The URL can be used to link to this page

13040195CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11882 PLACER SPRING CT CONTRACTOR: COLD CRAFT INC PERMIT NO: 13040195 OWNER'S NAME: SAKAMOTO RONALD K AND SAKAMOTA 181 LOST LAKE LN DATE ISSUED: 04/29/2013 OWNER'S PHONE: 4082557979 CAMPBELL, CA 95008 PHONE NO: (408)374-7292 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS ❑ LICENSED CONTRACTOR'S DECLARATION License Class(, /0i 3N Lic. # Le3 ti3 REPLACE (E) A/C UNIT IN SIDE YARD & FURNACE Contract Date -Vi INSIDE GARAGE AREA, SAME LOCATION FOR BOTH 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: $4086 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36655006.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 RMIT 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 F AS 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 �/ Iss ` Z9 granting of this permit. Additionally, the applicant understands and will comply with all non- oint source regulations per the Cupertino Municipal Code, Section RE -ROOFS: being installed. If roof is 9.18. Signature Date All roofs shall be inspected prior to any roofing material a installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Date: Signature of Applicant: 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 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) 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. I 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. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S 'ons 25505, 25 3, and 5534. Section 3700 of the Labor Code, for the performance of the work for which this L� Owner or authorized ager _ 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 inconsequence 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 R4 GENERAL PERMIT APPLICATION x� MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �C\ MISC CUPERTIiNO (408) 777-3228 • FAX (408) 777-3333 • buildino@cupertino.org \ V ❑ PLUMBING -MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS � /y .� APN # (f OWNER NAME PHONE �� E-MAIL t`�f� iIp STREET ADDRESS I ' �/ CITY STATE, ZIP FAX I. CONTACT NAME PW2 E-MAIL STREET ADDRESS ITY, STATE, ZIP Gls7w d. p7 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ONTRACTOR NAME 1& LICENSE NUMBER LICENSE TYPE ,i'3 BUS. LIC # 3 7 ^07 COMPANY NAME _ E FAV �`x, V STREET ADDRESS/ j _ JJp� / - CIT TATE, ZIP - /'n. ��(�Jn`�/` `�- (-(�,xx' �Tf Q[, PHOCLItJE/o. � �%_/�✓�� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN W B.DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK A Y1 ` C1 - TOTAL VALUATION: O $ REC B By my signature below, I certify to each of the following: I am the property owner or authori gent to act on the property o ehave read this application and the information IbOp provided is correct. lbayereadlhe Description of Work and verify it is accurate ee y with all applicable local ordinances and state laws relati to dig ns c ' thori esentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: k-MPPLEMENAL INFORMATION REQUIRED oaFlcE USE ONLY W a ' F OVER-THE-COUNTER ❑ EXPRESS x ❑ STANDARD - v a❑ a LARGE MAJOR MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO TT. T, Ti eT7A/i A. rn]D R11T11.1nTNCr nlVlglnN APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY LaADDRESS: 11882 PLACER SPRING CT DATE: 04/29/2013 REVIEWED BY: MELISSA 1BREMAIR APN: 366 55 006 BP#: "VALUATION: $4,086 %PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex 1MFR=<100 PENTAMATION FURN/AC PERMIT TYPE: A USE: # $133 WORK REPLACE E A/C UNIT IN SIDE YARD & FURNACE INSIDE GARAGE AREA SAME LOCATION SCOPE I FOR BOTH 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 Consimclion Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 TOTALS: i Travel Documentation Fee: 1TRAVDOC $200.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check 10.0 1 hrs Mech. Permit Fee: I Other Mech. Insp. Fo.0 hrs itech. Insp. Fee: $0.00 Ph;rub. flan Check PERMIT Plumh. Permit Tee: $45.00 Other Plumb Insp. Li Plurnh. Insp. Fere; Elect. flan Check Elec. Permit lee: Other Elec. Insp.Li Elec. Insp. Fee: NOTE: This estimate does not inctude fees due to other Departments (Le. Manns tg, rKOKI rr vino, �...••....• r - _ __ ___ _____ _ _ Cantart the Dent for addn'1. info. Ulstrtet' eta . 1 nese GG3 K/G UKDG FEE ITEMS (Fee Resolution 11-053 E . 7f% 11112) FEE QTY/FEE MISC ITEMS Plan Check Tee: Suppl. PC" pose PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee, PME Unit Fee: $200.00 PME Permit Fee`. $45.00 Consimclion Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fees: i Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Std s Commission Fee: 1BCBSC $1.00 " z $333.50 $0.00 $333.50 �\ Revised: 04/29/2013 2 P I c --car- '5pr i �5 sc"Al sem- 0 �J CUPERTINO 9uildina Department ws APR 2 9 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: _�,jpr,-r;T V COMMUNITYDEVP BUILDING Di1 !E;iCFa - C;1' This so_,t of plans and spsa"lons job sit-- during conslruic,.; I Ll changes or 05 � therefrom, without apPl'Ovalk)`p t;r, jD "71 The stamping of this plan a -,dl .IJ be hely to permit or t-,-,) of any P- - � rica c)r DATE PERNAIT NO. I A LA,_) CUE, cy"FLD DATE_ By.., APR 2 9 2013 DATE