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13080050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 STOKES-AVE CONTRACTOR:RESCUE AIR SERVICE PERMIT NO: 13080050 OWNER'S NAME: AGRAWAL GANESH 6007 MAJORCA CT DATE ISSUED:08/07/2013 OWNER'S PHONE: 4089311033 SAN JOSE,CA 95120 PHONE NO:(408)655-9916 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALO License Class C z0 Lic.# REPLACE(E)FURNACE,SAME LOCATION&INSTALL(N) A/C UNIT IN SIDE YARD AREA Contractor �� Date L 1 3 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:$4900 &41I 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:32649002.00 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 F 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 } granting of this permit. Additionally,the applicant understands and will comply s Date: .1 113 with all non-point source regulations per the Cupertino Municipal Code,Sectio 9.18. l RE-ROOFS: Signature �C�C�.=. DateAll 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. 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 25505,25533,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. 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 t GENERAL PERMIT APPLICATION �� MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �© 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTIN0 (408)777-3228• FAX(408)777-3333•build inclacupertino.or4 \� MISC ❑PLUMBING NMECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS '0p_©0 STO�/ C-s Kv. APN# (� n �0O OWNER NAME Ak V Ir. ^ Y`04 PHONE ��'�to E-MAI/LVjN7 : 1 ' STREET ADDRESS j ©GO(3 �� CITY, STATE,ZIP �9701 FAX CONTACT NAME 1 75 _r PHONE M E-MAIL STREET ADDRESS (O 00_1 \acCITY,STATE,ZIP i �� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME f7 \1 t SY t( LICENSE NUMBER LICENS�TYPE BUS.LIC# COMPANY NAMEC \ w Z E-MAIL 2 FAX 3Z - STREET ADDRESS(000 ` ` C CITY,STATE,Z> PHONE \ ARCHITECT/ENGINEER NAME m LICENSE NUMBER - BUS.LIC# COMPANY NAME E-MAIL FAX - STREETADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WB,DLAND ❑ YES PROJECT IN ❑/YES IS THE BLDG AN El YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ;Fr . NO FLOOD ZONE irl NO EICHLER HOME? LAS NO DESCRIPTION OF WORK (Wrle` ; `� O \0 Nc- lxns ►n 19104— o�ems_ TOTAL VALUATION: h �J By my signature below,I certify to each o the following: I am the property owner or autho ' agent to act on the property owner's a 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 agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED o>irt .oty Y, , OVER THFFCUVNTER E. I] EXPRESS 4 E-'.STANDARD Al Z, MEPMiscApp_201].doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10600 STOKES AVE DATE: 08/07/2013 REVIEWED BY: MELISSA. APN: 326 49 002 BP#: *VALUATION: 1$4,900 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK REPLACE E FURNACE SAME LOCATION & INSTALL N A/C UNIT IN SIDE YARD AREA SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 16REMAIR 1 # $70 Furnace, Forced-Air 1MFR=<100 1 # $139 TOTALS: $209 00 . Mech.Plan Check 0.01hrs $0.00 Phcmb.Plan Check Dec.Plan Check Mech.Permit Fee: IMPERMIT Plumb. Permit Tee: Elec. Permit f ee: Other Mech.Insp. FO-01" Other Plumb Insp. Li Other Elec.Insp. Allech. Insp.Fee. Plumb. hasp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina in ormation available and are onl an estimate. Contact the Det or addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. Pt:Fee PME Plan Check: $0.00 Pertnil Fee: Suppl. Insp Fee PME Unit Fee: $209.00 PME Permit Fee: $47.00 Construction Tax: FA Administrative-Fee: IADAIIN $44.00 Work Without Permit? ®Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $348.50 $0.00 0 >,Fj $348.50 Revised: 07/01/2013 GNCAk U,�Gcjo S, �o 1/,es P\"e— C� 'A—' no ' \\ e CUPERTINO LT uildin9 Depaftent 1p\Ase dcS`ollne REVIEW C BUILDING DIFSIION DEVELOPMENT EU FOR COD APPROVED Reviewed,sy. E COMPLIANCE This set of plans and specifications MUST be kept at the Job site during construction. It is unlawful to make any changes or alterations on same,or to deviate therefrom,without approval from the Building Official. The stamping o specifications SHALL NOT 'x fiN-c Ab be o perm' of be n approval of the violation I rdinance or State Law. t'f1 mel DATE & 3 PERMIT NO, 'Wr Pa�eti V.ence., VASsrnn t_��it nen ad C.N) NC, ��' F e14PC�- 11\ v�