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11010138 CITY OF CVPERTINO BUILDING PERMIT BUILDING ADDRESS: 10162 BILICH PL CONTRACTOR:SUSTAINABLE SPACES PERMIT NO: 11010138 INC OWNER'S NAME: CHIN WAYNE F AND JOAN L 1167 MISSION ST DATE ISSUED:01/26/2011 .NNER'S PHONE: 4082577181 SAN FRANCISCO,CA 94103 PHONE NO:(415)294-5380 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r- PLUMB r License Class Lic.# 3 g0 MECH RESIDENTIAL I— COMMERCIAL r Contractor 8.e _ ,,��Date Z I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE DUCT WORK,ADD INSUTLATION IN ATTIC (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:$10000 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. APN Number:31621064.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. A ditionally,the applicant understands and will comply with all non-point sou regul 'ons per the Cupertino Municipal Code,Section Issued by: Date 9.18. Signature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 permit is issued. Health&ISafety Code, tions 25505,25533,and 25534. 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 Owner orut r agent• ! / Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address -n the above mentioned property for inspection purposes.(We)agree to save .mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,-, ts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional 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: j PERMIT# OWNER'S NAME: :912ft PHONE # (41C- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 11 1i Kph CITY/ZIPCODE: , cp *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 SUBCO TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 7 I am not using any subcontractors: Signature to Please check applicable subcontractors and complete 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/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10162 bilich pl. DATE: 01/26/2011 REVIEWED BY: bobs. APN: C)(-,p P#: 0 3� "VALUATION: j$10,000 ;PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: I I PERMIT TYPE: WORK re lace duct work add insulation in attics ace. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Heating System 1MRRAA 1 # $63 TOTALS: $63.00 Mech.Plan Check 0.0 hrs $0.00 11hon 6 1'I'm C l <t L:`ic> P/Oi7(,h,,,,k Meeh.Permit Fee: IMPERMIT I'lutr:r3. Po-"nil Po"'. F", LcMe Mech.Insp. 1.0 hrs $42.00 E� ��, 13,�r,,lrr�r> Li 01h,r kicc. Ifrsp, .Insp.Fee: IMECHINSP $126.00 1'mih. ]',seg lay, / € NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 Ef. ',1%10) FEE QTY/FEE MISC ITEMS Platt C hack Fcle: SlIppl. PC 11-C PME Plan Check: $0.00 Permit Fce: Supp/. PME Unit Fee: $63.00 PME Permit Fee: $168.00 ("'o so-rrction 7tIA P<;ota:5licctl ILcvic iv Work Without Permit? 0 Yes E) No $0.00 I'lctrrrtitr�r Fees. Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS; $275.00 $0.00 TOTAL FEE:" $275.00 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO 0 GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM APN# Buildin dress: a I A 0 CA q � Mailing Address (if di Brent from building address): Are Hazardous Materials being used as part of this project? Yes 0 No FK HOA: (Exterior work only) Yes ❑ No .ff� If yes, provide letter from HOA If Residential.is house an Eichler? Yes ❑ No If yes, needs planning approval. Owner's Name: Phone#: Contractor: Phone: q r s-- .Z9`! - S3 Ir4 2 f L(I CLec Fax: Contractor License#: V4 3 3 V0 Cupertino Business License#: Contact: C.titri S �, jaM Phone: //S - / ' Sl Acf Fax/e-mail: Residential Commercial Job Description: at? l,cu t vck W o Z15v1 r- I k A 41 C Building Permit Info: Bldg 2" Elect ❑ Plumb ❑ Mech Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B v I n6r<- 4;t�' Valuation: Square Footage: O po� Project Size: Coun er Ex ress ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.buildittireen.2rg Revised 12/06/10