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13050015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10464 SCENIC CT CONTRACTOR:AVA CONSTRUCTION PERMIT NO:13050015 OWNER'S NAME: TSAI NEI-KWEI AND LI-HUA 21060 HOMESTEAD RD APT 216 DATE ISSUED:05/02/2013 OWNER'S PHONE: 6267577757 CUPERTINO,CA 95014 PHONE NO:(408)387-0999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# �� ` REPLACE(E)FURNACE,DUCT WORK(SAME LOCATION) c Contractor�V�SIJ o,TO Date�a/ 5 ADD(N)SUB-FLOOR INSULATION I hereby affir tri h.tY�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:$6000 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:35707017.00 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 FRO LED 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 granting of this permit. Additionally,the applicant understands and will comply Date: Z with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date_4 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 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. 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this j3 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 O ' GENERAL PERMIT APPLICATION / MEP,. i1, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MISC CiJPERT INC (408)7Ca7 77-3228 FAX(408)777-3333•buildinpcupertino.org Ij I 'II PLUMBING ! 'MECHANICAL ELECTRICAL;i MISCBLLANEOUS APN# PROJECT ADARE5S 'y ,,,,,,//// J V OWNER NAME '', PHONE )��-")_ EMAIL STREET ADDRESS )C�46/J 5__ _. e- C CITY, STATE,ZIP/" /_ "_ 6" 1ts-0 L-4 FAX CONTACT NAME 'f G�� ✓J , PHONE `S k i j �✓V EMAIL a p a VA C04-5JAI K. STREET ADDRESS rT r � .f�7/A/ CITY,STATE,ZIP 1 � /'A IS-O 14 FAX�i64 rj) 791'1640 ❑OWNER: ❑ OWNER'BUILpER; ❑'OWNER AGENT. ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑(DNEVELOPER ❑TENANT' CONTRACfORNAME \�:., � J. LICENSENUMBERLY5M LICENSE TYPE BUS.LIC# . L ;N �j � COMPANY NAME J � �!� EMAIL �y�nq FAX//J0�1 CGY C AL1 STREETAD{1RE$S 1 �,6� CITY,STATE,ZIP nY•VKtwt PHONE A� V'7i1,�J_ .i�. I ARCHITECT/ENGINEER'NAME LICENSE NUMBER BUS.LIC H - COIv1PANY NAML EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OFI ❑Sb.r DUPLEX ❑'MULTI-FAMQ.Y PROJECT IN WBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: 13COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO_. EICHLER HOME? ❑NO. - DESCRIPTION OFI WORi ;i I ill" '�� '�L • _-_ �%Iy� lW��' �. 17 T•""� I' 1i I i i I'jl III I I � ' II''� II I I I _ I j I li:ea II I �.i II p` li I � I I .III II I Iii , I Ii I I l ill lli _iJj III ' � I i II II .I ' I I ' I TOTAL VALUATION. By,niy signature below-l certi to"each of the following: I am the property owner or authorized age act on the p o er's alf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agre comply with all applicable local ordinances and sf� l�ws relahngi to b i g c n rize r rese tives of Cupertino to enter the above-ide tified property for inspection purposes. Signature of Applicant/Agent.l Date: ?/ SUPPL NTAL INFORMATION REQUIRED III I IID '. VIII II, I i i ', IIS Ili I III iii i;'I I I I I I II I I I I . I I I�II I i I� II I I MEPMiscApp_2011.doc revised 06121/11 'I :.,IIII I III CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10464 SCENIC CT DATE: 05/02/2013 REVIEWED BY: MELISSA APN: 357 07 017 BP#: 'VALUATION: 1$6,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: FURN/A WORK REPLACE E FURNACE,.DUCT WORK SAME LOCATION &ADD N SUB-FLOOR INSULATION SCOPE APPLIANCE/EQUIP TYPE FEE H) QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 TOTALS: $133.00 _ Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check F_lec..Plan Check Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec.Permit Fee: Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec.Insp. Li ltrtech.Insp.Fee: Plumb. hrsh.Fee: Elec.Insp. F'ee: NOTE:This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These-fees are based on the prefinmdina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: suPpl. PC Fee PME Plan Check: $0.00 Permit Fee: SuPPI. Insp I{'ee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction :Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg St&Commission.Fee: IBCBSC $1.00 $266.60 $0.00 jffi' =' - $266.60 Revised: 04/29/2013