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11120094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10561 CYPRESS CT CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 11120094 OWNER'S NAME: CUMINE HEATHER M 7020 COMMERCE DR DATE ISSUED: 12/16/2011 OWNER'S PHONE: 4082553296 PLEASANTON,CA 94588 PHONE NO:(925)444-4444 is LICENSED CONTRACTOR'S DEC�L�^A�RATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB rl License Class C ZO Lic.p S(� Il/ � [ �� /r MECH r RESIDENTIAL(- COMMERCIAL r Contmcto� h4,6, /W JV Date LkIN-1 1 hereby alarm that 1 am licensed under the provisions of Chapter 9 306 DESCRIPTION:REPLACE 9 SUPPLY,2 RETURN DUCTS (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 Cade,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5793 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 permit is issued. APN Number:31630057.00 Occupancy Type: APPLICANT CERTIFICATION 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 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 Jn with all non-point source regulations per the Cupertino Municipal Cade,Section Issued by- Datp`. ? 9.18. Signature � Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.Ira roof is 1 hereby affirm that I em exempt from the Contractor's License Lew for one of installed without first obtaining an inspection,I agree to remove all new materials for y P inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sale compensation, Signature of Applicant: Date: 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 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. 1 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(x)should 1 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 I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owtt Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions ofthe Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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 slate laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify 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 Dote CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630057.00 DATE ISSUED. . . . . . . : 12/16/2011 RECEIPT #. . . . . . . . . : BS000015583 REFERENCE ID # . . . : 11120094 SITE ADDRESS . . . . . : 10561 CYPRESS CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CUMINE HEATHER M ADDRESS . . . . . . . . . . : 10561 CYPRESS CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2423 RECEIVED FROM . . . . : IE INC 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 5,793 .00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 5,793 .00 0. 58 0. 00 0 .58 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 195.58 0 . 00 195 .58 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 195.58 #12163 --------------- TOTAL RECEIPT 195.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' CUPERTINO (408)777-3228 • FAX(408)777-3333• buildinclCacuoertino.orG sc PLUMBING NECHANICAL ELECTRICAL MISCEIAANEOUS PROJECCADDRESS 16561 . /�C(.� rt'sS `�� #& ' _ (D5-7 OWNERNAME NPA l2t"- Ii U.YVIIY!'[� PHONE E-MAIL 71MEETADDRESS CLTY, SLATE, FAX toss; ss �t a ri✓�o C!� 94i�� CONTACr NAME PHONE E-MAIL STREE7ADDRESS pt CITY,STATE,IIP FAX 13 OWNER 11OWNER-BUEJ3M 13 OWNER AGENT p COMRACrOR ❑CONTRACrORAGFNT ❑ ARCHr= ❑ENGINEER ❑ DEYFIAPER ❑TENANT CONTRACTOR AMB - - LICENSE NUMBER LICENSE TYPE BUS.LIC 0 _ ul�� 1a lDrts $gado X20 COMPANYNAME E-MAIL FAX STREr:TADDRESSsrATE nP nTorE -1020 or &W4--o b! (:paantovL OCA 9"/318Y qts Yyy-YYy`l ARCJDTECT/ENGIRM NAME LICENSE NUMBER IRIS.LIC p COMPANY NAMEE-MAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE USE OF SFV.DUPLEX [IMULTI-FAMMY PROJECT IN WILDLAND ❑ YES PROJECTBI ❑YES JSTHERIDGAN ❑ YES EUODINCL ❑ODMMERCJAL URBAN BITERFACE AREA ❑ NO I FLOOD ZONE ❑No ECHLER HOME] ❑NO DESCRIPTION OF WORK lct.� � sum l a (2etl.Lrns T�uc1-S TOTAL VALUATION: 5 1-I S. 00 REC'ETVED BY: By my signature below,I certify to each of the fallowing: I am the pmpeM GWum or authorized agent to act on the property owner's behalf i have Lead this application and the inI'otmation I have provided is COm L j have mad the Description of Work and verify it is acemate. I agree to cemply with all applicable local ordinances and state laws relating to 1Q�It/n�g connstractiom I authorize representatives of Cupertino to anter the above-identified property far inspection.pu@oses. Signature of Applicant/Agent' Data: 1a-(5-/( SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ar LT-A�FR-TUXCOUNTLR 6 ❑ EXPRESS Y U m ❑ SrANDARO S u ❑ LARGE ❑ MAJOR MPPMwc:App 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10561 cypress ct. DATE: 12/16/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $5,793 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURNIAC USE: PERMIT TYPE: A. WORK re lace 9 supply 2 return ducts. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Heating System 1MRRAA 1 # $65 TOTALS: $65.00 Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Etce.Plan Check Mech.Permit Fee: IMPERMIT I Pivnih,Permit Fire: F,7e. Permh Fir,: Other Mech.Insp. 0.0 hrs $44.00 Otde,-1'7unrh dup, oflur lar:c. brsp. Li Wed.tntp. Fee: Plumb. Imp. Fer; Lsier.Imp. Pee: 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 prelinina Information available and are oniv an estimate. Contact the Dept for addh7Info. FEE ITEMS(Fee Resolution 11-053 Eft 7/1/111 FEE QTY/FEE MISC ITEMS Plan Check Pee: Suppl. PC.Fee PME Plan Check: $0.00 Pcrntit Fere: Supi)l. lisp Fee PME Unit Fee: $65.00 PME Permit Fee: $44.00 Construction Ttr.v: Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes t) No $0.00 A,fi•anced Planning Pees: Travel Documentation Fee: ITRAVDOC $44.00 Strove Motion Fee: IBSEISM/CR $0,58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $195.581 $0.00 TOTAL FEE: f $195.58 Revised: 12/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOBADDRESS: $tit C r�ess Ct PERMIT OWNER'SNAME: Idea}er ('Upv mPHONE # 401 aSS - 3a-9ta GENERAL CONTRACTOR: Sparu-tIUyLS BUSINESS LICENSE# ADDRESS: "IOZ.O OWuv1,G^!.2 Dl- CITY/ZIPCODE: PIa.G.SCWtV✓I 4�I5K8 *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: Chi^rill I l 'l ' Signature Date Please check applicable subcontractors and complete the following information: V 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