The URL can be used to link to this page

13110030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21185 LAURETTA DR CONTRACTOR:CONDITIONED AIR PERMIT NO: 13110030 OWNER'S NAME: MCKEE LLOYD S AND KU YING-WEN 1701 LITTLE ORCHARD ST DATE ISSUED: 11/05/2013 OWNER'S PHONE: 4083187642 SAN JOSE,CA 95125 PHONE NO:(408)291-2220 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL !r 1L� REPLACE ALL(E)DUCTWORK FOR(E)HVAC SYSTEM License Clas Lic.# \ Contract \� Date l I hereby affirm that I am licensed under the provisions of Ch pter 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 Valuation:$3000 p,rformance of Tthe work for which this permit is issued. Sq.Ft Floor Area: 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:32655019.00 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 ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned erty for inspection purposes. (We)agree to save 180 DAYS F LAS ED INSPECTION. indemnify,and keep harmle tlk City of Cupertino against liabilities,judgments, costs, pen hich m accrue against said City in consequence of the Issu Date: 3 gran' g of this permit. ddit nal the applicant understands d 'll comply with all non-point sour regal tions er the Cupertino Mu Co ,Section 9.18: 1 RE-ROOFS: Signature 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to 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)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 define¢ ay a Air Quality Management istr'ct I performance of the work for which this permit is issued. will maintain complianc ith the aper n Municipal Code,Chapte 9.12 rt 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S do 25515, 5 ,and 25534. \ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY 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 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.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 . V GENERAL PERMIT APPLICATION O� MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO,CA 950143255 \\ (408) 778 777-3228 • FAX(408)7 -3333• building(acupertino.org misc CUPERTINO \ PLUMBING MECHANICAL ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS JAA f OWNER N CA CITY,STATE,ZTP FAX STREETADDRESS t�S PHONE E-MAIL CONTACT NAME CITY,STATE,ZIP FAX STREETADDRESS ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENr CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHrTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT LICENSE NUMBERL J y�j�- LICENSEE'J p�� BUS.LIC it CONTRACTOR N A) - \f r' [} COMPANY "�w�� 1\ E MA11 FA CITY,STATE ZIP PHOII�') STREET ADDRESS W/ I�1 LICENSE NUMBS BUS.LIC# pRCHITECT/FNGINEERNRME E-MAIL FAX COMPANY NAME' CITY,STATE,ZIP PHONE $TREE!'ADDRESS ROJECT IN [3 YEs IS THE BLDG AN YES USE OF ❑SFD arDUPLFX ❑ MULTI-FAMII Y DURBAN tIERFACEAREA ❑ NOYZS ROJECT IN WILDL4,ND 1:1 YES- PLOO ZONE ❑NO EICHLER HOME? ❑NO BUILDING: ❑Comm DESCRIPTION OF WORK - *� I 1v r B TOTAL VALUATION: I am the owner or authorized agent to act on th prop 's behalf I have read this By my Signa ow,I certfy-ttreach of the following prop�Y application and rtformation I have p3evided is correct, have read the Description of Work and mrify it acc te. I e to comply with all applicable pl�l asesal ordinances and aws ting to consGvc thorize representatives of Cupertino to enter the ov -identi d erty for Inspectionpurr Date: Signature of App2canttAgentf SLTPPLEMENTAL IIN URMA71ON REQUIRED OFFICE USE ONLY m OVER-TBE-COUNTER c ❑ EXPRESS Y U �_ ❑ STANDARD T V < ❑ LARGE a ❑ MAJOR MEPMrscApp 201 Ldoc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21185 LAURETTA DR DATE: 11/05/2013 REVIEWED BY: MELISSA APN: 326 55 019 BP#: `VALUATION: 1$3,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION 1RMAP1 USE: SFD or Duplex PERMIT TYPE: WORK REPLACE ALL E DUCTWORK FOR HVAC SYSTEM SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1BAPPLOT 1 # $70 TOTALS: $70.00 ------ Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT �'rrrh, C'o m,II F,v F,7r c- F'zrrtit h�e Other Mech.Insp. 1 0.0 hrs $47.00 Onccr 1""mrh In, Ll 0,rh�.,kiCt Cis,), NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District eta). These fees are based on the prelinddna information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(. 7%1/13) FEE QTY/FEE MISC ITEMS Plan Chcek f`ec: S'uppl. PC Fee PME Plan Check: $0.00 Pcrinit Fee: suppl. Insp FIT PME Unit Fee: $70.00 PME Permit Fee: $47.00 C'anstr-uctiMn Tcrc: Administrative Fee: IADMIN $44.00 Work Without Permit? © Yes Q No $0.00 ,��lvanced Planning,Fees: Travel Documentation Fee: ITRAVDOC $47.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee. IBCBSC $1.00 SUBTOTALS: $209.50 $0.00 TOTAL FEE: $209.50 Revised: 10/01/2013