12110137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7677 NORNIANDY WAY CONTRAC'MR:JBK AIRE,INC PERMIT NO: 12110137
OWNER'S NAMF-: MARGARETTINDLE KLUGHERZ 18450TECIINOLOGY DR DATE ISSUED: 1127/2012
OWNER'S PIIONE: 4087394895 MORGAN HILL,CA 95037 PIIONIi NO:(408)779-3296
❑. LICENSED CO\fRAC-fOpR'S2DPCLARA' ION .IORDESCRIP"I'ION: RESIDENfIAI- COMNIF,RCLU-LJ
License Class L- �� Lic.H g ( 3? REPLACE FURNACE
Contractor JJ& �r i a ��,J[�- Date A `bl,7-/2--
i
I hereby affirm That I am licensed under the prorisiams 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Cade,for the
performance of the work for which this permit is issued. Sq. Ft Fluor Arca: Valuntion:$3100
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:36611165.00 Occupancy Type:
permit is issued.
APPLICAN"f CERTIFIC TION
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 INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenseswhich may accrue against said City in consequence of the
granting of this pe . Additionally,the applicant understands and will comply Issued- y': Dote:
with all ron-pointo6r9ygulations per the Cupertino Municipal Code,Section
9.18,
nROOFS:
:my
Signator Uate All roofs shall be inspected prior to y rooting material being installed.If a roof is
installed without first obtaining rut inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby alarm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL R0017 COVERINGS TO RE CLASS"A"OR BE'FITR
1,as owner.ofti a 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 IIAZARDOIIS 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&Safely 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(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 1 use equipment or devices which emit hazardous
Compensation;as provided for,by Section 3700 of the Labor Code,for the air contaminants ns defined by the Bay Area Air Quality Alanagernem_Dislriet
performance of the work for which this permit is issued. will nuinlain compliance with the Cupertino Nlunicijml Code,Chapter 9.12 and ..
I have and will maintain A'orker's Compensntion Insurance,as provided for by the Health&Safely Code,Sectim ?'55115.25533,and 25534.
Section 3700 of the Labor Code,for dmc perlbrmance of die work for which this �7-
permit is issued. - Owner or nuthori'red aigau• Date.
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 CONSFRIICI'ION 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 work's for which this permit is issued(Sec,3097•Civ C.)
Leader's None
APPLICANTCERTIFICATION Lender's Address
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state Imus 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, ARCHITEC7I"S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand any 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
GENERAL PERMIT APPLICATION \1 M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �\ M I
CU PERTI NO (408)777-322x�8-1 FAX(408)777-3333• buildino ftupertino.oro \
SC
[-]PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS / W I
APN eq //
OW'\ER\A.\IE (O l.v PHONEI�* C3
STREET A1306 CIT SATE ZIP J DG7 FAN
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CONTACTNA PHO]. E-.\TA& A
STREET • C17• A`TF ZIPS `� --,I
FAY i 6 Tu rvo o � �s NoS72k• ,ZSa
❑OWNER Cl OW\ER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CON ACTO�\IM H-'� /� x122 ,( LICE\5 /�NU{[I /%�']/V�LIC/F/C. Tl'PI° BUS CSC/'J
COMPANY'NANIE (l l EV L NF e �i!\ F•�\DD !��•.71>�
STREETA Dj[F ',_1., CC �r CITN',STATEZIP,�,TD4 dE)// �� lJ�.'-1 PHONE o�77i• 3a9
ARCHrrECrIENGINEER NAME LICENSE NUMBER V '(•(C 7 IV BUS,LICK
COMPANYNAME E-NIAIL FAX
STREET ADDRESS CITY,STATF.ZIP PHONE
USE OF $FDur DUPLE\ ❑ MULTI-FAMILY PROIECTINWILDLAND ❑ VCS PROJECT IN C1YES IS THE BLDG AN ❑ VES
BUILDING MMINIERCIAL URBANINTERFACE AREA SO FLODDZONC \O EICHLER HOME: 2
0
DESCRIPTIO\OF WORK
1 /
A110<4a-
TOTAL VALUATION; /D(/ '� RECEIVED BY: /l
By my signature below,I certify to each of Lhdollo\ving: I am the property owner or authori7ed agent to act on the property owner's behalf. I have read this
application and the information I have Pro ((�� -correct. I ave read the Description of Work and verify it is accumte. I agree to comply with all applicable local
ordinances and state IaW's relating to build c r ?Pau representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgenC Date
SUI' LEMEN1'AL INFORMATION REQUIRED OFFICEIISEOSLY
VER=TIIt?COLI\'TBR
❑ EYPRE\N
1
❑ si-A\DARI1
❑ LARGE
❑ mAADR
MEp,bliscdpp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 7677 Narmandy Way DATE: 11/27/2012 REVIEWED Bl': Sean
APN: BP#: WALUATION: $3,100
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT T)'PE:
WORK Remove and replace furnace.
SCOPE
APPLIANCE/1,QUIP TVPE FEE ID QTl' UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
Mech.Plan Check 0.0 hrs $0.00 Phonh. Phn,Cheek £lec.Plan Check
Mech. Permit Fee: IMPERM/T Plumh. Permit Fee: Elec.Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Ll Other Elec.Lisp.
Mech.Insp.Fee: Plumb. ingp. Fee: Elce.Insp.Fee:
NOTE: This estimate doev not include jeer due to other Departments(i.e. Planning, Public Works, Fire,Sannaly Saver District,School
District,etc.). These fees are baser/on the prelitninan information available and are only aur estimate. Contact the De t or as do 7 info.
FEE ITEMS fFee Resolution 11-053 EfT 7/1//2) FEE QTY/FEE MISC ITEMS
Plan Check Fce:
Stipp/. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. /rtsp Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Construction Tai-:
Administrative Fee: IAD,111N $42.00
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA KDOC $45.00 A
Strong Motion Fee: IBSE1Sht/CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: /BCBSC $1.00
SUBTOTALS: $266.50 $0.001 TOTAL FEE: $266.50
Revised: 10/01/2012
.T.-."_..:-r• ..v:C _....:i, r. �.f.. �. _. .�_. •� .. • .. -+..�� _ .. • r. ..lr. . I ♦ .f.. ..F .t •.'S` A\
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Te Icphone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: /&�G// Z PHONE 1/DL° " �o
GENERAL CONTRACTOR: r= Aav BUSINESS LICENSE#
ADDRESS: zz d CITY/ZIPCODE: GL
*Our municipal code requires all businesses working in,the city to have a City of Cupertin business license.
NO BUILDING FINAL OR FINAL OCC ANCY 1NSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL C 'T C ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors;
Signature Date
Please check applicable subcontractors and complete the following information:
►/ 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/Contractor Signature Dale