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10070093 CITY OF CUPERTIT40 BUILDING PERMIT BUILDING ADDRESS: 20673 GREENLEAF DR CONTRACTOR:RMI MECHANICAL PERMIT NO: 10070093 CONTRACTORS " VNER'S NAME: LEI WANG&LIU HONGRAN 1385 LOWRIE AVE DATE ISSUED:07/13/2010 � VVNER'S PHONE: 4083072408 S SAN FRANCISCO,CA 94080 PHONE NO:(650)583-6200 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB License Class C2 Gam— Lie.# d !40 F r �'^ r 7h MECH RESIDENTIAL COMMERCIAL I " 40 Contractor j t�of Hid bate I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 100K BTU FURNACE&4 TON CONDENSER (commencing with Section 7000)of Division 3 of the Business&Professions @EXISTING LOCATION 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:$7890 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32656005.00 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 permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by Date:�� v �z,, 3 c;-nature Date 7/ L ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 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. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 Ow} authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: / / G V 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 work'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 the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify 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 I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: 1$7,890 -� PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Du lex APPLICATION USE: p _" _ TYPE: a4 w rx a 00 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES A/C Units (<=10K cfm) 1BR=MAIR 1 $63 Furnace, Forced-Air 1MFI2=<100 1 $126 TOTALS: $189.00 777 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 3 NOTE: These ees are based on the preliminairgy in ormation zvailable and are only an estimate. Contact the Det or addn'l info. FEE ITEMS (Fee Resolution 09-051 F.tf' ?i7i29j FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $183.00 PME Permit Fee: $4?.00 ( f c t{,. Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.00L_ $0.00 TOTAL FEE: $274.00 Revised: 6/30/2010 CITY OF CUPERTINO FUWiACE/AC CUPEkTINO PERMIT APPLJICATION FORM APN Date:#� W � } Building Address: l� Owner's Name: `� f. Phone#: Contractor: J Phone#:(l SI)-- S g 3 -- 0 2--O-D cc A-V) l G Fax#: CP S-7) 5 3' 1 Contractor License#: Cupertino Business License #: �'31y-n 3o & moo Contact: Phone#: 0 S-D - S S3 . LP 2d M a,l- y Gl of (?ln/ Fax#: 'ST - 5- S3 - SHI Building Permit Info: Elect ILI Plumb Mech Residential "V Commercial ❑ Job Description: ' 4 4 To Y) yzc p ) A c G 1 U U K 16rt Vt �1�1 >'n ll c �,1 SC/y, For Residential Installations: Attic ❑ Ist floor �C� 2nd floor ❑ Adhere to minimum setback requirement Lam' 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): 4 -1- yq0 k:,� Strapped ❑ On Platform Bonded D' New Location ❑ Replacement 0' Project Size: Express ❑ 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 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32656005. 00 DATE ISSUED. . . . . . . : 07/13/2010 RECEIPT #. . . . . . . . . : BE000010854 REFERENCE ID # . . . 1C070093 SITE ADDRESS . . . . . : 2C673 GREENLEAF DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . Ct"PERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LEI WANG & LIU HONGJIAN ADDRESS 2C673 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RONALD J MAFRICI CONTRACTOR . . . . . . . : RONALD MATRICI LIC # 30650 COMPANY . . . . . . . . . . : RMI MECHANICAL CONTRACTORS ADDRESS . . . . . . . . . . : 1_ 85 LOWRIE AVE CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080 TELEPHONE . . . . . . . . : (E50) 583-6200 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 890 . 00 1. 00 0 .00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 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 274 . 00 0 .00 274 . 00 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL I