013698 REFERENCE ID # . . . : 11060056 SITE ADDRESS . . . . . : 22324 CARTA BLANCA ST SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LARRY STEIN ADDRESS . . . . . . . . . . : 22324 CARTA BLANCA ST CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1009 RECEIVED FROM . . . . : ABC COOLING & HEATI CONTRACTOR . . . . . . . : GERALD UNRUH LIC # 24643 COMPANY . . . . . . . . . . : ABC COOLING & HEATING ADDRESS. . . . . . . . . . . : 31845 HAYMAN ST CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 471-8181 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 773 . 00 1 . 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 773 . 00 0 .50 0 . 00 0 .50 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 211 .50 0 . 00 211. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 211 . 50 visa 064580 --------------- TOTAL RECEIPT 211 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22324 Carta Blanca St. DATE: 06/08/2011 REVIEWED BY: BG RAPN: I BP#: I ' 'VALUATION: $3,773 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 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: T_7T1 Mech.Plan Check0.0 hrs $0.00I T T Mech.Permit Fee: I MPERMIT Other Mech.Insp. 0.0 hrs $42Li I .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 (Fee Resolution 09-051 PJ' 7;1/10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 F-1 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/29/2011 GENERAL PERMIT APPLICATION =�,, MEP Lis COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX (408)777-3333•buildinq(a)cupeRino.orq �\ MISC CUPERTINO ❑PLUMBING []MECHANICAL ❑ELECTRICAL MISCELLANEOUS PROJECT A DRESS APN# ) rjj �"n 41 V �) ` l— WNER NAME PHONE - _ E-MAIL LJOIqRT D RESS r� C �� CITY, STATE,ZIP So FAX /VCA C NTACT NAME PHO E-MAILCoo loqC4 C Coo STREET ADDRESS CITY,STATE,ZIP L FAX vM O ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONrRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT 6N ACTOR NAME IGEN NUM ER LICENSE TYPE BUS LIC# C COMPANY NAYE I E-MAIL FAX TR % L PHONE iL -'1111 NGINEER AME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO DFSCRIPTIO 'OF WORD w e u.1 F j eN d_--p 5 S P f i'D.� TOTAL VALUATION: 373 R. U 0 RECEIVED BY: 0 By my signature below,1 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 construction. I authorize representatives of Cupertino to enter the above-identifi/edd771 operty for inspection purposes. Signature ofApplicant/Agent: Date: �� (�t! / SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY pWp ❑ OVER-THE-COUNTER F ❑ EXPRESS x� ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 03/16/1/