11110003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10552 CEDAR TREE CT CONTRAC'T'OR:SERVICE PERMITNO: 1 1 110003
CHAMPIONS
OWNER'S NAME: WELLER DONALD 7020 COMMERCE DR DA'Z'E ISSUED: 11/01/2011
ER'S PIIONE: 4082539705 PLEASANTON,CA 94588 PHONE NO:(925)4444444
LICENSED CONTRACTOR'S DECLARATION r r r
1�U�(� BUILDING PF.RNI'1'INFO� tl1.UC Er C'1' PLUMB
r
License Class ZD Lic.k "O
({ MEGA RESIDENTIAL COMMERCIAL.
Con[raclo��..{,,.-.C.�V'C-6W1.]- Dale ��' �'(
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: R17PLAC17 FURNACE AND 9 SUPPLY DUC'T'S
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
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 tltis permit is issued. Sq.Ft Floor Area: Valuation:$10123
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:31634025.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and sole 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 YS 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 LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ..
costs,and expenses which may accrue against said City in consequence of the /
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.
rJ� Q„ 1 RE-ROOFS:
Signature 1 �'��V� Date l l l All roofs shall be inspected prior to any roofing material being installed. Ira roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
_O_WNFH-BUILDER DECLARATION
hereby affirm that 1 em exempt from the Contractor's License Law for one of Signature of Applicant: Dale:
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). 1 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 1
perlbrtoance 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 I Ieallh&Safety Code,Sections 25505,255 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this r
pcnni[is issucJ.
Owner or authorized agent: '""— Date: `
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 AGF,NCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is it 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
APPLICANTCERTIFICATION' Lender's Address
1 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
ratifyAliClll'fEC'I^S DI?CLARATION
ratify and keep harmless the City of Cupertino against liabilities,judgments,
,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
CITY OF CUPERTINO
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31634025 . 00
DATE ISSUED. . . . . . . : 11/01/2011
RECEIPT 4 . . . . . . . . . : BS000015202
REFERENCE ID # . . . : 11110003
SITE ADDRESS . . . . . : 10552 CEDAR TREE CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WELLER DONALD
ADDRESS . . . . . . . . . . : 10552 CEDAR TREE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2003
RECEIVED FROM . . . . : !E
CONTRACTOR . . . . . . . : KEVIN COMERFORD LIC # 31833
COMPANY . . . . . . . . . . : SERVICE CHAMPIONS
ADDRESS . . . . . . . . . . : 7020 COMMERCE DR
CITY/STATE/ZIP . . . : PLEASANTON, CA 94588
TELEPHONE . . . . . . . . : (925) 444-4444
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00
1BCBSC VALUATION 10, 123 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 10, 123 . 00 1 . 01 0 .00 1 . 01 0 . 00
1MFR=<100 UNITS 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1MRRAA UNITS 1 . 00 65 . 00 0 . 00 65 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 326 . 01 0 . 00 326 . 01 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 326 . 01 11098
---------------
TOTAL RECEIPT 326 . 01
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
• ADDRESS: 10552 Cedar Tree Ct. DATE: 11101/2011 REVIEWED BY: gs
APN: BP#: I "VALUATION: $10,123
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
Heating System 1MRRAA 1 # $65
TOTALS: $195.00
Meeh.Plan Check 0.0 Ins $0.00 Plumb. Plan Check Elec.Plmr Che,h
Mech.Permit Fee: 1 MPERMIT Plunih. Peumh Feer Etre. Permit Fee:
• Other Mech.Insp. 0.0 hrs $44.00 06iev Plumb lu,.7,- 011ila Eh.'c. 6rsp. El
.We h./ncp. Fee: Plumb, Iny. 1''' Eley.Inep. Fee,
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelindna Information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 ElT 711/11) FEE QTY/FEE MISC ITEMS
flan Check Fee:
Suppl, PC Nen
PME Plan Check: $0.00
Permit Nce
,Supp/. busp F'ee
PME Unit Fee: $195.00
PME Permit Fee: $44.00
Construction 7'az
Administrative Fee: (ADMIN $41.00
Work Without Permit? 0 Yes (j) No $0.00
Aelrnnced Pinrming Nees:
Travel Documentation Fee: ITRA VDOC $44.00
Strove Motion Fee: IBSEISMICR $1,01 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
$gBTOTALs:
$326.011 $0.001, TOTAL FEE: $326.01
Revised: 10101/2011
CITY OF
CITY OF CUPERTINO
0 FURNACE/AC
• CUPERTINO PERMIT APPLICATION FORM
/ll I abD3
APN# O Date:
Building Address:
1 ossz Cedar �u ee C
Owner's Name: p,uvio ;"J 0<i h Phone#:
av tiler- yp$ ZC3- 9-70.s
Contractor: Phone#: q 5 - Nyy- yyyy
swu«e, ek&Mp t61, S
Fax#:
Contractor License#: Cupertino Business License#:
gi-1ot4 0
Contact: Phone#:
Fax#:
Building Permit Info:
Elect❑ Plumb ❑ Mech
Residential DJC Commercial
• Job Description:
Ojae e u�na c� , Repl"-e, a SuWIy R'4-t-s
For Residential Installations:
Attic ❑ I' 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: Type of Construction (Usage Class):
1b, 123. DD
Strapped On Platform Bonded New Location Replacement
Project Size: Express Standard❑ Lare❑ Ma'or❑ 2 #K C o U"k&
Valuation:
10, 1 23'00
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
•
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: L0557, et PERMIT# /
OWNER'S NAME: W l I( L/ PHONE# 4tnS 5 3- T/ 705
_
GENERAL CONTRACTOR: _Wl;tC4, eJN&ijA Pc611 S BUSINESS LICENSE#
ADDRESS: 70Z0 mgt i77 CITY/ZIPCODE: ?W604i ED/L CA Sys
*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. �„N� !
1 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
Owner/Contractor Signature Date