13040177CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10383 NOEL AVE
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 13040177
MECHANICAL INC
OWNER'S NAME: TUAN VICTORIA R AND HSING T
6056 E BASELINE RD STE 155
DATE ISSUED: 04/24/2013
OWNER'S PHONE: 4082577915
MESA, AZ 85206
PHONE NO: (866) 692-5273
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C — 2 O Lic. #
REPLACE (E) FURNACE IN INTERIOR CLOSET &
.,t rte• -�; c
Contractor e �.in Date
REPLACE
p s (> v—
(E) A/C UNIT IN REAR YARD
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
Sq. Ft Floor Area:
Valuation: $7918
performance of the work for which this permit is issued.
1 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: 32647066.00
Occupancy Type:
permit is issued.
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 DAYS FR 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
I Date: Z 4 3
granting of this permit. Additionally, the.applicant understands and will comply
with all non-point source regul ns per the ina-Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date l /
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
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER .
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,
Business &Professions Code)
1, 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
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. 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.
will 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 25505,255:33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:Date:
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 California. 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 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work'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
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand 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
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — RITILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10383 NOEL AVE
DATE: 04/24/2013
REVIEWED BY: MELISSA
UNITS
APN: 326 47 066
BP#:
"VALUATION:
1$7,918
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
USE:
$67
PENTAMATION
PERMIT TYPE: FURN/AC
WORK
REPLACE E FURNACE IN INTERIOR CLOSET & REPLACE E A/C UNIT IN REAR YARD
SCOPE
1
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
1
#
$67
Furnace, Forced -Air
1MFR=<100
Suppl. Insp Fee*
1
#
$133
PME Unit Fee:
$200.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADMIN
$42.00
Work Without Permit? ® Yes (j) No
$0.00
TOTALS:
TravelDocumentation Feer 1TRAVD0C
$200.00
Strong Motion Fee: 1BSEISMICR
Mech. Plan Check 10.0 1 hrs $0.00 Ptu...b. Plan Cheek Elec. Plan (:heck
Mech. Permit Feer 1MPERMIT Plumb. Permit Fee: Elec. Permit Fee:
Other Mech. Insp. Fo.0 hrs $45.00 Other PlumbInsp.FT
Other L:lee. Insp,
Alech. Insp. Fee: Plun7b. Insp. Fee: Elec. InsP, Fee:
NOTE: This estimate does not include -fees due to other Departments (L a Planning, Public Works, Fire, Sanitary Sewer Dist
School
District etc These ees are based on the relimina in ormation available and are onl an estimate. Contact the De t or addh7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check 1�ee:
Supp 1. PC, Fee
PME Plan Check:
$0.00
Perinit .Fee:
Suppl. Insp Fee*
PME Unit Fee:
$200.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADMIN
$42.00
Work Without Permit? ® Yes (j) No
$0.00
f dvanced Pltanning T"—s.-
ees:Travel
TravelDocumentation Feer 1TRAVD0C
$45.00
Strong Motion Fee: 1BSEISMICR
$0.79
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
_
$333.79
$0.00 �� L FES
$333.79
Revised: 04/01/2013
COMNnj EN1!7y r!
i,,jFN7
BIJILDH,,',,G DIVISIC2N -
Th;F -,,cat of plans and :'01 -IST be C.. the
c,i. iil, vtfthout ap:
The s'i:arnping of this pl,.n anc'; s,pecificatlon SH.ALL N�',T
be held to permit or t be an approval of the violation
of anV or ity OrLW
i-waGo-ep-8�a',
DATE -
PERMIT NO.
OFFICP Adffdk AO% Alk
cV
CHEICKED BX
DATE 2q / 13
--�-6ANNI
CUPERTINO
Building Department
APR 24 2013
REVIEWED FOR CODE COMPLIANCE
DATE /0
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