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10070094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1202 RUPPELL PL CONTRACTOR:RMI MECHANICAL PERMIT NO: 10070094 CONTRACTORS 'NER'S NAME: JI GUIJUN 1385 LOWRIE AVE DATE ISSUED:07/13/2010 OWNER'S PHONE: 4085977374 S SAN FRANCISCO,CA 94080 PHONE NO:(650)583-6200 ❑ LICENSED CONTRACTOR'S DECLARATIONI— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C7_0 Lic.# 9-3A I-d G MECH r RESIDENTIAL I- COMMERCIAL F_ Contractor ��V ,PLIC&k'&-1 Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 100K BTU FURNACE&4 TON CONDENSER (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: 1 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:$8290 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 permit is issued. APN Number:36230043.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relatin€ PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. j � —/ ature��• Date / of RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one oinspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 p Health&Safety Code,Sections 25505,25533,and 25534. 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 Owne authorized agent: / Compensation laws of California. If,after making this certificate of exemption,I Date: L become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relatin.; to building construction,and hereby authorize representatives of this city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save _tnnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 1 CITY OF CUPERTINO 5 ITEMS OF 10 PERM-'.T RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B--k: Lot: APN 36230043 .00 DATE ISSUED. . . . . . . : 0'7/13/2010 RECEIPT #. . . . . . . . . B:3000010854 REFERENCE ID # 10070094 SITE ADDRESS . . . . . : 1:202 RUPPELL PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA OWNER . . . . . . . . . . . . . JC GUIJUN ADDRESS . . . . . . . . . . : 1202 RUPPELL PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RONALD J MAFRICI CONTRACTOR RONALD MATRICI LIC # 30650 COMPANY . . . . . . . . . . : RMI MECHANICAL CONTRACTORS ADDRESS 1385 LOWRIE AVE CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080 TELEPHONE ( S50) 583-6200 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 290 . 00 1 . 00 0 .00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0. 00 63 . 00 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 274 . 00 0 .00 274 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 548 .00 VISA --------------- TOTAL RECEIPT 548 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$8,290 µPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex TYPEICATION � USE: ° , xW gg a O O 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES A/C Units (<=10K cfm) 1 B EMAIR 1 $63 Furnace, Forced-Air 1MFR=<100 1 $126 TOTALS: $189.00 Mech.Plan Check 0.0 hr $0.00 ' - Mech.Permit Fee: IMPERMIT 1' Other Mech.Insp. 0.0 1 hrs 1 $42.00 ;),; �; f :. "r _ , , NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-051 F'tf' 7/1/09) FE-E QTY/FEE MISC ITEMS F 71 PME Plan Check: $0.00 F71 PME Unit Fee: $1 E 9.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRA VDOC $2.2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC . 1.00 SUBTOTALS: $2i 4.00 $0.00 TOTAL FEE: $274.00 Revised: 6/30/2010 10 0-7 CITY OF CXPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # � ( � � � � Date: d2 0 Building Address: 2, KAAG� Owner's Name: Phone #: t, W i L4 0 X " 57 q Contractor: Phone #: (,5'O M JIJ��-C/�1-A/j'1 ( G Fax#: 6:5-0 6G-5 ( i Contractor License #: Cupertino Business License #: 31 +tld 3oCP�D Contact: Phone #:05D 5-g3 Fax#: Building Permit Info: Elect�/ Plumb Mech Zesidential Comm rcial ❑ Job Description: For Residential Installations: Attic ❑ 1 S`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 Re uired ❑ Cost of Project: Type of ConEtruction (Usage Class): Strapped ❑ On Platform Bonded [ft' New Location E!t' Replacement Project Size: Express Standard ❑ Large ❑ Major ❑ Valuation: 4 b 1-z-q 0 Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, includc in plan set & the sheet index. Revised 01/07/09