10110128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1096 NOVEMBER DR CONTRACTOR:AAA FURNACE& PERMIT NO: 10110128
AIR CONDITIONING
''VNER'S NAME: SHU LEE-LEAN AND HELEN 1712 STONE AVE DATE ISSUED: 11/18/2010
OWNER'S PHONE: 4088073650 SAN JOSE,CA 95125 PHONE NO:(408)2934717
Cy LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class e C 70 Lic.# 7 d
MECH r- RESIDENTIAL COMMERCIAL
Contractor f �(,I r,meq Q,_ Date I — "/ JOB DESCRIPTION:REMOVE AND REPLACE FURNACE IN SAME LOCATION
REWORK FLUE TO CODE
I hereby affirm that 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$2371
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'36217024.00 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 Gity of Cupertino against liabilities,judgments,
costs,and expenses which may"accrue against said City in consequence of thea'
granting of this permit. Ad tionally,the applicant understands and will comply Issued by Date: /r/- _
with all non-point soµfce gulations per the Cupertino Municipal Code,Section
9.18. J
RE-ROOFS:
nature Date 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
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)
1,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)shoul�,store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipme 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 a /Air.Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cu ert�7.
nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cod s 2 50 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this /—/� ;
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1096 November Dr DATE: 11/18/2010 REVIEWED BY: jsg
APN: BP#: `VALUATION: 1$2,371
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex 1 . PENTAMATION
USE: FURN/AC
TYPE:PERMIT
WORK Remove existing furnace and install new one in same location.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: $126.00
Mech.Plan Check 0.0 hrs $0.00 r. .
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 De t or addh 7 info.
FEE ITEMS ('Fee Resolutioli 09-051 Ef T'1;101 FEE QTY/FEE MISC ITEMS
PhIII C:'hc'lk
Supp/. P 1't;
PME Plan Check: $0.00
Per snit I e>r
SuppI. In'sp I`t'e>
PME Unit Fee: $126.00
PME Permit Fee: $42.00
C'01as1rarC1i0n 7ri.r
Work Without Permit? 0 Yes E) No $0.00
t'lcrrrrtirr�r f'c}<'�:
Travel Documentation Fee: ITRAVDOC $42.00
i
Strop},Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE:1,
$211.50
Revised: 11/08/2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: \,' e IZ_ j'' ;?V- PERMIT# (�
OWNER'S NAME: j_e tf PHONE# 40 S
GENERAL CONTRACTOR: ,� ��r',v�"C BUSINESS LICENSE#
ADDRESS: / 7/L /?--u-- CITY/ZIPCODE: S-1 zj—
*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:
t/ 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 k
Til
-/c
Owner tractor Signature Date
CITY OF CUPERTINO
FURNACE/AC l oll D l�8
'a10 F
CUPEkTINO PERMIT APPLICATION FORM
APN # 3�9A -7 Date:
Building Address:
Owner's Name. Phone#:
L SHL< , 3E HCl
Contractor: r t4 61 Phone #:9 - -:?
Fax #: 4L�r) ',7 -7
Contractor License #: 7 L Cupertino Business License#:
Contact: Phone #: zl�:,
Fax #: 9 3— 6
Building Permit Info:
Elect 11 Plumb ❑ Mech
Residential [T Commercial
Job Description:
For Residential Installations:
Attic ❑ I` floor 2nd floor F-1
Adhere tominimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) E]
Structural Calculations required for new installation D
New installation Planning Approval Required I]
Cost of Project: Type of Construction (Usage Class):
c
Strapped On Platform Bonded New Location E] Replacement
Project Size: ExpressE] Standard 0 Large 0 MajorE]
Valuation:
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 01/07/09