The URL can be used to link to this page

09100069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10784 JOHNSON AVE CONTRACTOR: PELLE HEATING & AC INC PERMIT NO: 09100069 OWNER'S NAME: YINAN WANG 3728 C CHARGER PARK DR DATE ISSUED: 10/12/2009 ;ER'S PHONE: 4089338793 SAN JOSE, CA 95136 PHONE NO: (408)978-7060 LICENSED CONTRACTOR'S DECLARATION F_ ELECT PLUMB �� pQ� QQ O O BUILDING PERMIT INFO: BLDG License Class Lic. # O f- f- RESIDENTIAL COMMERCIAL � Contractor // {� �' Date /O � �� MECH 1 hereby affirm that I am censed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE CHANGEOUT (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 Sq. Ft Floor Area: Valuation: $2500 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 APN Number: 37531003.00 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 qr_�,( Z S granting of this permit. Additionally, the applicant understands and will comply Issued by.:•�� '"'�_---"�f------- Date with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. p �0 �'� �i Signatu to RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is CJ OWNER-BUILDER DECLARATION installed without first obtaining an inspection, I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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) ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Compensation, as provided for by Section 3700 of the Labor Code, for the Safety Code, Section 25532(a) should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally, should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance, as provided for by 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 Section 3700 of the Labor Code, for the performance of the work for which this Health & Safety Code, Sections 25505, 25533, and 25534. permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall Ow author' ent: A not employ any person in any manner so as to become subject to the Worker's ate: 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 C STRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 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.) APPLICANT CERTIFICATION Lender's Name 1 certify that 1 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 Lender's Address 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 i nify and keep harmless the City of Cupertino against liabilities, judgments, C 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 pen-nit. 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 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37531003.00 DATE ISSUED.......: 10/12/2009 RECEIPT #.........: BS000008883 REFERENCE ID # ...: 09100069 SITE ADDRESS .....: 10784 JOHNSON AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............. YINAN WANG ADDRESS ..........: 10784 JOHNSON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: PELLE HEATING & AIR CONTRACTOR .......: STEVE PELLE LIC # 27593 COMPANY ..........: PELLE HEATING & AC INC ADDRESS 3728 C CHARGER PARK DR CITY/STATE/ZIP ...: SAN JOSE, CA 95136 TELEPHONE ........: (408)978-7060 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 2,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 2,500.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 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 1PPERMITFE 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 ---------- 232.50 ---------- 0.00 232.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 232.50 --------------- 232.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #3959 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM coq j 0 ou�� APN # ,� ' � Q � � � Date: to qlncl BuildingAddress: Owner's Name: Phone #: Contractor: Phone #: �� ,� rL f 'Io(ca T-61c,�. � � Fax #: L -4-'0°$'.r T 4 170 Contractor License #: Cupertino Business License #: qoR 91151T3 Contact: Phone #: 4019 9n$ lea 6,(ff1e Fax#:,cl�g•�� L� Building Permit Info: Elect 0/'" Plumb �Mec Residential Commercial LJ Job Description: R4rK4C.C, CAA, Gtr e DCAJ' For Residential Installations: Attic ❑ I St floor 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): k4 Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement Project Size: Express ❑ Standard& Large ❑ Major ❑ Valuation: n n Z) . �� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revised U1/U7/U9 CITY or CITY OF CUPERTINO FURNACE/AC 1�" FEE SCHEDULE CUP R7'INO Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE floor mounted unit heater. Quantity Fee ID Fee Description Fee Group Permit Type 1MRAPPVNT Residential for the install/relocate/ or replacement of ea appliance vent install & not incl in an appl permit. M FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES r 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1MFRN>100 Furnace Syst > 100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M I 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B CITY OF .'UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS:xd%do;rzl j �� PERMIT # o n _�1 l (,::,qOWNER'S NAME: Qin Cabinets & Millwork PHONE # GENERAL CONTRACT �/e � FAX # Electrical I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: l�—/� ,0< Date 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile l�—/� ,0< Date