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13070081 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10373 MENHART LN CONTRACTOR:A&H HEATING PERMIT NO:13070081 OWNER'S NAME: HOON SANG YI 770 CHESTNUT ST DATE ISSUED:07/11/2013 OWNER'S PHONE: 4088027867 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL❑ COMMERCIALS License Class C- 20 Lic.# '3,0L1 c4 7Z- ADD(N)DUEL SYSTEM A/C UNIT TO(E)HEATING i SYSTEM Contractor tit/ Date:7 —' 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:$10000 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:37515045.00 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 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 Date: 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. RE-ROOFS: Signature Date / 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) I,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(x)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 Owner or authorized agent: Date:/`] —/( permit is issued. V IF 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. It 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 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 GENERAL PERMIT APPLICATION Q V MEP -1. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 h u misc CUPIErRTIIN+D (408)777-3228•FAX(408)777-3333•building a(Dcupertino.org (�.� El PLUMBING �MECIiAIdICAL RELECTRICAL ❑MISCEL TEOUS PROJECT ADDS a ). `, L�4► APN# S ►• :.L O N { P NE EMAIL . S o z-7 6 DD.5-5 ` STREET D C ST ZIP FAX CONT CT AME. Pr —2 —V ZZ DG7 TI G`•t=[/ i STREET ADDRES �, C S TE,ZIP FAX ❑ OWNER 13 QWNER-BUILDER: O OWNERAGENT LTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑TENANT . CO O l! I LICENSENUMBER LICENS TYPE_O BUS.LTC# ^' }} ` M L �Q 0 4cq COMPANY NAMEDKLE y J (`w G!%YyI W96z !7—102 STREET ADDRESS CITY,STA E,ZIP PHO ARC AME LICENSE NUMBER BUS.LIC# COMPANY NAME E MAII FAX STREET ADDRESS I CITY,STATE,ZIP PHONE USE OF ❑SFD oc DIJPLEX'q 13 MUL11-FAMQ..Y PROJECT IN WII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑.YES BUII.DING ; ❑COMMERCIAL _ URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? [3NO DESCRIPTION OF VyORiC I U!I I I I I I , By my slgnatuie Ibelow,I certify to each of the following: I am the property owner or authorized agent to act on the property o er' ave s appllcahon and the Info�inatlon I,have provided is correot I have read the Description of Work and verify it is accurate. I agree to c with all applicable OCR: ordinances and.state haws relatingljto building construction. I a ori representatives of Cupertino to enter the above-identified property for inspection purposes.; Stgiature of Ap�Ilicant/Agent Date: '' ' 'SUPPLEMENTAL INFORMATION QUIRED �: p I II W II II I MEPMiscApp_2011.doc revised 06/21/11 F CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION t: ADDRESS: 10373 MENHART LN DATE: 07/11/2013 REVIEWED BY: MELISSA APN: 37515 045 BP#: *VALUATION: $10,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: i WORK ADD N DUEL SYSTEM A/C UNIT TOE HEATING SYSTEM SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $70 TOTALS: $70.00 Mech.Plan Check 0.0 his $0.00 P&zrrrb.Plun Check Elec.Plan(;heck Mech.Permit Fee: IMPERMIT Plrtmb.Permit Fee: Elec. Permittee: Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elec,Insp. Bfech.Insp. Fee: Plumb. hist.Fee: Elec.Insp,I,ce: NOTE:This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prefintina information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E�' 7/1/12) FEE QTY/FEE MISC ITEMS Plein Check Fee. Suhp1. PC'I ee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Feer $70.00 PME Permit Fee: $47.00 Construction Tats: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $47.00 i Strong-Motion Fee: 1BSEISNfICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 210.00 $0.00 � . 1 i � $ p a._ t. $210.00 r Revised: 07/01/2013 �Lt ccs c2 y l 7 3 WONY;4 z�r ,k- c� F—v !; r//V& 'tY T / Gj - oalis Do Ot 1-0 C , O o �0, 0��y�� ;0/0! r� ' F�a�a Z `Fog At beJb2.5 OCT -I CUPS F3uiiding D R �£ JUL 1 i o,3 '' R R COp � rn Reviewed gy COMPL.igNCE MOT "-mom B.Y. (� PLA NI ID T. IE ��tic..