10090063 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10932 WILKINSON AVE CONTRACTOR:RELIABLE AIR PERMIT NO: 10090063
MECHANICAL SYSTEMS
'ER'S NAME: PAUL CHIANG 6080 GLEN HARBOR DR DATE ISSUED:09/09/2010
OWN'ER'S PHONE: 4087250539 SAN JOSE,CA 95123 PHONE NO:(408)930-3029
In LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB
License Class G 7-0Lie.# 1 3 2- 1 `
q MECH RESIDENTIAL r COMMERCIAL�
Contractor Vcwe1(C AIR— + fte (`
JOB DESCRIPTION:TWO FURNACE CHANGE OUT
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:$4200
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:35613058.00 Occupancy Type:
permit is issued.
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 PERMIT EXPIRES IF WORT{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 pe Additio t e applicant understands and will comply
with all non-point ou e r ation er the C ertino Municipal Code,Section Issued by�'r��
9.18. _
i
Q, Aure Date �� r
— RE-ROOFS:
❑ 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
contaminants as define the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain complia wit the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health a e ode ections 255059 25533,and 25534.
1 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 Own or h ed a - Yr e�
Compensation laws of California. If,after making this certificate of exemption,I Date:
Date-
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
the above mentioned property for inspection purposes.(We)agree to save
unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
IQFEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
AP BP#: VALUATION: $4,200
x -77
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY R)1'111: PENTAMATION 1 RMAP6
USE: SFD or Duplex V/001Z iPERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 2 # $252
TOTALS: $252.00
Mech.Plan Check 0.0 hrs $0.00 P')�w i4
Mech.Permit Fee: IMPERMIT F >%>- P'<row P'"'t1"VI r� P t mii VC,
=- -Other Mech.Insp. 0.0 hrs $42.00 01,'Ivr P, =,,t}Ir�� C r,r , 1,i , Irz,z.
Lj
NOTE. These fees are based on the preliminary in ormation 7vailable and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS LFee Resolution 09-05I Eff.' UlOj FEE QTY/FEE MISC ITEMS
C'11(%'A Fec:
Sit/)IPI. PC I, e
PME Plan Check: $x.00
Per init Fcc
.Bili" Illsp Hee
PME Unit Fee: $252.00
PME Permit Fee: $42.00
t.wrtslrtrciiorr 1 tr.�
tc;c>z�.5tizarl l�'er°ieii'I�'e�>:
Work Without Permit? 0 Yes 0 No 10.00
I'lawlin<' VCCS.
Travel Documentation Fee: ITRA VDOC $x•2.00
Strong Motion Fee: 90.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 5)1.00
SUBTOTALS $3';7.50 $0.00 TOTAL'FEE $337.50
Revised: 9/01/2010
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN 35613058 .00
DATE ISSUED. . . . . . . : 09,'09/2010
RECEIPT #. . . . . . . . . BS000011421
REFERENCE ID # . . . : 10090063
SITE ADDRESS 10932 WILKINSON AVE
SUBDIVISION . . . . . . .
CITY CU?ERTINO
IMPACT AREA . . . . . . .
OWNER PAJL CHIANG
ADDRESS . . . . . . . . . . : 10)32 WILKINSON AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : RELIABLE AIR MECHAN
CONTRACTOR . . . . . . . : TRDY PETTY LIC # 31850
COMPANY . . . . . . . . . . : RELIABLE AIR MECHANICAL SYSTEM
ADDRESS . . . . . . . . . . : 6080 GLEN HARBOR DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 930-3029
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- -----
1BCBSC VALUATION 4, 200 . 00 1. 00 0 .00 1. 00 0 .00
1MFR=<100 UNITS 2 . 00 252 .00 0 .00 252 . 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 337 .00 0 .00 337 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- _ ------------------
CHECK 337 .00 #1012
---------------
TOTAL RECEIPT 337 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
Building Department
City Of Cupertino
Is 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 32 LJ lk 1N'�OA) 'Jt✓ PERMIT#
OWNER'S NAME: h L PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE # 8F Z tcl2
ADDRESS: �n5 L U I k K NS CITY/ZIPCODE: &JZZ r�Nv CA, q
*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 S ON ACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. _
I am not using any subcontractors: _
Signature Date
Please check applicable subcontract rs and complete the following information:
&/ 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
C1 ` � �
CITY 4F
CITY OF CUPERTINO
FURNACE/AC
C U P E RT!N O PERMIT APPLICATION FORM
APN# *1 , Date:
,
Buil in ddress:q 3]4
WL
O isam L/EWAA V Phone#:U Vq —/� + C/r03 q
PawContractor: Phone#: q HT- Z 0 U - '7007
"chafida ) Fax 2,00 - 7903
Contractor License#: Cupertino Business License#-
pakcl on
q (I ) ClZ u r
Contact: Phone#:
()ou �� r�- Fax#:
Building Permit Info:
Elect Plumb ❑ Mech
Residential W Commercial LJ
Job Descript n:
For Residential Installations: r
Attic 44- 1St floor [�- 2nd HOOT ❑
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):
Strapped On Platform U Bond(d -New Location Replacement
Project Size: Express P-K Standard 0 Large[I 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