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13090211 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10376 AVENIDA LN CONTRACTOR:RESIDENTIAL HEATING PERMIT NO: 13090211 AND A/C INC OWNER'S NAME: MONCTON LEE S AND JULIE W TRUSTEE 65 CRISTICH LN DATE ISSUED:09/26/2013 OWNER'S PHONE: 4082535758 CAMPBELL,CA 95008 PHONE NO:4083774073 LICENSED CONTRACTOR'S DECLARATION ��^�, r BUILDING PERMIT INFO: BLDG ELECT' PLUMB License Class Lic.#� ]��-) y 1 trQ I MECH RESIDENTIAL COMMERCIAL Contractor ul VVahmate I hereby affirm that I am licensed under the rovisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING FURNACE WITH 96%NEW IN SAME (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION.ADD 23 NEW SUPPLY DUCTS 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$21755 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34245037.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DA S FROM L CAL ED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply . L with all non-point source regulations per the Cupertino Municipal Code,Section � 9.18. ,9 ( Issued by: ate: atur Sign " In Date • 1- ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should,I fuse equipment or devices which emit hazardous air contaminants as detinejii by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Lode;Sections 25505,25533,and 25534. 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 O to o•. t horized a ent: become subject to the Worker's Compensation provisions of the Labor Code,I must ate: 1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPER1 (408)777-3228•FAX(408)777-3333•buildingO-cupertino.orq MISC ❑PLUMBING- �`CHANICAL [—]ELECTRICAL ❑ SCELLANEOUS PROJECT ADDRESS I 0�� /Q ry n' tc L&n7APN# y 37 OWNER NAME Lee � �wl I Q /�on c-y\� PHONE ' i09 /J 52,^ �J r) E-MAIL STREET ADDRESS 1`.� 7 - A V IW(6 k, L1 1 1 Vane CITY, STATE,ZIP �L.. ;J t i A C) -gnjj FAX CONTACT NAME 1 �(�' PHONE V V V 317_q o • % E-MAII, STREET ADDRESS u ch S fi w G. L ` CITY,STATE,ZIP ur i c FAX ❑OWNER ❑ OWNER-BUILDER ElA OWNER GENT Es CONTRA1:113CTOR CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ --., LICENSE NUMBER 7 0 5 5 ! LICENSE TYPEBUS.LIC# n f� 40 COMPANY NAME ,/'p{/� I L E-MAIL FAX STREET ADDRESS(P5 CI i ` ` CITY,STATE,ZIP j6WLrWj 4rAPHON`40 -317 q 07 LIM ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# v COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK In _fher le 5 4 TOTAL VALUATION. G) 5 ' By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 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 t b .1din co struction. I authorize representatives of g4ertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE AL INFORMATION REQUIRED - ..... r 6PN,lit Iliriih ila it �� fM'F Ike.. J , . MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1376 Avenida lane DATE: 09/26/2013 REVIEWED BY: larrys APN: BP#: *VALUATION: 1$21,755 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK re lace existing furnace with 96% new in same location. add 23 new supply ducts SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 Ventilation System 1BREMVENS 1 # $104 TOTALS: $._ $243.00 Mech.Plan Check 0.0 hrs $0.00 Phrnrb.Plan Cheek Elec.Plan Check Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: lilec. Permit Fee: FOt,herMech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other£Yee.Insp.Insp.Fee: Plumb, hrsp. Tee; Elee.Insp.Fee: 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 prefinWdna information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E 7f 11/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp F'ee PME Unit Fee: $243.00 PME Permit Fee: $47.00 Consiruction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes ie) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEZSMICR $2.18 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $1.00 ... .M. $384.18 $0.00 r xOTA :FEE ' $384.18 Revised: 08/01/2013