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15030175CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7494 HEATHERWOOD DR CONTRACTOR: ABC COOLING & PERMIT NO: 15030175 HEATING OWNER'S NAME: ZHANG ZILI AND OUYANG RUSHA 3266 INVESTMENT BLVD DATE ISSUED: 03/27/2015 OWNER'S PHONE: HAYWARD, CA 94545 PHONE NO: (510)471-8181 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REPLACE (E) FURNACE, SAME LOCATION. REPLACE 11 �[ C 4--,2-0 v DUCT RUNS License Class Lic. j Contractor QC>!" Date 1 I hereby affirm that I am licensed unVer 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: $9400 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35928049.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 180 T CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Z� costs, and expenses which may accrue against said City in consequence of the Issued Date: granting of this permit. Additionally, the applicant understands and will comply with all non-po' source regulations per the Cupertino Municipal Code, Section 918. RE -ROOFS: Signature Date 27 j 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. 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, Sectio 5505, 25510 25534 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 ��,—,��,,� CITY OF CUPERTINO rm—ml FFF F.STIMATOR — BUILDING DIVISION LaiADDRESS: 7494 HEATHER DR DATE: 03/27/2015 REVIEWED BY: MELISSA Mech. Plan Check 0.0 hrs $0.00 APN: 359 28 049 BP#: *VALUATION: 1$9,400 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du IeX p PME Plan Check: PENTAMATION FURN/AC USE: Plumb. hasp. Tee: PERMIT TYPE: WORK REPLACE E FURNACE SAME LOCATION. REPLACE 11 DUCT RUNS SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 TOTALS: W {Y 2 ,I $143.00 ., :MEIN WP - , 201 101 Plumb, Plan Check QTY/FEE Elec..Phm ("heck Mech. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Plumb, Permit Fee: Suppl, P(:`Tfec Islet Perry, i Iii Mech. Insp. 0.0 hrs $48.00other Plumb Insp. PME Plan Check: 0111et, L lec. hasp. Llher Insp. Fee: Plumb. hasp. Tee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n6..*.. f #, 1 71.... f— nro hacad np tho proliminary information available and are only an estimate. Contact the Deptfor addn I info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check P'ee: Suppl, P(:`Tfec PME Plan Check: $0.00 Permit Fee: . zq)pl. Imp P'ee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Pl£ rming Tees: A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.22 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 r s i $286.221 $0.00 T " AL FEES,; .>t - $286.22 Revised: 02/14/2015