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10100123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21876 HYANNISPORT DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 10100123 CC SOLING nWNER'S NAME: YAN-QING WE 11 71 N 4 TH ST DATE ISSUED: 10/15/2010 JVNER'S PHONE: 4086157882 SA N JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION JC B DESCRIPTION: RESIDENTIAL COMMERCIAL License Class ? G Lic.# �`j�0 REPLACE FURNACE Contractor ✓g l tt y r"e Z 4-a f C(16,1 rc�Date a��9 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. Sq.Ft Floor Area: Valuation:$4446 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. AINNumber:35614060.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF 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 DAY ALLED 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 granting of this permit. Additionally,the applicant understands and will comply Is,ued by: Date: v with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. signature ^/'/ CiS2&�t� 1011512af o RE-ROOFS: Al 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 ins pection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Sil nature of Applicant: Date: 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the Ca lifornia Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three ms intain 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 mi terial. 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. wi I 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 25505,25533,_and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Tt_ V �lX�z' O�✓ner or authorized agent: ,Cdcd te:!G/l&42,Y 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 Califomia. 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 h:reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. we rk'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 ­,)n the above mentioned property for inspection purposes.(We)agree to save innify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .,.,its,and expenses which may accrue against said City in consequence of the I u iderstand 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 Lii.ensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBI�ONTRACTOR LIST JOB ADDRESS: nlz"S O'-�- , PERMIT# 621-- 2 OWNER'S NAME: Y4� � (,J PHONE # d — j 5 -778�'FZ GENERAL CONTRACTOR: 4 liq BUSINESS LICENSE # L''t ADDRESS: /17 N: r CITY/ZIPCODE: 5,?,1 11,7 *Our municipal code requires all businesses working in thf city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY 1NSPECTION(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: Signal ure Date Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$4,446 R;;PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: FURN/AC WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check0.0 hrs $0.00 [Mech.Permit Fee: IMPERMITF - , Other Mech.Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information avail,rble and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-051 Elf.' 71;10) FEE QTY/FEE MISC ITEMS Sl"Pp/. PC PME Plan Check: $0.00 Pci-11,111 t°`cc ,S`I/pr/. I11s,1) Vi", PME Unit Fee: $126.00 PME Permit Fee: $42.00 C.-r�t71,bt1'ut'Xlfht7 7t,.� 1c'oustrca/ Work Without Permit? Q Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 _7 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 9/29/2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: [jot: APN . 35614D60 . 00 DATE ISSUED. . . . . . . : 10/15/2010 RECEIPT 4 . . . . . . . . . : BS000)11761 REFERENCE ID # . . . : 10100123 SITE ADDRESS . . . . . : 21876 HYANNISPORT DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERPINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YAN-QING WE ADDRESS : 21876 HYANNISPORT DR CITY/STATE/ZIP . . . : CUPERI'INO, CA 95014 RECEIVED FROM . . . . : VALLEf HEATING CONTRACTOR . . . . . . . : ATKIN,3ON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 :1 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 4,446 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4,446 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1MFR=<100 UNITS 1 . 00 L26 . 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 2:1218 --------------- TOTAL RECEIPT 211. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CITY OF C UPERTINO Is FURNA(-E/AC CUPERTINO PERMIT APPLICATION FORM APN # 141 V 1�1D ` Oo Date: Building Address: 2 (� 76 14,kP Lt rtrl� 5 ©r•� Owner's Name: Phone#: �Gn-(,� Gc�� ti 6. � 2 Contractor: �, Phone#: slog-2 IFy CF Z qC l a 1►� P� ,`„� Ca d;,�,� Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: 4 o -211f- 4 24 6 �r,•C Jo.�NS Fax#: Building Permit Info: Elect©� Plumb �� Mech Residential 0 Commercial ❑ Job Description: Fu r'n 4 C'C k ep lac e For Residential Installations: Attic ❑ 1st floor 2nd 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 Required ❑ Cost of Project: Type of Construction(Usage Class): L- � Strapped ❑ On Platform ❑ Bonded [ —New Location❑ Replacement Project Size: Express Standard ❑ Large F] Major F] Valuation: $ �*q& 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