B-2016-1400 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1400
10701 BAXTER AVE CUPERTINO,CA 95014(326 11 092) (RANDO AAA HVAC
INC)
SAN JOSE,CA 95125
OWNER'S NAME: TANG LYNN Y AND WANG KAINING DATE ISSUED:02/22/2016
OWNER'S PHONE:3236205334 PHONE NO:4082934717
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C431C20 Lic.#768871
Contractor(RAN DO AAA HVAC INC)Date 02/22/2016 X BLDG _ELECT _PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions ofChapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE(E)FORCED AIR FURNACE,SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
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 permit is issued. Sq.Ft Floor Area: Valuation:$9293.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above ,CPN Number: Occupancy Type:
information is correct.I agree to comply with all city and county 326 11 092
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 indemnify and keep
harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAS CALLED INSPECTION.
Co�ction.9. Issued by:PAUL O'SULLIVANSignaures�— Date 02/22/2016 Date:02/22/2016 ( `
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
1. 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(See.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:02/22/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. 1 have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
this permit is issued. material. Additionally,should I use equipment or devices which emit hazardous
3. 1 certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Sa o e, ctions 25 5,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the %
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:02/22/2016
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance
I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 02/22/2016
GENERAL PERMIT APPLICATION 5016-WO, MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
Ct,J€' RTtNQ
E " (408)777-3228•FAX(408)777-3333•building(ftupertino.org MISIC
❑PLUMBINGMECHANICAL []ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS O- fo APN# OCA�J
OtvNER NAM
E-TNAyr, ` d U AJA ANJA Kk-gj\ P 2 Y 2-0 J 1 E-MAIL
STREET ADDRESS / CITY,STA E,ZIP '/U
�\ ' FAX
CONTACT NAME 6 PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ owNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME�r LICENSE NUMBLICENSE TYPt BUS.LIC#
COMPANY NAME AA
1 f-d r/ C L. 6 IL PN 1 S� c r(� FAX�[D8 2_�+
�`J.
a �vfMAiC T C �
,..
STREET ADDRESS ,r-) � ��A�2 �Q CITY TE 5 CSI PHO7 f7 �Q 1
ARCHITECT/ENGINEERNAME LICENSE NUMBER ,( l BUS.LIC#l7
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN El YES IS THE BLDG AN ❑YES
BUILDING:. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ 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 the property owner's b half.. I have read this
application and the" ation I have prov' chis correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances an e laws relating to building co._ truc" r/I thorize representatives of Cupertino to enter the above-idenfi ie property for inspection purposes.
Signatur of Applicant/Agent: (/� Date:
SUPPLEMENTAL INFORMATION REQUIRED
. OFFICE USE Oz�I 1
� 4 OVER TI�'�COUNsTER
c. 3.
� � MAJOR t
MEPMiscApp 201].doe revised 06121111
CITY OF CUPERTINO t ,
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10701 BAXTER AVENUE DATE: 02/22/2016 REVIEWED BY: PAUL
APN: 326 11 092 BP#: "VALUATION: 1$9,293
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFq or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE E FORCED AIR FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: $143.00
Mech.Plan Check 10701hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp, 0.0 hrs $4$.00 F., f frEIF-1-
U-W
`.,-
r
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the preliminary information available and are only an estimate. Contact the De t for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1,113) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $143.00
PME Permit Fee: $48.00
t =six ra:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes Q No $0.00
Travel Documentation Fee: ITRAVDoC $48.00
Strong Motion Fee: IBSEISMICR $1.21 Select an Administrativ
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $286.21 $0.00 TOTAL.FEE. $286.21
Revised: 01/01/2016
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