14060082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10791 BROOKWELL DR CONTRACTOR:RESCUE AIR SERVICE PERMIT NO: 14060082
OWNER'S NAME: YUN XIAO AND MENG YU 6007 MAJORCA CT DATE ISSUED:06/13/2014
OWNER'S PHONE: 4086231087 SAN JOSE,CA 95120 PHONE NO:(408)655-9916
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
ADD A/C UNIT TO SFDWL
License Classr_7 0 I�Lic.# OI�oZ�
Contractor 'P. SLkxe QCr Date Czl �l.k
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:$3800
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:36921015.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT TMLAST
ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN ERMIT 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 DAYSCALLED 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 complyIssued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
2� RE-ROOFS:
Signature�� �i� Cic� Date<V (a! 4 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 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: �� ,. 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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(W-cupertino.org b misc
❑PLUMBING 1'J MECHANICAL EJELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS i O-, O+,[ ,l 1� APN# 1� L�
OWNER NAME V1, V`v �f PHONE E-MAIL V J
STREET ADDRESS �^ �'UOK4v2�� `rte C CITY,STATE,ZIP Cu uer-�`AO CjA 1�h l\k FAX '
CONTACT NAME l� 1J PHONE & ` r-Y U �1 • �v�
STREET ADDRES$rP „�O,, A i CITY,STATE,dc I ZIP &.-110
FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 2p Cue NL� LICENSE NUMBER 6 ,u_ ! ' LICENSE TYPE BUS.LIC#� Sri
COMPANY NAME �aoke E-MAIL r w FAX V
STREET ADDRESS/ o b, ` CITY,STATE,ZIP S PHONE r��
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# `p
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑707
ES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: RECEIVED BY.
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on th roperty ow�behalfve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. applicable local
ordinances and state laws relating to building construction. I a thorize representatives of Cupertino to enter the above-identiifiedction purposes.
Signature of Applicant(Agent: 6 es/ Gf� Date: �� 1 —!' I L+
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
COUNTER
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10791 br000kwell dr DATE: 06/13/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$3,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK add a/c unit to sfdwl
SCOPE
Mech.Plan Check T0.0 rhrs $0.00 Plumb. P/ora Cha,Cn Eiiec. ('/<it�l7,ect{
Mech.Permit Fee: IMPERMITPlum(. Permit Pee.
Other Mech.Insp. Fo.0 L!jOther Plumb Imp- Oilr,�iIJ,:: h.-S;
1-lxzr.`!a. Ins/?_ Plumb, h2sp. Fee: L:lac. FL,'.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7/f 1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Mechanical
Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $70.00 IBREMAIR A/C Units(<=10K cfm)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: _T_T $47.00
Consrvticiion TUX:
Administrative Fee: IADMIN $44.00 Q
Work Without Permit? ® Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$139.50 $70.00 , . . TOTAL FTE: ; $209.50
Revised: 04/01/2014
10791 Brookwell Dr- Google Maps Page 1 of 1
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REVIEWED FOR CODE COMPLIANCE
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PLOT PLANS Reviewed By: ¢,i�'
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Map data 02014 Google 20R
https://www.google.com/maps/place/10791+Brookwell+Dr/@37.3113241,-122.0194486,2... 6/12/2014