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10120136 ,C1TY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10430 GLENVIEW AVE CONTRACTOR:PELLE HEATING&AC PERMIT NO: 10120136 INC OWNER'S NAME: DANIEL YU 3728 C CHARTER PARK DR DATE ISSUED: 12/20/2010 OWNER'S PHONE: 4085122006 SAN JOSE,CA 95136 PHONE NO:(408)978-7060 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class e"011 Lic.##�i�09� REPLACE 60,000 BTU FURNACE ADD 3 TON AC Contract /�' /�`*`��ate" I hereby affirm Ot 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:$6826 1 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:36911019.00 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 DAY OM LAST CALLED INSPE TIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 2 /J • granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: ��+ with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ROOFS: Signature .!l/1 to All roofs shall be inspected prior to anyny 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). I 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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent ate 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 CONSTRUCTION LENDING AGENCY 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 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: ////W `/�� PERMIT# ,� 201-3 65) OWNER'S NAME: die PHONE GENERAL CONTRACTOR: �PclTji! �ie BUSINESS LICENSE# 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: 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 Date ner/Contra Signature CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10430 glenview ave. DATE: 12/20/2010 REVIEWED BY: bobs. APN: BP#: `VALUATION: 1$6,826 R;:PERMITTYPE: Mechanical Permit I PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY TO _I1, PENTAMATION FURN/AC USE: SFD or Duplex f�,,,' �, PERMIT TYPE: i WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: I MPERMIT - - Other Mech.Insp. 0.0 hrs L$42.00 Ll NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept-for addh I info. FEE ITEMS (Fee Resolution 09-051 E . T ,40) FEE QTY/FEE MISC ITEMS P/on Chc°<:h FCC" C .err,p/} PC PME Plan Check: $0.00 Srpp/. Jmlp FC PME Unit Fee: $189.00 PME Permit Fee: $42.00 t`ou'lrrrc rif it TUA Work Without Permit? © Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.68 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.68 $0.00 TOTAL FEE-.T $274.68 Revised: 12/07/2010 3c:0 (-rl✓ A-vQ--) CITY OF CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM ``,, ! v APN Date: Building Acidres : If residential,is house an Eichler? Yes ❑ No If yes, needs planning approval. OwTa,vt s Name: Phone#: I CA tc) • �to o�t✓OLO LPhone#: 'kO8 .1kr Fax#: Contractor License#: Cupertino Business License#: Contact: IPhone#: `-toS --n s —'(ffNJC"' V G( [ Fax/e-mail: ' OS -9"7'9,4 7Sb Building Permit Info: Elect Plumb Mech Residential 79, Commercial ❑ Job Description: CIC)0 For Residential Installations: G4e2%i�1 Attic F-1 1St 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: o1CP 02- Type of Construction (Usage Class): Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑ Project Size: Counter ❑ Express ❑ Standard Large ❑ Major ❑ Valuation: (n C-D- 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 12/06/10