13060198 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11079 FLOWERING PEAR DR CONTRACTOR:ONE HOUR HEATING PERMIT NO:13060198
AND AIR
OWNER'S NAME: NANCY CHIANG PHUA 1400 PETALUMA HILL RD DATE ISSUED:06/ 5/2013
OWNER'S PHONE: 4408218828 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALU
License Clasr1r10 C 2 y Li..# 7gbg4q REPLACE HEAT DUCT
Contractor Date 6
I here r am licensed under the provisions of Chapter 9
(com encing 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:$4176
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:32345034.00 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,40 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 DAYPNYM 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 b
granting of this permit. Additionally,the applicant understands and will comply Y Date: /
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature ate �Z�^"t�' 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
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS 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&Safety Code,Sections 25505,25533,and 25534. I 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date:
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 CONSTCTION LENDING AGENCY
RU
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.)
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 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 ARCHITECT'S DECLARATION
indemnify 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
GENERAL PERMIT APPLICATION MEP
Im COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION '
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.org MISC
❑PLUMBING ❑MECHANICCAgL, ❑ELECTRICAL �j ❑t�MISCE(LLLA�NEOUS
PROJECT ADDRESS -lq F INC PG�7 R R. APN# �2 `� l "��
OWNERNAME N 4N IV( ^H HQ _zt �ts 1 E-MAIL
STREET ADDRESS//07q
DDRESS/D 7 / `� r � 6 PMA
R. 1660r
ZIIA,O CA �r-' FAX
CONTACT NAME `� /�•(, PHONE ,V •�+E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEvELOPER ❑ TENANT
CONTRACTOR NAMEJ8Q6 L LICENSE $ER�QaQ LIQ SEOTYP`2-0BUS.LIC#
COMPANY NAME INS Hoof, t' S"(Nci E-MAIL -1 ` FAX
STRET Spr_VLUM /`, 4 CITY TATE, 9osA C 4 ^`,46L/ Pc)7E SSS-` O
ARCHITECT/ENGINEER NAME LICENSE NUMBER C•�CJ BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES rE.CHLER
THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO HOME? ❑NO
DESCRIPTION OF WORK
''p A pot-%?
TOTAL VALUATION: 141-7 RECEIVED
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on0/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 build' ns n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: V — 5—13
U TAL INFORMATION REQUIRED OFFICE USE ONLY
w R-T1E-00UNTER
❑ EXPRESS
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❑ STANDARD
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11079 FLOWERING PEAR DR DATE: 06/25/2013 REVIEWED BY: MENDEZ
19iAPN: BP#: "VALUATION: 1$4,176
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK REPLACE HEAT PUMP
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Heat Pump (<=10K cfm) 1BREMAIR 1 # $67
TOTALS: I Ot
$67.00 ali
_ <� . � << . a 111
,
Mech.Plan Check 0.0 hrs $0.00 .Phurrb. Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Phrmh.Per�mil Pee: l lec. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Cather Plumb Insp. Other Elec.Insp. L-1
Alech. Insp. /'ee: Plumb. Insp.Fee: Elec,Insp—l"ce
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PNM Plan Check: $0.00
Perinit Fee:
Suppl. Lisp Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes (j) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Com mission Fee: IBCBSC $1.00
3 6� L 200.50
$200.50 $0.00 $
Revised: 04/29/2013
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: //0_77 FLW&JNCP61" M PERMIT#'
OWNER'S NAME: &J0jfWy J> IJ PHONE# 06
GENERAL CONTRACTOR: r— 0OUK HEM BUSINESS LICENSE#- -7 1b94 9
ADDRESS Q l bL. PD CITY/ZIPCODE.j,94NT1j tzmor C* C S44
*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 subco ctorAs 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 Date