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13070057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19780 AUBURN DR CONTRACTOR:EURO CLIMATE PERMIT NO: 13070057 OWNER'S NAME: ALOK GUPTA 1667 ROGERS AVE DATE ISSUED:07/09/2013 OWNER'S PHONE: 4083400021 SAN JOSE,CA 95112 PHONE NO:(408)441-0468 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL E] COMMERCIALE] . - aQL REPLACE FURNACE&RELOCATE TO ATTIC AREA License Class Lic.# � � :. � �') (V.I.F.CEILING JOIST SPAN/CONTRACTOR TO UPGRADE Contractor ELA RO CL.(yATrTbate Q 1?D SUPPORT IF FOUND INSUFFICIENT) 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:$6500 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:31635015.00 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 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 AST CALLED 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 �3 granting of this permit. Additionally,the applicant understands and will comply Issue y. te: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ('� ^ RE-ROOFS: Signatu a Date 1 `'� 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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, 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. Date:ri Q �� 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. Signal GENERAL PERMIT APPLICATION MEP I COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 misc (408)777-3228•FAX(408)777-3333•buildin-g a)cupertino.org CUPIERT-INO I ❑PLUMBING' . gNEMANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS " DP—. APN# 3 l •� 3 /'� C OWNERNAME r PHONE C) E-MAIL �V (�/.r1clm qwxal Len STREET ADDRESS ' n n nP� CTPY,STATE,Z ( n FAX CONTACT NAME II �': `f �J , P O CIE-MAIL e-LA✓'O a' i (YtG( L4 Lt i-nLit, STREET ADDRESS CITY, STATE, FAX ❑ OWNER ❑ OWNER-BUILDER:. 13OWNERAGENT ❑ CONTRACTOR CTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAbAE i. ENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL E�(�G,l MR S�� FAX EuP Ck,tr�A,� IOG. STREET ADDRESS I I , - CITY, ATE,Z1� PHONE ©'� ►� i 1a- t=-O L4 ARCHITECTI$NGIl IEER!NAME LICENSE NUMBER BUS.LIC# COMPANY NAME &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USJ;;OF ia DUPLEX I, ❑1 MULTI-FAMII.Y PROJECT IN WBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑.YES - BUILDING: � MMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE �.�I4• EICHLER HOME? NO DE$CRIl'TION OF VVORIC i ; L^ -r- j II,I II 'III Illi I 'I wC LJ ! . J b. I . I TOTALYAIgATIQ ! By my signature�beloW,I certify to each of the following: I am the property owner or autho agent to act on the p owner' alf. I have read this appl[catioq and the lin#oiinatlon I have provided is correct I have read the Description of Work and verify it is accurate. o comply'with all applicable local ordinances and:state laws relatmg;to building construction. representatives of Cupertino to enter the above-identified property for inspection purposes. Slgpature,ofApplicant/Agent Date: PLE TAL INFORMATION REQUIRED ILII ( ;I I , I I� I, illi I i I I III ' III MEPMiscApp_2011.docrevised06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19780 AUBURN DR DATE: 07/09/2013 REVIEWED BY: MELISSA APN: 316 35 015 BP#: "VALUATION: 1$6,500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: FURN/A WORK REPLACE E FURNACE& RELOCATE TO ATTIC AREA V.I.F. CEILING JOIST SCOPE SPAN/CONTRACTOR TO UPGRADE SUPPORT IF FOUND INSUFFICIENT) APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 TOTALS: $139.00 ` Mech.Plan Check "00 $0.00 Plumb.Plan Check Elec.Plan(heck Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee: Flee. Permit Fee: Other Mech.Insp. 0.0 hrs $47.00 Other-Plumb Insp. Other Elec.Insp. Li Alech.Insp. Fee: . Plumb. lisp.Fee: Elec.Insp.fere: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are on an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sulrpl. PCI"ee PME Plan Check: $0.00 Permit.Fee: Suppl..Insp Fee PME Unit Fee: $139.00 PME Permit Fee: $47.00 Consirztction Tax. Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes Q No $0.00 Aelvunced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion.Fee: IBSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $278.65 $0.00 $278.65 Revised: 07/01/2013 r ! tYL3Ute; !N Qno 4--VU'tjjA6-fV 1 V p VDI.) 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