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12070189
CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 904 FERNGROVE DR CONT'RACT'OR:SMITH ELECTRIC INC PERMIT NO: 12070189 OWNER'S NAME: THOMAS CI IIN 15732 LOS GATOS BLVD DA'Z'E ISSUED:07242012 OWNER'S PlIONE: 4087688411 LOS GATOS,CA 95032-2504 PIIONE NO:(408)835-2122 /1LICENSED CONTRACTOR'S DECLARATION 3011 DESCRIPTION: RESIDENTIAL COMMERCIAL11 License Class C D r I nLia�k R8s3 D INSTALL 2 EXHAUST FANS IN BATHROOM, INSTALL 4 Contractor IYIEI C.CI J L-C tic"`C 7', L(-/� LIGHT FIXTURES IN BEDROOM AND 1 LIGHT FIXTURE 1 herebv affirm that I am licensed under the provisions of Chapter 9 LIVING ROOM (conuneaciag with Section 7000)of Division 3 of the Business&Professions Code and thus my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to sell'-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:$800 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of die work for which this ,\PN Number:37538031.00 Occupanq•'1\'pr. permit is issued. APPI.IC,\N7'CIiR'I'II:ICA'1'10\ I certify that l 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 countyordimmces laid state laws relating WITHIN U S 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 DAY LAST CALLED INSPEC IO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said Cit)•in c0nsequenec of the granting of thi ,permit Additionally,the applicant understands crud will comply Issued b}': Date: with all non o'it nice regulon rs per the Cupertino Municipal Code,Section 9.18. ) / .Z 1 e /� RGROgm Signator \ Dale All roofs shall be inspected prior to amyroofinng material being installed.I(a rool'is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-RIILDER DECLARATION Signature of Applicant: Dale: I hereby affirm that am exempt from the Contractor's License Lane for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BF.'1'1'IiR I,as owner of the property,or m) employees with wages as their sole compensation, will do the work,and the stricture is not intended or offered for sale(Sea7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to DAZARDOUS MATERL\I S DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code.Sections 25505.25533,and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Ilealth&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 performance of the work for which this permit is issued. will maintain compliance oil he Cupertino Municipal Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by (lie Ilealth&Safety Code.S2553 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this /-� /•f (honer or authorized ager Dat permit is issued. Dole: I certify that in the performance of the work for which tris permit is issued,1 shall - not employ an),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 CONSTRU47FION LENDING 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 w'ork's for which this permit is issued(Sec.3097,Civ C.) Lender's Name AI'1'I.IG\N'1'CISR'I'IFIG\'1'IUN Lender's Address I certify than I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances told 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 ,\RCIIITF.CI"5 DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may acerae 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 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 904 Ferngrove Dr DA'Z'E: 07/24/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $800 *PERMIT TYPE: Electrical Permit PLAN CIIECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1REAP1 �VOIiK Install 2 exhaust fans in bathrooms install 4 light fixtures in bedroom and 1 light fixture in the living SCOPE room. APPLIANCE/EQUIPTYPE YPE FEE ID QTl' UNITS BP FEES Fixtures, Lighting 1BREMFIXT. 7 # $67 1BREMPOWER T•OTA LS: $67.00 Xlech. Plan Check Pho)A Plan Check Elec. Plan Check 1 0.0 1 hrs $0.00 Aleah. Permit Fee: Phunh.Pfr•mit Fre: Flee. Permit Fee: IEPERAHT Other,llerh. ingr. Other Plumb Invp. Ll I Other Elec. Insp. 0.0 hrs $45.00 kkch. brap. Fee: Plush. /nap.Fee: Eler. Insp.Fee: NOTE': This ertitnate roes not include jeev due trr other Departments(i.e. Planning..Public Works, Fire,Sanitary Server District,School District. etc.). These feav are baser/on the prelinriitai3r information available and are only nn estimate. Contact the De t or athin7 in o. FEE ITEMS (Fee Resolution 11-053 E(L 7/Ull) FEE QTY/FEE MISC ITEMS Plan Check l-ee: Supp/. PC Fee PMH Plan Check: $0.00 Permit Fee: Supp/. Insp Fee PMH Unit Fee: $67.00 PME Permit Fee: $45.00 Constra:tion Tax: Administrative Fee: LIDAIW $42.00 Work Without Permit? O Yes Q No $0.00 Advanced/'luring Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strove Motion Fee: 1BSF/SAI/CR $0.50 Select an Administrative Item BiCIa Stds Commission Ffe: IBCBSC $1.00 SUBTOTALS: 1 $200.501 $0.001 TOTAL FEE: F$200.50 Revised: 07/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIIerations CF-IR-ALT-HVAC Climate Zones I and 3-7 Site Address: r> Enforcement Agency: Date: y Permit d: O W 7 T 1T. Conditioned -Ductinsulation Equipment t List Minimum EBicien Floor Area requirement Thermostat Packaged Unit �/ a C" 4o R of ducts ttrnace t�[yI A}FUE 7 �. e COP_ etbaek �2 Swsd by system added err teplarsd in Indoor COH rQJLER HSPF S (if not ah<advpresen4 mrut be ondensing Unit 0 EER_ ❑Resistance s( unconditioned spas ievtanedJ Otba ©R 6 (CZ!. 3-5) 1. Equipment Type:Choose the equipment being installed;if more than one system,use mother CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER 78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Autbor's/Responsible Designer's Declaration Statement) • I catify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design idend6ed on this Certificate of Compliance. • 1 cutify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Tide 24,Para I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application./� Name: Y r t� tl Company: Date: 7 2 Address: 4--47,3 &'11 Y'7 C��- License: Citylsune/Lip: S Phone: 2008 Residential Compliance Forms.doc revised 04/10112 ?-107c) ( �sFS GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 MI /� CUPERTINOyyS5// (408)777-3228 • FAX(408)777-3333 t buildincrcDcupertno-oro v\ IjI PLUNSING L/J N•fECF AMCAL ELECTRICAL ❑Ni1SCELLA.NEOUS PROJECT ADDRESS �.5 AFN0 OWNER NAME L ` 0. ` PHONE bZ' 4,Q a74i/� EMAR STREETADDRESS L �+ � l CITY, STATE,ZIP a RY `(" FAX CONTACT NAME / KK PHONE E-MAIL A/N� G�PYr OR STREET ADDRESS IT , CITY.STATE, ZIP FAX ❑OWNER CIOWNER-BUDDER ❑ OWNERAGENT 2 C/ONiRAC OR ❑CONTZACIDRAGFM ❑ ARCHTET ❑ENmHEzR ❑ DEVELOPER ❑ TANT, CONTRACTOR NAME rALW •W1�j-& L'CENSE NUINBEI�Oo �� LICENSE ME I BUS.LICa COMPANY NAME / 2 t E-MAIL ��ff FAX STREET ADDRESS 4z'Z3 VWO w� 4u, I CITY,STATE,ZTP CA I PHONE ARCHITECT/ENOL'EER NAME LICENSE NUMBER R I Bus.LIC a COMPANY NAME E-MAIL FAX STREET ADDRESS Cf-Y,STATB,ZIP PHONE US OF ❑SFD m DUPLX ❑ MIJLT,-FAMRY PROJECT IN WDDIAND ❑ YES =!;E ROTCr IN ❑YES IS THE BLDG AN ❑ YF3 HUM-DING: ❑COMMERCLAI. URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOA4. ❑NO DESCRIPTION OF WORK TOTAL VALUA77ON: lt;-�39oJ RECEIVED BY: / By my signamre below,I ccrtiry m each of the following: I=the property owner or acrhorized agent m act on die property owner's/behalf I have read this application and the information I have provided is cottecL I have read the Description of Work and verity it is accurate. I agree m comply with all aoplicable local ordinances and scam laws relating to buildi c ns=cticm. e- ori=mprvacamdves of Cuper ac,to enter the above-id= .5(1 Pm e:,y far inspection purposes. Signaawe ofApplicantlAgrne ��J Dam: 7�21?_ SUPPLEN[ENTAL INFORIM ATION REQUIRED OFFICE USE ONLY N OVER-THE-COUNTER 'r' ❑ EXPRESS u U ❑ STANDARD u Z ❑ LARGE 5 ❑ MAJOR ,blb-PMac9pp_2011.doc revised 06PI111