15030164CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1586 POPPY WAY
CONTRACTOR: LIU REX C AND
PERMIT NO: 15030164
CATHERINE S
OWNER'S NAME: LIU REX C AND CATHERINE S
1586 POPPY WAY
DATE ISSUED: 03/26/2015
OWNER'S PHONE: 4084804008
CUPERTINO, CA 95014-5307
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
REMOVE AND REPALCE FURNACE
License Class Lic.#
Contractor Date-
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $8000
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36610107 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
WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS ST CALLED INSPE TION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in consequence of the
/
�
costs, and expenses which may accrue against said
Issued by Date: G `
granting of this permit. Additionally, the applicant understands and will comply
_
with all non-point source regulations 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.
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)
owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
co Ntruct 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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
pe ormance of the work for which this permit is issued.
#fiave and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sections, 25533 and 25534.
i
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent7_7t 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
Code, I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
918.
Date
Signature
CITY OF CUPERTINO
Ti I 1 1 CTTM A rrnlD _ RTTTT .11TNf DIVIRION
LaiADDRESS:
1586 poppy way
DATE: 03/26/2015
REVIEWED BY: Mendez
UNITS
APN:
BP#:
"VALUATION:
$8,000
PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
$143
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
remove and replace furnace
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$143
Permit Fee_
S1q)pL Jr/sp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
i3Ons1ruction 7,ax:
T
-T
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
TOTALS:
i
WE
ro.
Asa. n
$143 00
'
Mech. Plan Check 10.0 1 hrs $0.00 111jutrb. Platt Check
Mech. Permit Fee: IMPERMIT Plumb. Permil Fee:
Other Mech. Insp. 1 0.0 1 hrs 1 $48.001 Oilier Plumb Insp.
9dech. Insp. Fee: Plumb. Insp. Tie:
Elee. Plan Check
Llec, Permit Pipe'
Other Ilex. Insp.
Lslec. Insp. Fee:
NOTE: This estimate does not include fees due to other uepartmenrs ft a rianning, ruauc ►T urns, [•ire, Ounuuiy ucrvu
:^antart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. Zjd-31
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
slippl. I'(' Feae
PME Plan Check:
$0.00
Permit Fee_
S1q)pL Jr/sp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
i3Ons1ruction 7,ax:
T
-T
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fees:
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
f
$286.04
$0.00
$286.04
Revised: 02/14/2015