11030023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10250 LOCKWOOD DR CONTRACTOR:AIR AND PLUMBING PERMIT NO: 11030023
SYSTEMS
OWNER'S NAME: ALBERT KUO 285 SOBRANTE WAY STE P DATE ISSUED:03/04/2011
NER'S PHONE: 4083416338 SUNNYVALE,CA 94086 PHONE NO:(408)733-2000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class n Lic.# �6r} INSTALL 2 WALL HEATERS AT FIRST FLOOR LOCATION
Contractor Date !/ l
I hereby affi at I lis under the provision of Chapter`9
n
(commencing with Section 7 )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:$3390
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 ich this. APN Number:34214038.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION V�_�
I certify that I have read this application and state that the above information is PERMIT EXPULESJJF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITH 180 DAYS 04 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 L T CALLED INSPE TION.
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. Additionaly,the applicant understands and will comply Issued by: Dat
with all non-point source regulati s per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
u
OWNER-BU,ILBER 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. 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(x)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 NSunicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: e:
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 CONSTRUCTIO NDING 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
'Amnify and keep harmless the City of Cupertino against liabilities,judgments,
.s,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
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:a w -QC& w6wPERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: /'� �-Y' �^^�a��-� BUSINESS LICENSE#
ADDRESS: 2�' _,e i2ott,--LC- CITY/ZIPCODE:
*Our municipal code requires all businesses woriking in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT ?TORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: - '
ign re Date
Please check applicable subcontractors and co plete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner tractor Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34214038 . 00
DATE ISSUED. . . . . . . : 03/04/2011
RECEIPT # . . . . . . . . . BS000012832
REFERENCE ID # . . . : 11030023
SITE ADDRESS . . . . . : 10250 LOCKWOOD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALBERT KUO
ADDRESS . 10250 LOCKWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AIR PLUMBING SYSTEM
CONTRACTOR . . . . . . . : AIR AND PLUMBING SYSTEMS LIC # 31732
COMPANY . . . . . . . . . . : AIR AND PLUMBING SYSTEMS
ADDRESS . . . . . . . . . . : 285 SOBRANTE WAY STE P
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 733-2000
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 390 .00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 3, 390 . 00 0 .50 0 . 00 0 .50 0. 00
1MFLRFURN UNITS 2 . 00 126 . 00 0 . 00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 211. 50 0 . 00 211 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 211 .50 visa
---------------
TOTAL RECEIPT 211. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10250 lockwood dr. DATE: 03/04/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$3,390
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE:
WORK install 2 wall heaters at first floor location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Floor 2 # $126
TOTALS: $126.00
Mech.Plan Check0.0 hrs $0.00 �'' - '
Mech.Permit Fee: 1 MPERMIT
Other Mech.Insp. 0.0
hrs $42.00 :'a �,
�'FiCt tti:7 �`,'<�_ - 1ii-. 13 t' �'£ . I;, 'C.Iri l'�). 1`•`.'('.
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 L 7%1/70,) FEE QTY/FEE MISC ITEMS
Plan
S2upp/. Pt.'Fcc
PME Plan Check: $0.00
PME Unit Fee: $126.00
PME Permit Fee: $42.00
Work Without Permit? ® Yes No $0.00
Travel Documentation Fee: ITRA VDOC $42.00 A
Strong;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 —71
SUBTOTALS: 1 $211.50 $0.00 TOTAL FEE: $211.50
Revised: 03/01/2011
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building .cupertino.org MISIC
CUPERTIN0
0�3 00O3
UMBINGMECHANICAL ❑MISCELLANEOUS 1
PROJECT ADDRESS Aq ?__60 / I APN#
-- VVOPLAI l!"
OWNER NAME At &fEJ- t, d PHONE r f E-MAIL
STREET ADDRESS CITY, STATE,ZIP ( (J FAX
APPLICANT NAME L„��}� , PHONE� ` E-MAIL
STREET ADDRESS � ��A �h C_
CITY,STATE, ZIP ' } FAX
❑OWNER 11OWNER-BUILDER /L❑+�``O"WNERAGENT R CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ��C,(/ /y/ J�t`� LICENSE NUMBER �j�/JJ I// LICENSE TYPE BUS.LIC#
COMPANY NAME e v v (/LC W t� E-MAIL �/C_ T G FAX
STREET ADDRESS �6 _� }j �L CITY,STATE,ZIP v� � PHONE
ARCHITECT/ENGINEER NAME /l L LICENSE NUMBER BUS.LICL#(/(f
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF PROJECT IN WILDLAND PROJECTIN
!
STRUCTURE: t4 Residential ❑ Commercial URBAN INTERFACE AREA ❑3 Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: RECEIVED BY:
By my signature below,I certify to each of the f ing: 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 provide correct. I have read the Description of Work and verify it is accurate. I agree to ca ply with all applicable local
ordinances and state laws relating to building struction. I authorize representatives of Cupertino to enter the above-ident' led pro rty for inspection purposes.
Signature of Applicant/A Date:
1
SUPPL M INFORMATION REQUIRED OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 03/02/11