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11040065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22603 WOODRIDGE CT CONTRACTOR:VALLEY HEATING& PERMIT NO: 11040065 COOLING OWNER'S NAME: CHENG BOCHING AND JENN-YUAN J 1171 N 4 TH ST DATE ISSUED:04/11/2011 IER'S PHONE: 4084461324 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB f— License Class G'a Lic.# SRSLf �/ MECH f— RESIDENTIALr COMMERCIAL Contractor `f Date //—/f I hereby affirm t I licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 80%11 OK BTU FURNACE IN EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions OUTDOOR Code and that my license is in full force and effect. CLOSET 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2950 permit is issued. APPLICANT CERTIFICATIONAPN Number:34215068.00 Occupancy Type: I certify that I have read this application and state that the above info n 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 D YS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. l Signature Date —� —I l Issued by: /( Date: L O R-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner tt r' ed agent: `��// forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save ira--unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the gi—ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34215068. 00 DATE ISSUED. . . . . . . : 04/11/2011 RECEIPT #. . . . . . . . . BS000013147 REFERENCE ID # . . . : 11040065 SITE ADDRESS . . . . . : 22603 WOODRIDGE CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHENG BOCHING AND JENN-YUAN J ADDRESS . . . . . . . . . . : 22603 WOODRIDGE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2674 RECEIVED FROM . . . . : VALLEY HEATING &COO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 950.00 1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 2, 950.00 0.50 0. 00 0.50 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 1TRAVDOC FLAT RATE 1.00 42. 00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211.50 0. 00 211.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 211.50 #21889 --------------- TOTAL RECEIPT 211.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22603 woodridge ct. DATE: 04/11/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $2,950 R'PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: I I PERMIT TYPE: WORK replace furnace at oudoor existinq closet. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1 MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn 7 info, FEE ITEMS (Pee Resolution 09-051 E f. 7-1,"IN FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 A Strong-Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 01/15/2011 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: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# 1 r ADDRESS: CITY/ZIPCODE: *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 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a,cupertino.org MISC CUPERTINO ❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS as&0 3 G�4�1 6 -r APN#�� I r T OWNER NAME 60 FONFqo E-MAIL O � S STREET ADDRESS CITY, STATE,ZIP FAX aawo 3 �,aoae�n e C 6wergri"o 960 CONTACT NAME (/ PHONE40 Mq-,d10 EMAIL STREET ADDRESS /J. I-to S7 • CITY,STATE,ZIP O CAIS-5-11d ( /a F job aq 1(_ �a4 7 ❑OWNER ❑ OWNER-BUILDER 1:1 OWNER OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOP`E'R ❑TENANT CONTRCX f, E CLICENSf/"!)D BUS.LIC UV1COMPANY NAME E-MAU, # FA G �9y- pa STREET ADDRESS -1 �. CITY.STATE,ZIP 45,n CA,aS'II a P14 6?9,f►{`W9 o ME ARCHITECT/ENGINEER NALICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ISE OF XSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK n �^n �0`�Io D V � ' n �.GL.OL M1 t J TOTAL VALUATION: a9 SO RECEPIEITBY ' By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the 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 building I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ( ' SUPPLEME L ORMATION REQUIREDAM � - >Jsia asaK r € 3>e+ILFD�IRI �r Y s ! _ 2ERGFI Ok MEPMisc4pp_2011.doc revised 03/16/11