13050139CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10315 STONYDALE DR
CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 13050139
OWNER'S NAME: SLAYTER CRAIG K AND LORI L
7020 COMMERCE DR
DATE ISSUED: 05/20/2013
OWNER'S PHONE: 4088572728
PLEASANTON, CA 94588
PHONE NO: (925) 444-4444
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIP'T'ION: RESIDENTIAL ❑ COMMERCIALD
C Z f7 Lic. #: S 1—?0(40
REMOVE AND REPLACE FURNACE AND A/C & COIL
License Class
SPLIT
yy
Contractor SerL?v-,P, A" ),$ Date S��-1 ",
SYSTEM
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.
Sq. Ft Floor Area:
Valuation: $20353
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32637013.00
Occupancy Type:
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
PERMITZfXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and.countyordinances and state laws relating
WIZ. 1 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 D OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in consequence of thei3
costs, and expenses which may accrue against said
Issued by: Date:
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.
�20� 3
RE -ROOFS:
being installed. If a roof is
Signature Date
All roofs shall be inspected prior to any roofing material
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDEKDECLARATION
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 (See. 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(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
perforriance 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, Sec io s 25505, 2553 and 2,555534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen"V Wv Date:
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
CONSTRUCTION LENDING AGENCY
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
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
GENERAL PERMIT APPUCAT1ON (�
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ADDRESS: 103.15 stonydale
DATE: 05/20/2013
REVIEWED BY: Mendez.
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APN:
BP#:
*VALUATION:
1$20,353
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex .
PME Permit Fee:
PENTAMATION FURN/AC
USE:
PERMIT TYPE: A
WORK
remove and re `lace furnace and a/c & coil split sstem
Advanced Planning Fee_
Travel Documentation Fee: ITRAVDOC
SCOPE
Bldg_ Stds Commission Fee: IBCBSC
Mech. Plan Check 0.0 1 hrs $0.00 Plumb, Plan Check Flee. Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec. Permit Fee:
Other Mech. Insp. Fo.0 hrs L$45.00 Other Plumb Insp.E17L__ Other Elec. Insp. .
Alfech. Insp: Tee: PTurrtb. IrtsTt. Fee: Elee. Insp. Fee.
NOTE: This estimate does not.includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
rmadon available and are only an estimate Contact the wept jor aaan [info.
FEE QTY/FEE I MISC ITEMS
$0.00 F-7-1 # Mechanical
$0.00 $133.00 1MFR=<100 Furnace, Forced -Air
$0.00 F 71 # Mechanical
$0.00 $67.00 IBREAmm A/C Units (<=10K cfm)
$0.00
$0.00
$45.00
$42.00
$0.00
$0.00
$45.00
$2.04
$1.00
$135.041 $200.00
G
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Building or Structure
Select an Administrative Item
W-01 � = 1 $335.04
Revised: 04/29/2013
FEE ITEMS (Fee Resolution 11-053-E . 711/12)
Plan Check Fee:
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
PME Plan Check:
Permit Fee:
Suppl. Insp. Fee:Q Reg. 0 OT
0,0
hrs
PME Unit Fee:
PME Permit Fee:
Consiniction Tax:
Administrative Fee: 1ADMIN
Work Without Permit? 0 Yes. (E) No
Advanced Planning Fee_
Travel Documentation Fee: ITRAVDOC
Strong Motion Fee: IBSEISMICR
Bldg_ Stds Commission Fee: IBCBSC
rmadon available and are only an estimate Contact the wept jor aaan [info.
FEE QTY/FEE I MISC ITEMS
$0.00 F-7-1 # Mechanical
$0.00 $133.00 1MFR=<100 Furnace, Forced -Air
$0.00 F 71 # Mechanical
$0.00 $67.00 IBREAmm A/C Units (<=10K cfm)
$0.00
$0.00
$45.00
$42.00
$0.00
$0.00
$45.00
$2.04
$1.00
$135.041 $200.00
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W-01 � = 1 $335.04
Revised: 04/29/2013
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