The URL can be used to link to this page

11030058 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7507 DE LA FARGE DR CONTRACTOR:RELIABLE AIR PERMIT NO: 11030058 MECHANICAL OWNER'S NAME: FLORA CHANG 3670 D CHARTER PARK DR DATE ISSUED:03/11/2011 ER'S PHONE: 4082553260 SAN JOSE,CA 95136 PHONE NO:(408)266-7267 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# 1�511SQL,b �Q A ( MECH r RESIDENTIAL r COMMERCIAL r Contractor L��--c, L l-�,�t �U Date l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE CHANGE OUT IN ATTIC (commencing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:$2500 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 permit is issued. APN Number:35926022.00 Occupancy Type: APPLICANT CERTIFICATION PO 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply wi -p urce regulations per the Cupertino Municipal Code,SectionIssued by:,,, Date• 18. I re Date l( RE-ROOFS: L OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 H afety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shat not employ any person in any manner so as to become subject to the Worker's O n o authoriz ag t. Compensation laws of California. If,after making this certificate of exemption,I Date: L become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save i• -mify 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 gting of this a it.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with on-point urce re Mations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature " V Date Y CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7505 de la farge dr. DATE: 03/11/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,500 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK re lace existing furnace at attic. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: 1 $126.00 Mech.Plan Check 0.0 hrs $0.00 - F Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 LLJ --------- NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Pee.Resolution 09-051 Iff 7/b'70) FEE QTY/FEE MISC ITEMS F• PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item B1d�Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO 112 FURNACE/AC C U P E RT I N O PERMIT APPLICATION FORM APN# Date: j Building Address:- 507 Oe L,61 r Owner's Name- ,,�oYC,� /�� Phone#: 7� C -Zj�J Contractor: Phone#: LSC —9,0&-72,0-7 kd[(Uttr, Fax #: 14P - 7,0C1--71S& Contractor License#: Cupertino Business License#: 5 OLI CO .37,,0 2�1 Contact: Phone#: 110 ---2V0 72-07 -Ph, I DO Fax#: Building Permit Info: Elect Plumb Mech { ' Residential Commercial Job Description: Furyvff epatz lad �z For R i ential Installations: Attic 1St floor ❑ 2"d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of Construction(Usa e Class): �500 e. Strapped ❑ On Platform BondedEl New Location Replacement Project Size: Ex ress Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist&attach it to the application or if applicable,include in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35926022 . 00 DATE ISSUED. . . . . . . : 03/11/2011 RECEIPT #. . . . . . . . . : BS000012883 REFERENCE ID # . . . : 11030058 SITE ADDRESS . . . . . : 7507 DE LA FARGE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FLORA CHANG ADDRESS . 7507 DE LA FARGE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PHILLIP A DORE CONTRACTOR . . . . . . . : PHIL DORE LIC # 32027 COMPANY . . . . . . . . . . : RELIABLE AIR MECHANICAL ADDRESS . 3670 D CHARTER PARK DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE (408) 266-7267 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 . 00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 2, 500 . 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 ----------------- --------------- -------------------- CHECK 211. 50 #5015 --------------- TOTAL RECEIPT 211 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL