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15080184CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6660 JOHN DR CONTRACTOR: ARANDA AIR INC PERMIT NO: 15080184 OWNER'S NAME: YOUNG ALBERT P AND YU FATIMA K 1805 LITTLE ORCHARD ST STE 137 DATE ISSUED: 08/25/2015 OWNER'S PHONE: 4082530491 SAN JOSE, CA 95125 PHONE NO: (408) 271-8835 1Q LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] REPLACE (E) FORCED AIR FURNACE IN HALLWAY License Class Lic. # CLOSET Contractor �a� �%� Date O!'i 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 Sq. Ft Floor Area: ♦ aluation: $4000 performance of the work for which this permit is issued. 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: 36923009.00 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 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 DAYS FROM LAST CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, I costs, and expenses which may accrue against said City in consequence of the �A �s " granting of this permit. Additionally, the applicant understands and will comply Issued by: cJ u`� Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date *�• Vlt7_ 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. 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, Sectjon 5505, 3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this J Owner or authorized agent: Date: permit is issued. 1 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ingCa)cupertino.org ❑ PLUMBING & ECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS MEP MISC PROJECT ADDRESS / APN # OWNER NAME t? C4 S _ E-MAILYL U l STREET ADDRESS CITY, ATE, ZIP • -- FAX n, CONTACT NAME %Jw- PHOII�� E-MAIL G STREET ADDRESS �� ` /' �J CITY, STA FAX IW&,P )S;? Cd _ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAA nG LICEN NUMBER _ LICENSE TYPE BUS. LIC O COMPANY NAME E-MAIL FAX G r STREETADDRESSCITY, off" ly STAT P Gn cam- ysia� PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDLNG: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK CXR TOTAL VALUATION: RECEIVED BY By my signature below, I cerW to each of the o owing: 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 to building pons tion. I au . e representatives of Cupertino to enter the above -i entified property for inspection purposes. Signature of Applicant/Agent: SUPPL NTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER THE COUNTER � 45� �RA � �x 4 W. a� ; STANDARD U , rr •. ❑ LARGE MEPMiscApp_2011.doc revised 06121/11 CITY OF CUPERTINO Q FEE ESTIMATOR - BUILDING DIVISION �lU KaADDRESS: 6660 John Drive DATE: 08/25/2015 REVIEWED BY: PAUL aNI APN: 369 23 009 BP#: "VALUATION: 1$4,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE. WORK Replace E forced air furnace in hallway closet SCOPE SuppL Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plumb. flan Check QTY UNITS BP FEES Etoc. Permit Isar Furnace, Forced -Air 1MFR=<100 Other Elea Insp. 1 # $143 ,"'crmit l"ee: SuppL Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 . iistruction '/ply: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $143.00 Strong Motion Fee: IBSEISMICR 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) Mech. Plan Check 10.0-1hrs $0.00 Plumb. flan Check Elec. Plan Check Mech. Permit Fee: IMPERMIT Plumb, Permit Fee: Etoc. Permit Isar Other Mech. Insp. 0.0 hrs $48.00 r ther.Plutrih Lisp. Other Elea Insp. Plumb. Insp. Fee: flee. Insp. Fey 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS lan Check Fee: tippl. P(' Fee PME Plan Check: $0.00 ,"'crmit l"ee: SuppL Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 . iistruction '/ply: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 [lv need Planning f Pc.�: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $285.52 $0.00 TOTAL FEE: $285.52 Revised: 07/02/2015