10100150 CITY OF CUPER'CINO BUILDING PERMIT
BUILDING ADDRESS: 10311 N BLANEY AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 10100150
OWNER'S NAME: RAJ MAISURIA 7020 COMMERCE DR DATE ISSUED: 10/20/2010
VNER'S PHONE: 6507044454 PLEASANTON,CA 94588 PHONE NO:(925)4444444
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# U 7 0 REPLACE FURNACE/AC SPLIT SYSTEM
Contractor Sp(t)+Cs2 C:N&f1 m�l d� S Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Profession.,
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarati,)ns:
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. Sq.Ft Floor Area: Valuation:$7217
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:31633008.00 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 rehiting WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enti r
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgment;,
costs,and expenses which may accrue against said City in consequence of the Q
granting of this permit. Additionally,the applicant understands and will compl" Issued by: Date: �y V
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 0-70-10 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.
V OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for o ie 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 compens,tion,
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 contractor;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(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 I
performance 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 Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thiE • Iv-ZO l L
permit is issued. Owner or authorized agen Date:
I certify that in the performance of the work for which this permit is issued,I sf all
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 rel sting
to building construction,and hereby authorize representatives of this city to ent sr
upon the above mentioned property for inspection purposes.(We)agree to save
•mnify and keep harmless the City of Cupertino against liabilities,judgmen s, ARCHITECT'S DECLARATION
,,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 compl,
with all non-point source regulations per the Cupertino Municipal Code,Sectio 1 Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10311 N. Blaney DATE: 10/20/2010 REVIEWED BY: jsg
APN: BP#: *VALUATION: $7,217
;��PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: 1(>�_ ;i1 PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 # $63
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: $189.00
_77 Mech.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. 0.0 hrs $42.00 (Wry ._�_ , ` =r
t l cJ-, _
NOTE: Thesefees are based on the preliminary in ormativn available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-05I Eff. 7/1%10) FEE QTY/FEE MISC ITEMS
Plail
suppf. PC['ce'
PME Plan Check: $0.00
M"v—trlit Fcc,.
supp/. In p F'' '
PME Unit Fee: $189.00
PME Permit Fee: 542.00
('otz iniciion Tax
lc;'ouslicul Rc iliciv Fec.
Work Without Permit? 0 Yes E) No $0.00
Ill(.Ztvli 7<' V ('si'
Travel Documentation Fee: 1 TRA VDOC $42.00
Strom;Motion Fee: 1BSEISMICR $0.72 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00 ��
SUBTOTALS: $:?74.72 $0.00 TOTAL FEE: $274.72
Revised: 10/17/2010
CITY ClF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Falk: Lot:
APN . . . . . . . . : _ 1633008 . 00
DATE ISSUED. . . . . . . : =.0/20/2010
RECEIPT #. . . . . . . . . : DS000011795
REFERENCE ID # . . . . :.0100150
SITE ADDRESS . . . . . . :.0311 N BLANEY AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RAJ MAISURIA
ADDRESS :.0311 N BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2331
RECEIVED FROM . . . . . E INC
CONTRACTOR KEVIN COMERFORD LIC # 31833
COMPANY :SERVICE CHAMPIONS
ADDRESS '7020 COMMERCE DR
CITY/STATE/ZIP . . . : ]?LEASANTON, CA 94588
TELEPHONE 1925) 444-4444
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 7, 217 .00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 7, 217 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1MFR=<100 UNITS 1 . 00 126 . 00 0 .00 126 . 00 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 274 . 80 0 . 00 274 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- -------------- - --------------------
CHECK 274 . 8 ) 5203
-------------- -
TOTAL RECEIPT 274 . 8)
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Jul] Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ S"UBCONTRACTOR LIST
JOB ADDRESS: 031) 11ot+lk Na ne PERMIT# l
OWNER'S NAME: u' " 5(A/-/& PHONE # (0y0
S
GENERAL CONTRACTOR: (60 "D BUSINESS LICENSE #
ADDRESS: 7C�06Q Mnt e✓c e. a V CITY/ZIPCODE: basaVktrJH
*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�-� fV v
I 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
CITY OF
CITY OF CUPERTINO
FURNACE/AC
C U P E RT I N O PERMIT APPLICATION FORM
APN# �' j j •Jj1�� Date: 1 __zo -to
Building Address:
Sri orfs ala
Owner's Name: Phone#:
VL,CtA fol vt! LA-r t C(r (g So 7D Ll - Ll y S q
Contractor: !�ZT U 1-( L IA-N /Ovv . Phone#:
(� '6�-6 Fax#:
Contractor License#: Cupertino Business License#:
68 17 0'-(0
Contact: Phone#•�
Fax#:
Building Permit Info:
Elect❑ Plumb ❑ Mech In
Residential Commercial
Job Description:
PW16_&-J, FV[A - Ale— f y to
For Residential Installations:
Attic ❑ 1,floor ] 2"d floor El
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 RequiredEl
Cost of Project: Type of Construction(Usage Class):
Strapped On Platform Bonded New Location Replacement
Project Size: Ex ress ❑ Standard ❑ Lar e❑ Major❑
Valuation: •1 a l -1, C)0
Green Building: Please complete relevant portion of the Green Building Checklist&attach it to the
application or if applicable,hiclude in plan set&the sheet index.
Revised 01/07/09