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11070215 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11446 LINDY PL CONTRACTOR:RELIABLE AIR PERMIT NO: 11070215 MECHANICAL OWNER'S NAME: WILSON LARRY W AND BEVERLY A 3670 D CHARTER PARK DR DATE ISSUED:07/27/2011 ER'S PHONE: 4082553984 SAN JOSE,CA 95136 PHONE NO:(408)266-7267 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB� License Class � V Lic.# �� ( L(0 V MECH f- RESIDENTIAL r COMMERCIAL Contractor A -7—)--)- -)Date - C/ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING FURNACE AND ADD A/C UNIT(SAME (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION) 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$4500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35624010.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point ulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: SignatuPe L Date 7-- �( LL OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shallafety Code,Sections 25505,25533,and 25534. 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 O er uthori e a become subject to the Worker's Compensation provisions of the Labor Code,I must Date: ,i 1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Hork's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address ,mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MDDRESS: 11446 lindy pl. DATE: 07/27/2011 REVIEWED BY: bobs. PN: BP#: "VALUATION: $4,500 Y°PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK replace existing furnace add a/c unit. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAiR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 0.0 hrs $44.00 NOTE: Theseees are based on the preliminaryinformation available and are onlyan estimate. Contact the Det or addn7 info. FEE ITEMS (lee Resolution.11-053 1) FEE QTY/FEE MISC ITEMS . .... .... .._.. PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg? Stds Commission Fee: IBCBSC $1.00 $41.00 ]ADMIN SUBTOTALS: $284.501 $41.00 TOTAL FEE: $325.50 Revised: 07/04/2011 AU 3 lZ} CF She �u nu Li searm� foraltf� an�isf�is�Afl+er --- • deQm { �� oairrar� .PW °°°�1Q•Ifl3{�} I L. 2,7 { HVACSYSTM• jCWCkMdN& � Type ZJsIDe sad Madel 'Z '�ej Loe+ a� Ind I 9VW AV36 for lie Do* dmad- C*Ikk ( ', 6 - - -� � 3 � .t �� --�1•x -IIS � � u y . cabala- bhmbw sod.$ 8111 _ : Dm - Co ft BDUDMG D$P9RTMBNP,BS R&'=(Mrs��s A, • {4 oZJ -D GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• buildingQcuoertino.org MISC CUPERTINO ❑PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �'j �l� A` 9 ATN .c2, Of O OWNER NAME L 6 PHONE L �r ^�C�'�p�C E-MAU- STREET ADDRESS J CITY, STATE,ZIP l�^ J 1 FAX CONTACT NAME PHONE STREET ADDRESS �^-�6 e� ��✓� CITYy ! 6 C `�S FAX , ! , El OWNER 1:1OWNER-B=ER ❑ OWNER AGENT CONTRACTOR —❑CONTRACTORAGENT ❑ ARCHITECT 1:1 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - t 0�� LICENSE NUMB 5L,'jo� LICENSE TYPE \ BUS.LIC 9 ` COMPANY NAME r MCC E-MAIL /�U� STREET ADDRESS, ��✓�C CITY,STATE,ZIP PHONE ARCH,I ECTIENGDdEER NAME {� i� LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIL DLAND ❑ YES PR07ECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK -L ,Q C-e Q ' TOTAL VALUATION: I)V wC RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property wner's behalf. I have read this application and the inforrpatierrt-bave pro d is correct.,I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and stat laws relating t build' construc o ` anIize represen9l ves of Cupertino to enter the abov -identified pr erty for inspection pudposes. Signature of Applican�nC-"' - Date: � SUPPLEMENTAL INFORMATION REQUIRED OFFICgJJSE ONLY OWER-THE-COUNTER G ❑ EXPRESS U w ❑ STANDARD U ❑ LARGE ❑ MAJOR MEPMIscApp_2011.doc revised 06121111