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14060062 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11785 SEVEN SPRINGS PKWY CONTRACTOR:ALL STAR HEATING PERMIT NO: 14060062 AND COOLING INC OWNER'S NAME: CHUNG ROBERT AND BETSY 1953 O'TOOLE WAY DATE ISSUED:06/11/2014 OWNER'S PHONE: 4082533813 SAN JOSE,CA 95131 PHONE NO:(408)943-1953 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0 ./� ?L REPLACE(E)A/C UNIT&FURNACE,SAME LOCATIONS License Class Lic.# 4f Contracto / Date bN I hereby affirm that I am licensed ur e provisions of Chapter 9 (commencing with Section 7000)of INvision 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:$7400 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:36653027 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 WITIIIN 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 DAY LAST CALLED INS/PEJ;N .ON 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date 7 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) 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,Sect* ns 25505,25533, nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this ( Date: permit is issued. Owner or authorized agent: 7 r 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 cn V V GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O�( 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 v( CUPERTIN© (408)777-3228•FAX(408)777-3333•building cupertino.org MISC ❑PLUMBING XMECHANICAL )&LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 # r y� / 2 D OWNER NAME ,!w � �` PHO f t 7 STREET ADDRESS 1`j� �rs V � 1 C TAT_E,ZIP 047&ZI,013-cA FAX CONTACT NAME 1 `� P PONE E-MAIL STREET ADDRESS 1, ,STATE,ZIP QN FAX PCOOMPA WNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT TRACTOR NAM LICENCE NUMB _ LICEN E TYPE BUS. # 4� a � tyY NAME ^ E-MAIL � FAX L� q� q q "7 L V A �/ r STREET ADDRESS ;TATEZJP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF WFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA gj�NO FLOOD ZONE tq NO EICHLER HOME? NO DESCRIPTION OF WORK 0_6� � 6__ ) 6Z Savn e_ tts-" TOTAL VALUATION: N; ...... By my signature below,1 certify to each of the following: I am the property owner or authorized age o act t e property owner's behalf. I have read this application and the information 1 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 relatin g cpt �c���affwIze representatives of Cupertino to enter the above-identified property for inspection purposes. /� I�Z51'�._/ ACL 67— S- 14 rJ�^—' � �/ Signature ofApplicant/Age t: @--- U E Date: 67 ' 'T SUPPLEMENTAL INFORMATION REQUIRED Q y©s1�E IQNTER yA 72 [ 7CP E � 3 ". C'�'tAekRD MAro . MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11785 SEVEN SPRINGS RKWY DATE: 06/11/2014 REVIEWED BY: MELISSA APN: 366 53 027 BP#: *VALUATION: 1$7,400 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK REPLACE E A/C UNIT& FURNACE SAME LOCATIONS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 113REMAIR 1 # $70 Furnace, Forced-Air 1MFR=<100 1 # $139 TOTALS: $209.00 " a Mech.Plan Check 0.0 hrs $0:00 Plad,b.Pl a,t'ifec;b Mech.Permit Fee: IMPERMIT '?dir? .1 ermil Fels: LiOther Mech.Insp. 0.0 hrs $47.00 ofhe=1' m.'h blsP. Wch.Irrt''. F°-e: 1'lwr,-b.hsr3,.1'sc Elec.1Sa p.1 c c NOTE:This estimate does not include fees due to other Departments(Le.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 Dept./or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113,) FEE QTY/FEE MISC ITEMS Plaw Check fr<°e: Supi"71, PC Fee PME Plan Check: $0.00 1'c'`rai 'e': .`3upy)/. Insp E'E= PME Unit Fee: $209.00 PME Permit Fee: $47.00 Administrative Fee: 1ADAHN $44.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.74 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 H $348.74 $0.00 TOTAL FEE: $348.74 . . Revised: 04/01/2014 06/11/2014 1:00 PM FAX 0002/0002 '"A' � •'yrl�tl ;'5q,•: . .h a. Simplified Ic'res=ip&e CertMeate of ComPftxkce:Zoos 1tes�dchfia? `Y�1CAlterrrtlorrc CF-1R-A,�,T TrYVi� awatc 2amts 1 aad 3-1 SYte.t;ddra�: F�jorcenforrlA�rrr4q: � ' Dafe1"`,: Perfrstr:�:•„1, , Conditioned Duct ies�ulatloa p�,y�,,�ont i ''L3'si`I+tlrlitrkiloo�Effidc .i bld'orJlie� 'acf '' ' , Th.Szaiosfat"'.r . . 23.A 6vrr40401 "Served.by s). = Weid . Qna Indoor Coll pry mwiGs CondmiteUnit EER_ .� 10d=-, n J.Equipment'fypC Choose the t*4wMtbeb*Mrtallcd;ifmoro then ono*%c6t,use another CY- fi-AL, -• IW.4LC.for oath 3ya= 2•Mlatmnm Egai moat XMctoocivC 13 SEER 78%AFM VESPF for typical residential•rystct$. Contmeior(I)cumebtattog Author's/Rcspandlb)e Destener's Dodantioia Statement) • 1 eatlfy that thle Cortilicato ofCompliame doenrritntotion b accurate and oDray)txc. • i am clWc under Division 3 ofthe Calilbrnia RMInemn and Pfo6essioas Coda to ameptrespoasibfllty lbr the desk id= .Bed,on tilt ca6fiaatc of campliaoco• • I ocatity that the cnetgy Ajoures and perforwBace speoifi=6oa+for the dosisa idtzacd on this Canll rte of tomplianoa conform to the roT*cv cnZx ofZgo 24,Pant 1 sad 6 of the California Code of Ropl4ona• • `Me design fcw=i6alifhod on this C='Scatc of Compiieaoc are vmsistut with the ihfeamatloa dooamentcd on other applicable wmpliaace foams,worksLoats,eleulaliona•plapa and sporct tioru sabmtttod to the eat agency iar ahpmvat with rbc parmit appucadon. r ' Nattier va1V0 Clty/St"Z;p: - ^>_ : r �i �; T, ... Met: -. • ' raw:. r , ./ ' ,.It 1: ..1 . , - �~ ” 2008 Putdantial Compllonca Forms.doc rcvlc¢d 04/10/12