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11100084 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10408 NORMANDY CT CONTRACTOR: °ERMIT NO: 11100084 OWNER'S NAME: MICHAUD LEO H AND JANET D ` I f�b 5 DATE ISSUED:10/12/2011 O 'ER'S PHONE: 4082523744 PHONE NO: LICENSED CONTRACTOR'S DE�C/L(A�RATION BUILDING PERMIT INFO: BLDG� ELECT� PLUMB License Class—C Lic.# / S� `( / J ` MECH RESIDENTIAL COMMERCIAL� Contractor Q nl_ Ja'.g SVryt" Date ( � — L f JOB DESCRIPTION:REPLACE FURNACE AT SAME LOCATION 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. 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:$4000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36929023.00 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 pen-nit. 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 Date L RE-ROOFS: OWNER-BUILDER DECLARATION 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 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 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 Owner or authorizSAA become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 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%ork'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. and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ig of this permit.Additionally,the applicant understands and will comply wiui 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 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36929023 . 00 DATE ISSUED. . . . . . . : 10/12/2011 RECEIPT #. . . . . . . . . BS000015022 REFERENCE ID # . . . : 11100084 SITE ADDRESS 10408 NORMANDY CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER MICHAUD LEO H AND JANET D ADDRESS 10408 NORMANDY CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3109 RECEIVED FROM . . . . : LYNDON BROWN CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41. 00 0 . 00 41 .00 0. 00 1BCBSC VALUATION 4, 000 .00 1. 00 0. 00 1.00 0.00 1BSEISMICR VALUATION 4, 000 .00 0 .50 0. 00 0 .50 0. 00 1MFR=<100 UNITS 1.00 130. 00 0. 00 130 .00 0. 00 1MPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0.00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260 .50 0 . 00 260 .50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CD oe�v GENERAL PERMIT APPLICATION MEP La COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• building(5cupertino.org MISC CUPERTINO PLUMBING FZIMECHANICAL FrELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# r .1/q () 7 _ �3 ,64� X/0Kf0A-9wA1j V OWNER NAMELeb PHCq �� Y c�^ 7 E-MAIL STREET ADDRESS CITY, STATE,ZIP j FAX 5 s'✓rlYti CONTACT NAME PHONE E-MAII STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTFAMRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME ^` LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME 6"/b SIR=ADDRESS ^ICrp(,STATE, p PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT iN ❑YES IS THE BLDG AN YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO IICHLER HOME? ❑NO DESCRIPTION OF WORK / TOTAL VALUATION: f 1 RECEIVED BY: 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.j 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 construc' authorize representatives of Cupertino to enter the above-idea' edMi for inspection pu('oses. Signature of Applicant/Agent" Date: /: S E AL INFORMATION REQUIRED OFFICE �USE ONLY 4= OVER-THE-COUNTER ❑ EXPRESS x U W ❑ STANDARD T U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10408 normandy ct. DATE: 10/12/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: $4,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK replace furnace at same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT - Other Mech.Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'l info. FEE ITEMS (]-'Le Resolution 11-053 G . 7 j II) FEE QTY/FEE MISC ITEMS F71 PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes (E) No $0.00 Travel Documentation Fee: ITRAVDOC $44.00 i Strom(Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 Ti I SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: dy G RMr�K� PERMIT# / OWNER'S NAME: .�� PHONE# 1 v Zoe)—C�CQ GENERAL CONTRACTOR2v BUSINESS LICENSE# ADDRESS:aR 10 CITY/ZIPCODE: SA-4Cl 4517 *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 1(� 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 fc�—j c2,s Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile v Owner/Contractor Signature at