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11060010CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10220 YOSHINO PL OWNER'S NAME: HOGAN ELAINE OWNER'S PHONE: 4082574792 L LICENSED CONTRACTOR'S DECLARATION License ClassG_'®®16G�—,Meo- Vic. # .2e4nq3S-_ Contractor 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 declaratirns: 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. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 4 Signature -.c�J Date C OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, co— and expenses which may accrue against said City in consequence of the ig of this permit. Additionally, the applicant understands and will comply wi.., all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONTRACTOR: ALLIED AIRE SERVICE INC PERMIT NO: 11060010 470 S HILLVIEW DR DATE ISSUED: 06/02/2011 MILPITAS, CA 95035 PHONE NO: (408)934-8844 BUILDING PERMIT INFO: BLDG I— ELECT f— PLUMB f— MECH F RESIDENTIAL COMMERCIAL JOB DESCRIPTION: REMOVE & REPLACE FURNACE AT SAME LOCATION AND ADD AIR CONDITIONING Sq. Ft Floor Area: I Valuation: $4200 APN Number: 37503009.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: / Z -- l 1 RE -ROOFS: 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. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534. O� ho •' a nt• L Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37503009.00 DATE ISSUED.......: 06/02/2011 RECEIPT #......... BS000013631 REFERENCE ID # ...: 11060010 SITE ADDRESS .....: 10220 YOSHINO PL SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: HOGAN ELAINE ADDRESS ..........: 10220 YOSHINO PL CITY/STATE/ZIP ...: CUPERTINO, CA 95014-3437 RECEIVED FROM ....: ALLIED AIRE SERVICE CONTRACTOR .......: STEINER, ARNOLD R LIC # 19207 COMPANY ALLIED AIRE SERVICE INC ADDRESS 470 S HILLVIEW DR CITY/STATE/ZIP ...: MILPITAS, CA 95035 TELEPHONE (408)934-8844 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- -ADMIN ------------- HOURS ---------- 0.50 ---------- 39.00 ---------- 0.00 39.00 0.00 1BCBSC VALUATION 4,200.00 1.00 0.00 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 0.00 1BSEISMICR VALUATION 4,200.00 0.50 0.00 0.50 0.00 1MFR=<100 UNITS 1.00 126.00 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 ---------- 313.50 ---------- 0.00 313.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 313.50 --------------- 313.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #22298 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING WNW OF CUPERTINO FFF VSTIMATOR — BUILDING DIVISION im ADDRESS: 10220 YOSHINO PL DATE: REVIEWED BY: UNITS APN: BP#: *VALUATION: 1$4,200 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex7 USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK REMOVE & REPLACE FURNACE & SAME LOCATION & ADD A/C SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $126 Air -Handling (<=10K cfm) 1BREMAIR 1 # $63 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $189.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check hrs $0.00 0.0 Mech. Permit Fee: IMPERMIT 77 Other Mech. Insp. 1 0.0 1 hrs 1 $42.00 1 - NnTF. - Thoce foes are hosed an the nreliminary information availahle and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (&e Resolution 09-051 E . 7/1110, FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 A Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 J hrs Admin./Clerical Fee $39.00 (ADMIN Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $274.501 $39.00 TOTAL FEE: $313.50 Revised: 04/29/2011 -UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS.,/0.2,W PERMIT # U OWNER'S NAME: fzd,4 t PHONE # Dg Z57 P - ,V-2— .ZGENERAL GENERALCO TRACTOR:,�;� ,r` �� ' BUSINESS LICENSE # ADDRESS: � I -S; CITY/ZIPCODE:�• .rS' rT'Je *Our municipal code requires all businesses working 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing OAA�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 ,L/i Date CUPERTINO GENERAL PERMIT APPLICATION fI MEP COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a?.cupertino.org 54PLUNMING SIECHANICAL J�4£TECTRICAL ❑ MISCELLANEOUS MISC PROJECT ADDRESS /,�y S / i ' n APN H f O OWNER NAME � /��Jfl�i �0 p Z E MAR' STREET ADDRESS CITY STATE, ` A , FAX CONTACT NAMEO / _649&e� 6 J PHO /8 / E MAII STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT XTONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C079 LICENSE NUMBER CENSE TYPE BUS. LIC II COMP E -MAR. FAX S ADDRESSTE, �/� /�i Alit ARCI=CP/ENGINEERNAME „ / LICENSE NUMBER BUS. LIC 9 COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE. ZIP PHONE 'ISE OF 1"-SFD or Duplex ❑ Multi -Family , rRUCI'URE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes XNO PROJECT IN FLOOD ZONE ❑ Yes I NO DESCRIPTION OF WORK _ TOTAL VALUATION: �D .1 sKp 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 behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to g construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicandAgent Date: G / MEPMiscApp_Z011.doc revised 03/16/11