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10090258 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 11887 WOODHILL CT CONTRACTOR:COLD CRAFT INC PERMIT NO: 10090258 OWNER'S NAME: LUBIN GEE 181 LOST LAKE LN DATE ISSUED:09/28/2010 ,'NER'S PHONE: 4084977176 CAMPBELL,CA 95008 PHONE NO:(408)374-7292 ❑ LICENSED CONTRACTzOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB License Class Cl 38 Lic.# ✓� (1 /,,,, MECH RESIDENTIAL COMMERCIAL Contractor (. Lt t?(XZ f ,INC— Date Of I�y1to JOB DESCRIPTION: REPLACE FURNACE AND A/C 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:$4913 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:36604068.00 Occupancy Type: 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 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 expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non- oint source regulations er 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS 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 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(a)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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec'ons 25505,25533, d 25534. r Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: l 1 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 become subject to the Worker's Compensation provisions of the Labor Code,I muss 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.) 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 relatint. to building construction,and hereby authorize representatives of this city to enter -)n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ;mnify 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 9.18. Signature Date CITY OF C UPERTINO FFEE ESTIMATOR-:BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $4,913 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY a f PENTAMATION 1 RMAP6 USE: SFD or Duplex f� p . -t: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1 MFR=<100 1 # $126 A/C Units (<=10K cfm) 1BREMAiR 1 # $63 TOTALS: $189.00 Mech.Plan Check 0. hrs $0.0001 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 0.0 �hrs �$42�.0O ; Ar NOTE. These ees are based on the preliminar information available and are ontv an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 09-051 E(L 7/1/10) FEE QTY/FEE MISC ITEMS -1 PME Plan Check: $0.00 PME Unit Fee: $1811.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $).00 Travel Documentation Fee: 1 TRA VDOC $42.00 Select an Administrative Item Strong Motion Fee: $0.50 Bldg IBCBSC Stds Commission Fee: 1.00 SUBTOTALS: $274.50 $0.00 TOTAL FEE: $274.50 Revised: 9/22/2010 CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36604068 . 00 DATE ISSUED. . . . . . . : 09/::8/2010 RECEIPT #. . . . . . . • . : BS000011582 REFERENCE ID # . . . : 10090258 SITE ADDRESS . . . . . : 11837 WOODHILL CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LUBIN GEE ADDRESS : 11867 WOODHILL CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : COLD CRAFT CONTRACTOR . . . . . . . : PENNING, KENT LIC # 18644 COMPANY . . . . . . . . . . : COLD CRAFT INC ADDRESS : 181 LOST LAKE LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (4C8) 374-7292 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- -- 1BCBSC VALUATION 4, 913 .00 1 . 00 0 . 00 1 . 00 0 . 0 1BSEISMICR VALUATION 4, 913 .00 0 . 50 0 . 00 0 .50 0 .00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 1MRRAA UNITS 1 . 00 63 .00 0 .00 63 .00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0 .00 42 .00 ------0_00 - --------- ---------- ---------- TOTAL PERMIT 388 .50 0 .00 388 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ------- CHECK 388 .50 3643 --------------- TOTAL RECEIPT 388 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION __ _ -------- ------------------------ -- ----------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 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: �jvnee-- GENERAL PERMITOWNER'S NAME: u. PHONE#CONTRACTOR: L'D L 0 CkArT— BUSINESS LICENSE# ADDRESS: lot Loft Ll-'10- bx• CITY/ZIPCODE: 19bdt *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: Date Signature Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINKiIS 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 CXPERTINO FURNACE/AC CUPEkTiNO PERMIT APPLICATION FORM j 0() 6J0;257Y APN# Date: Building Address: 119Y1 hi.)I Cf. Owner's Name: Phone k Contractor: COLD CRAFT INC. 631837 Contact: Cupertino Business License#: KENT PENNING 1864,4 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech Job Description: �" lQ p f jjrhtlkU ay A �C Residential Commercial ❑ For Residential Installations: Attic El 1-1 floor 12nd floor❑ Adhere to min set back r uirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight(;tructural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: Type of Constru;tion: Occupancy group: 4 Strapped ❑ On Platform ❑ Bonded 11 Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Fee Group Applicable Fee ID Fee Description P BENERGY Energy BUILDING BREMFURN [relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch&Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING