10090274CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20613 SCOFIELD DR
CONTRACTOR: JBK AIRE, INC
PERMIT NO: 10090274
OWNER'S NAME:
18450 TECHNOLOGY DR
DATE ISSUED: 09/30/2010
OWNER'S PHONE:
MORGAN HILL, CA 95037
PHONE NO: (408) 779-3296
❑ LICENSEDCONTRACTOR'S DECLARATIO
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
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License Class Lic. # (� ✓
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RESIDENTIAL COMMERCIAL
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Contractors � �� � c t�iC.- ��✓ c- Date
MECH
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: INSTALL FURNACE @NEW ATTIC LOCATION, REPLACE
HALLWAY WALL HEATER &INSTALL NEW DUCTS, REGISTERS
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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: $5000
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the workfor which thi
permit is issued.
APN Number: 35909007.00
Occupancy Type:
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above
correct. 1 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 dditionally, the applicant understands and will comply
with all non -point s egulations r the Cupertino Municipal Code, Section
9.18•
Issued by: Date:�f—��
�d
Date?
Signature
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1 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)
1, 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).
HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
1 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 &
have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should 1 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 1 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 & Saf t 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, 1
Owne
V
become subject to the Worker's Compensation provisions of the Labor Code, 1 mus
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
`
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
1 hereby affirm that there is a construction lending agency for the performance of work's
1 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 relatint;
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,
costs, and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
1 understand my plans shall be used as public records.
9.18.
Licensed Professional_
Signature Date
/"�7T�T /1T !'�7TnT71 T71�T/1
APPLIANCE / EQUIP TYPE
vll 1, V1'%-,-, ll _u1X 111\V
FEE ESTIMATOR — BUILDING DIVISION
"i<<,,,h. Nui" (
QTY
ADDRESS: DATE:
REVIEWED BY:
f-fec Permit Fee'
APN:
B#: P
'VALUATION: 1$5,000
PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE:
Alteration / Addition / Repair
PRIMARY SFD or Duplex
]*OTAL
Suppl. Insp Fee
PENTAMATION
FURN/A ;
USE:
$63
FLOOR <IRF,A:
PME Unit Fee:
PERMIT TYPE:
WORK
$42.00
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
"i<<,,,h. Nui" (
QTY
UNITS
BP FEES
f-fec Permit Fee'
Furnace, Forced -Air
1MFR=<100
1
#
$126
Heating System
1MRRAA
Suppl. Insp Fee
1
#
$63
PME Unit Fee:
$189.00
PME Permit Fee:
$42.00
Consiruction Tay
.4coustical Review Fee:
Work Without Permit"? Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$189.00
Strong Motion Fee:
NOTE: These Pees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn 7 into
EEE ITEMS (Fee Resolwioa7 09-051 Ef. . 7/1/1 0)
Mech. Plan Check 0.0 1 hrs $0.00
"i<<,,,h. Nui" (
hian Cllr
Mech. Permit Fee: I MPERMIT
Plrrmh. Permit f4.
f-fec Permit Fee'
Other Mech. Insp. 0.0 hrs $42.00>r'Ll
Aleck. frasp. ,-
PME Plan Check:
$0.00
NOTE: These Pees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn 7 into
EEE ITEMS (Fee Resolwioa7 09-051 Ef. . 7/1/1 0)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl_ PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$189.00
PME Permit Fee:
$42.00
Consiruction Tay
.4coustical Review Fee:
Work Without Permit"? Yes (F) No
$0.00
Planni, ,
Travel Documentation Fee: ITRA VDOC
$42.00
Strong Motion Fee:
$0.50
Select an Administrative Item
Bldp_ Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$274.50
$0.00 TOTAL FEE:
$274.50
Revised: 9/29/2(': -10