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11040118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10445 ALICIA CT I CONTRACTOR: SERVICE CHAMPIONS I PERMIT NO: 11040118 OWNER'S NAME: BRETZ KENNETH L AND SANDRA A 1 7020 COMMERCE DR I DATE ISSUED: 04/18/2011 I (" "NTER'S PHONE: 4089739393 �L LICENSED CONTRACTOR'S DECLARATION g License Class � ZJ Lic. # � -7 U Lib / Contractor U tt-e /r C� t`j y1Wj p (( 5 Date `` � E f ~ 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 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 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 permit is issued. 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 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ` Q % Signature Z Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 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. 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 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 of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply wnn all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date PLEASANTON, CA 94588 PHONE NO: (925) 444 -4444 BUILDING PERMIT INFO: BLDG ELECT f— PLUMB MECH RESIDENTIAL f— COMMERCIAL f— JOB DESCRIPTION: REPLACE 6 SUPPLY DUCTS Sq. Ft Floor Area: I Valuation: $4050 APN Number: 34245029.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ow ! h rig ze gen�y��/ CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34245029.00 DATE ISSUED.......: 04/18/2011 RECEIPT #... •. BS000013212 REFERENCE ID # ...: 11040118 SITE ADDRESS .....: 10445 ALICIA CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: BRETZ KENNETH L AND SANDRA A ADDRESS ..........: 10445 ALICIA CT CITY /STATE /ZIP ...: CUPERTINO, CA 95014 -2634 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... IE INC KEVIN COMERFORD LIC # 31833 SERVICE CHAMPIONS 7020 COMMERCE DR PLEASANTON, CA 94588 (925) 444 -4444 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---- - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- lADMIN ------- - - - - HOURS -- ---- - - - - -- 0.50 ---- - - - - -- 39.00 ---- - - - - -- 0.00 39.00 0.00 1BCBSC VALUATION 4,050.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 4,050.00 0.50 0.00 0.50 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MRRAA UNITS 1.00 63.00 0.00 63.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - - - -- 187.50 ---- - - - - -- 0.00 187.50 0.00 METHOD OF PAYMENT --------------- -- CHECK TOTAL RECEIPT : AMOUNT --------------- 187.50 --------------- 187.50 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER --------------- - - - -- #8184 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 507 FINAL PLUMBING CITY OF CUPERTINO 117117 U CTII-M A TnR — RITlT .DING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10445 alicia ct. DATE: 04/18/2011 REVIEWED BY: bobs. UNITS APN: BP #: 'VALUATION: 1$4,050 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p $63 PENTAMATION FURN /AC PERMIT TYPE: USE: WORK replace 6 supply duct over 40 ft in length-. PME Unit Fee: $63.00 SCOPE $42.00 APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Heating System 1 MRRAA 1 # $63 PME Unit Fee: $63.00 PME Permit Fee: $42.00 Work Without Permit? Yes No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $63.00 Strom Motion Fee: IBSEISMICR Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 hrs $42.00 "_ ----- _ --- !'nrrinrf 1%f0 nOnt %1 O/1/1l2'1 info. FEE ITEMS (Fee Resolution 09 -051 E ff 7.4,10) FEE QTY/FEE - - -- MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 Work Without Permit? Yes No $0.00 A Travel Documentation Fee: ITRAVDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 LL5 J hrs Admin. /Clerical Fee $39.00 1ADMIN Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $148.50 $39.00 TOTAL FEE: $187.50 Revised: U1/1b/ZU1I CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: �y_ A 1L1 Gl PERMIT # L-( OWNER'S NAME: j3 ztZ CA PHONE # U 1 T5 GENERAL CONTRACTOR: « u S BUSINESS LICENSE # ADDRESS: - q C "i&ot 4U e— CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of uupertino ausmess 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: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building 0cuoertino.orn 011e MEP F-1 vI I mmrnrr, IS6 MECHANICAL n ELECTRICAL ❑ MISCELLANEOUS MISC PROIECTADDRESS 14q '5 ,A OWNER NAME 6 7 3—q3 Cj 3 E MAIL STREET ADDRESS )G yy S /41 r C r c L / CITY. Sf 1�ZIP lj CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ AROCIECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �) j v / /� S V "V W ` ! LICENSE NUMBER (3 „ �J (1 LICENSE?, � (� BUS. LIC k COMPANY NAME E -MAIL FAX MEET ADD" /�� t CIT'!. STATF�ZIP J o s �� i i Pi�o p �� ! - 3 / ARCHISECT/FNGINEER NAN(E LICENSE NUMBER BUS. LIC A COMPANY NAME E -NJAIL FAX STREET ADDRESS CITY. STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi- Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes 1W`NO PROJECT IN FLOOD ZONE ❑ Yes No DESCRIPTION OF WORK C� s� 4 CIS TOTAL VALUATION: q RECEIVEITBY 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 building construction. I rize representatives of Cupertino to enter the above-identified property for inspection purposes. S i gnature of Appl icant/Agent: V k�` Date: SUPPLEMENTAL INFORMATION REQUIRED _QffiE SUSS O1V7a� � �_: r MEPMiscApp_2011.doc revised 03116111