14060026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22025 MCCLELLAN RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 14060026
MECHANICAL INC
OWNER'S NAME: RICHARD TSAI AND ANGELA HUANG 6056 E BASELINE RD STE 155 DATE ISSUED:06/05/2014
OWNER'S PHONE: 4083662450 MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REPLACE(E)A/C&FURNACE,SAME LOCATIONS.
License Class ter Z0 Lic.# � REPLACE
(E)GAS SHUT OFF VALVE&INSTALL(N)BREAKER&220
Contractor / Date OUTLET RECEPTACLE
I hereby . t t l 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:$5820
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:35713016.00 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 DA 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 CALLED INSPECTION
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /`� /
granting of this permit. Additionally,the applicant understands and will comply
costs,and expenses which may accrue against said City in consequence of the J
s y'
with all non-point source reg ns per the Cupertino Municipal Code,Section
9 18. �i
RE-ROOFS:
Signatur 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
1,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,Sections2550 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater
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
Y�
=101 E P
GENERAL PERMIT APPLICATION 1 Q
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \ h
(408) 777-3228•FAX(408)777-3333•buildina(aD-cuDertino.ora, \" MISC
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LUMBING MECHANICAL WFLECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
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ARCHITECT/ENGINEER NAME LICENSE NUMBER I BUS.LIC 9
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USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT A ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICIMER HOIVM7 ❑ No
DESCRIPTION OF WORK
2 2
. 7
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TOTAL VALUATION: S 20 -0 0
By my signature below,I certify to each of the following: I am the property ovmer or authorized agent to on the property ovmer's behalf. I ead this
application and the information I have provided is co t have read the Description of Work and verify it is accurate. I agree to coma ll applicable local
ordinances and state laws relating to buildi Ion. I authorize representatives af-Enp rfo-To enter the abo,,t-identifie -tty rfor inspection purposes.
Signature of Applicant/Agent:::: Date: J
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IV2EPA1isctpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22025 MCCLELLAN RD DATE: 06/05/2014 REVIEWED BY: MELISSA
APN: 357 13 016 BP#: *VALUATION: 1$5,820
47PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE: A
WORK REPLACE E A/C & FURNACE SAME LOCATIONS. REPLACE E GAS SHUT OFF VALVE &
SCOPE INSTALL (N) BREAKER & 220 OUTLET RECEPTACLE
a �ti b
Mech.Plan Check To.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT
rther Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. L. hrs $47.00 Other Elec.Insp. 0.0 hrs $47.00
a. hz,v,. flhoxlb, insp. lie: f_.'<;c.Msp,,Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are onL an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-1 I # Mechanical
Suppl. PC Fee: (j) Reg. 0 OT 0.0 1 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $70.00 IBREMAIR A/C Units(<=10K cfm)
Suppl. Insp. Fee:Q Reg. 0 OT -0.01 hrs $0.00 1 Electrical
PME Unit Fee: $0.00 $47.00 IBREMRECEP Recep/Switch/Outlets
PME Permit Fee: $141.00 I I # Plumbing
$70.00 1PGASRES Piping,Gas<=4 Outlets
Administrative Fee: ]ADMIN $44.00 0
Work Without Permit? ® Yes 0 No $0.00 E)
Advanced PlTjgjn�e: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure
Strong/Motion Fee: 1BSEISMICR $0.58 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$233.58 $326.00 < 4 TOTAL-FEE:uI $559.58
Revised: 04/0112014