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13040024CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: ,10445 ALICIA CT CONTRACTOR: ALLIED AIRE SERVICE PERMIT NO: 13040024 INC OWNER'S NAME: BRETZ KENNETH LAND SANDRA A 470 S HILLVIEW DR DATE ISSUED: 04/03/2013 OWNER'S PHONE: 4089739393 MILPITAS, CA 95035 PHONE NO: (408)934 -8844 -up JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL0 LICENSED CONTRACTOR'S DECLARATION License ClaS 3a Lia #�oCrib REPLACE (E) FURNACE IN GARAGE & (E) A/C UNIT .5 �3 LOCATED IN SIDE YARD Contractor Date -'- 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 perjuryone 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 Sq. Ft Floor Area: Valuation: $5000 performance of the work for which this permit is issued. 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 34245029.00 Occupancy e: p y Typ 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 F CALLED INSPECTI N. indemnify and keep harmless the City. of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 3 granting of this permit. Additionally,: the applicant understands and will comply y: Date: with all non -poin source regulations per the Cupertino Municipal Code, Section 9.18. 3 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) I, 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(x) 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 performance of the work for which th is 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 Health & Safety Code, 5505, d 25534. Section3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 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 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 indemnify and keep harmless the City Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 perthe Cupertino- Municipal Code, Section Licensed Professional 9.18. Signature Date. CUPERTINO APPLICATION /� GENERAL PERMIT � fVl COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION , 10300 TORRE AVENUE • CUPERTI NO, CA 950143255 U (408) 777 -3228 • FAX (408) 777 -3333 • building(- guoertino.org 0 MISC F-1PLUMBTNG F— MECHANICAL RELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS Z'G, ' APN 3 4 Z - l , - / Q OWNER NAME, � S �� t Q �C OP ?- -c - E STREET ADDRESS C STATE; nIO /,y I FAX , 7 CONTACT NAME T us� l p P O I j I27�I (o E-MAIL STREET ADDRESS e f CITY' TE Z S'o 3 S F.4X y,3�88� ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT >4�01111CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA R NAME • � 4V Z� C- LICENSE NUMBER 6 OO.3 LICEIITSE TYPE - o- o C 38 BUS. LIC COMPANY NAME E -MAIL FAX S ETADDRESS /�✓ �TATEsZIP�s J NTE 5 8 ARCHITECTIENGI ATEER NAME ICENSEI\TUNMFR BUS. LIC IiJ COMPANY NAME' E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF or DUPLEX ❑ MULTI- FAMB..Y BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK 2 loor TOTAL VALUATION: �m� RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to In co traction. I authorize represe tives of Cupertino to enter the above -i nti f d propel for inspection puflposes. Signature of ApplicantlAgent: Date: SUP LEMENTAL INFORMATION REQUIRED [��� V � ` L OFFICE USE ONLY k<OVER- THE - COUNTER ❑ EaTRESS U y U ❑ STANDARD ❑ LARGE ❑ AfAJOR 1EPJ&cApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION Mech. Plan Check 0.0 1 hrs $0.00 .Plumb. Plan Check Elec. flan {:;heck Mech. Permit Fee: IMPERMIT Plumb. Permit Pee: Elec. Permit fee: Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec. Insp. ET_L_ Wech. Insp. Fae: Plumb. lisp. Fee: Elec. Insp. f'ee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School FEE ITEMS (Fee Resolution 11 -053 E . 711112) Plan Check Fee: Suppl. PC Fee: (D Reg. ® OT 0.0 hrs PME Plan Check: Permit Fee: Suppl. Insp. Fee.e Reg. ® OT 0 0 hrs PME Unit Fee: PME Permit Fee: Construction Tax: rmation available and are only an estimate. Contact the Dept for addn'1 in FEE QTY/FEE MISC ITEMS $0.00 0 # Mechanical $0.00 $133.00 IMFR = <100 Furnace, Forced $0.00 F 1-1 # Mechanical $0.00 $67.00 1BREAMIR A/C Units ( < =10K cfin) $0.00 $0.00 $45.00 Select a Non - Residential 0 Building or Structure i Select an Administrative Item $333.50 Revised: 04/01/2013 N ' 10445 ALICIA CT DATE: 04/03/2013 REVIEWED BY: MELISSA JimADDRESS: APN: 342 45 029 BP #: *VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: FURN /A WORK REPLACE (E) 'FURNACE IN GARAGE & E A/C UNIT LOCATED IN SIDE YARD SCOPE Mech. Plan Check 0.0 1 hrs $0.00 .Plumb. Plan Check Elec. flan {:;heck Mech. Permit Fee: IMPERMIT Plumb. Permit Pee: Elec. Permit fee: Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec. Insp. ET_L_ Wech. Insp. Fae: Plumb. lisp. Fee: Elec. Insp. f'ee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School FEE ITEMS (Fee Resolution 11 -053 E . 711112) Plan Check Fee: Suppl. PC Fee: (D Reg. ® OT 0.0 hrs PME Plan Check: Permit Fee: Suppl. Insp. Fee.e Reg. ® OT 0 0 hrs PME Unit Fee: PME Permit Fee: Construction Tax: rmation available and are only an estimate. Contact the Dept for addn'1 in FEE QTY/FEE MISC ITEMS $0.00 0 # Mechanical $0.00 $133.00 IMFR = <100 Furnace, Forced $0.00 F 1-1 # Mechanical $0.00 $67.00 1BREAMIR A/C Units ( < =10K cfin) $0.00 $0.00 $45.00 Select a Non - Residential 0 Building or Structure i Select an Administrative Item $333.50 Revised: 04/01/2013 N ' ALLIED AIRE SERVICE HEATING & AIR CONDITIONING COMMUNITY DEVELOPM ENT DEPAR Fi,-i Ni E BUILDING DIVISION - CUPERTINO APPROVE-D This set of plans and specifications MUST be Y 6 job site during construction. It is unlawful tc),M,�3� changes or alterations on same, or to therefrom, without approval from the Building it l The starnping of th Ian and specifications SWsA-1 be he I permit to be an approval of the T,�'; any provisio of any City Ordinance or ESAal:. L'a ' -V1.1 �", ,l, Br CV actm� ViaA01 P, "- sc \-\ GC)M? PERMIT NO. DID S 041e\0 &lLAl e-?- hawse /V onz -101<rr JILM - Cart 0C A ex 14/6 'ICA 147 7/- 470 S. Hillview Drive, Milpitas, CA 95035 - Lic. #260035 - Ph: 408.934,8844 - Fax: 408.934.8840 3 1;3 �� l V) p ) L Serving Northern California Since 1968