The URL can be used to link to this page

10070091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22422 BALUSTROL CT COT TRACTOR:SERVICE CHAMPIONS PERMIT NO: 10070091 OWNER'S NAME: NELSON LEROY AND GAYL M 7020 COMMERCE DR DATE ISSUED:07/13/2010 lER'S PHONE: 4082535706 PLE ILSANTON,CA 94588 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATION r ? �i / BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class � '� Lic.# U ��'q�/) / MECH I- RESIDENTIAL F COMMERCIAL Contractor Via/(j�� L lti i�((il�i(�(f Date 1-/3 /0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE FURNACE&A/C SPLIT SYSTEM (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. Sq.I t Floor Area: Valuation:$9010 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. APN Number:35603018.00 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, ]_g0 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 with all non-point source regulations per the Cupertino Municipal Code,Section Issui.-d by ��— Date:-? 9.18. /� / Signatureli(,f.>(/�A Date RE-ROOFS: v OWNER-BUILDER DECLARATION All rc ofs 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspe-tion. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Sigm ture of Applicant: Date: 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 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 Calif)rnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the com f liance 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(a)should I 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 contf minants 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 Heals h&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Own,-r or an __7 Compensation laws of California. If,after making this certificate of exemption,I V Date: 7 if 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. CONSTRUCTION LENDING AGENCY I here by affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for w rich 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 state 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 -mify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gianting of this permit.Additionally,the applicant understands and will comply I und-:rstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licer sed Professional Signature Date p V CITY OF CU:?ERTINO 5 ITEMS OF 5 PERMIT R];CEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: hot: APN . . . . . . . . : 35603018 .00 DATE ISSUED. . . . . . . : 07/13,2010 RECEIPT #. . . . . . . . . : BS000010852 REFERENCE ID # . . . : 10070091 SITE ADDRESS . . . . . : 22422 BALUSTROL CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPER"INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NELSON LEROY AND GAYL M ADDRESS . . . . . . . . . . : 22422 BALUSTROL CT CITY/STATE/ZIP . . . : CUPER-INO CA, CA 95014-3948 RECEIVED FROM . . . . : IE INC CONTRACTOR . . . . . . . : KEVIN COMERFORD LIC # 31833 COMPANY . . . . . . . . . . : SERVICE CHAMPIONS ADDRESS . . . . . . . . . . : 7020 COMMERCE DR CITY/STATE/ZIP . . . : PLEASliNTON, CA 94588 TELEPHONE . . . . . . . . : (925) 444-4444 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 9, 010. 00 1 . 00 0 .00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 0 . 00 1MFR=<100 UNITS 1 . 00 :.26 . 00 0 . 00 126. 00 0 .00 1MPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT x;74 . 00 0 . 00 274 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 274 . 00 #-': 891 --------------- TOTAL RECEIPT 274 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CU PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: HATE: REVIEWED BY: APN: BP#: 'EVALUATION: $9,010 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex APPLICATION 1 R3SFDADD/REM USE: i, TYPE: � w as 3U APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES A/C Units (<=10K cfm) 113REMAII2 1 $63 Furnace, Forced-Air 1MFR=<1(0 1 $126 TOTALS: F $189.00 Mech.Plan Check FTI hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 1 hrs $42.00 _ �:. T-1 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 F/f 7;'J.,09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRAVD0C $42.00 I"i " " I I Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.00 $0.00 TOTAL FEE: $274.00 Revised: 6/30/2010 CITY OF /007 0./ 9 / CITY OF CUPERTINO FURNA(;E/AC C U P E RT I N O PERMIT APPLICATION FORM APN# / `l p, 0 /9/ Date: Building Address: 2? z� fIu �fl t Owner's Name: Phone#: 416)S Z S 3-5 76 tm Contractor: �^��E L Q dt Q v�.t�iG'�t s Phone#: ` -7 S q`/q-qggLl CZ �� QySS Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: Fax#: Building Permit Info: Elect 19-- Plumb Qi- Mech Residential Commercial Job Description: For Residential Installations: Attic ❑ 0 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 Constniction(Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express ❑ Standard❑ Large❑ vla'or❑ Valuation: q010 , 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