13080189 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7591 KIRWIN LN CONTRACTOR:DG HEATING&AIR PERMIT NO:13080189
CONDITIONING
OWNER'S NAME: DING WU AND JIN RE 2288 CHERRY AVE DATE ISSUED:08/23/2013
OWNER'S PHONE: 4088135811 SAN JOSE,CA 95125 PHONE NO:(408)978-1411
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL COMMERCIALE]
� REMOVE AND REPLACE FURNACE AND A/C&
License ClassLi,.#
n n DUCTWORK
Contractor_:t— N -'Ftai Date 2
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:$10895
ave 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:35921008.00 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 D LAST CALLED IN SP TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued b Date: 3
granting of this rmit. Additionally,the applicant understands and will comply Y'
with all non-p source regulations per the Cupertino Municipal Code,Section
9.18.
�f 1 RE-ROOFS:
S e ate v C 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(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 equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by t e ay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with a upertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health& ety Code,Sec s 2550 3,and 25,04.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or nut h ized a t• 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 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 MEP
10 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 950143255
CUPERTINO (408)777-3228.FAX(408)777-3333-buildingfoumtno.org MISC
❑PLUMBING MECHANICAL EIELECMCAL OWSCUIANEOUS
PROJECT ADDRESS APN# 5q /�) (30 S
O"ERNAME WAYNE•tJ W 1 I� X408-813-5811 jE-MA%
BTREETADDRF.SS 7591 KIRWINIANE CITY STAT"'Z'PCUPERTINO CA 95014 FAX
CONTACT NAME - PHONE E-MAII,
STREET ADDRESS CITY,STATE,ZIP FAX
❑owNER ❑owNERnuu"ER 13 owimAm f McoNnuwcTDR ❑coN>RAcroRAc&u ❑ ARcmw= ❑ENGam ❑ neww ER ❑TENANT
CONTRACrORNAMEJOHN GARDNER ICISEN mBm 928315 LICENSET"EC20 BUS.LIC#31568
COMPANYNAME DG HEATING&-AIR CONDIT. EMAIL JGARDNER1212@AOL.CO FAX 408-978-1411
S MEETADDRESS 2288 CHERRY AVE CITY,STATE USAN JOSE CA 95125 P0NF408-978-1411
ARCWTEC A NGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑sFD.DuPIEx ❑ MDLTFFAMB,YPROIECCINWUMLAND ❑ YES FROIECrIN ❑YES ISTBEBLDGAN ❑YES
BUILDING: 13 COMMERCIAL URBAXWERFACEAREA FLOOD ZONE ❑NO EICBLERROME7 ❑NO
DESCRIPTION OF WORK
INSTALL FURNACE,AC, & DUCTWORK
TOTAL VALUATION:
By my signature below,I certify 10 of 'following I am the property owner or authorized agent toad on the property owner's I have read this
application and ormation I have is I have read the Deslaipti accurate-of Work and verify it is accurate- I agree to comply with all applicable local
ordinances and la M%to I of Cupertino to enter the Wpve-ideMlfic property for inspection purposes-
Signature of Appli
urposes.SignatlreofAppli Agent I
SUPPLEMENTAL REQUIRID oMcX usE orILY
w
OVER-xEUR-CourrrRIt
Ip ❑ STANDARD
UU LARGE
a. ,
MAJOR
MEPM1scApp_A11.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7591 kirwin In, DATE: 08/22/2013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$10,895
RPERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lexL PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK remove and replace furnace and a/c&ductwork
SCOPE
, t
Mech.Plan Check 0.0 his $0.00 Plumb.Plan Check Elec.Plan(.;heck
Mech.Permit Fee: 1 MPERMIT Plumb.Permit Ice: Elec. Permit Fee:
Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. LL] (Other Elec.Insp. LLJ[Other
&Insp.I ee: Plumb. lash.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 information available and are onlyan estimate. Contact the Det or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 Ef. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Mechanical
Suppl.PC Fee: (E) Reg. Q OT 0.0 hrs $0.00 $139.00 IWR=<1007 Furnace,Forced-Air
PME Plan Check: $0.00 F 171 # Mechanical
Permit Fee: $0.00 $70.00 IBREMAIR A/C Units(<=1OK cfin)
Suppl. Insp.Feer Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ®Yes ie) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0
A
Strong Motion Fee: 1BSEISMICR $1.09 Select an Administrative Item
Bldp_Stds Commission Fee: 1BCBSC $1.00
$140.09 $209.00 _ $349.09
Revised: 07/0.1/2013