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13100113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10670 MERRIMAN RD CONTRACTOR:SERVICE CHAMPIONS. PERMIT NO:13100113 OWNER'S NAME: RAGHURAMA BRAT 7020 COMMERCE DR DATE ISSUED:10/16/2013 OWNER'S PHONE: 4085170980.. PLEASANTON,CA 94588 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class 2a Lic.# b-77 Q 40 REPLACE(E)FURNACE,SAME LOCATION Contractor&t ULA l 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 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:$4065 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:34216140.00 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 relating WITHIN 180 DAY IT 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 DAY LA ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in of the sued by Date• l0/6 / 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. ��! RE-ROOFS: Signatur . Date �j [ 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 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended of 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(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, 533,and 25534. 1`0/^ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: GV 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 C ON GENERAL I� � � \` M EP _ CpAI�ftB�f I`II��11fli�i�IT D��F€t�+�-BL1I�.�II�t��3iVESIC}�t �� - 1 Gt.lPT'iNO,Cmc£3'^.€ii-s-�2�T �\ m CUPSR'i'tN0 (4W=-3= FAX(�)M-,3 33-buB PIS3M8Il�TC t; t^GreA73t'eY OmFcTCAL isc QbIISC�L IIS �a hu roma �a.fi wog 5t��v�gv , AML SMEEr"'1DVX) Wl�e-{ttY✓►ov�t 1 �'MAZe&tto gsct� CONrACr NAMES �VAIL sr$�e �srnL,� rAX DowtmL 04 IIumw courmcm i II o eamom E3 nommpm a CCWA14YXA3dE BMAiL - FAX 4ZD f 'DF Ra sand )VA wv� CdBdPANYNAb--- SKAMMAX STB A17DEr3S Cny.STA== Um OF SIIs�T II tAIS.taaarY rsvt Q� !{t �U^r� �s:* azs Q r7CM8EMCrAL SIL1'OR'dT-'AE S 13 NO 7 Li. o � 13M 1 �� - 2CMALVALURIEM gVWS►V Bymy ig daw:ies fY�adic €ams I=xL t g=-Otgm n=arzr-Lmadm-qZimaacm doLAWMEihasc �Ca4aasar£d�ci�nis��s�htbeE3rs�ar"FTa�c�-��=r�s��,-•,� FeT��?wi�zL�ei�:l rf aadziawsrd ii rcrrs �'.•,.�s:n„ U/ IOC Sigmat—ofAgp&=dAq=L- 2 Dam= s��'�tL PaKWMAIMN REQUBLEM o ca t�cn t CVER-T o 0 �r�rasAau _ u - 0 Laxes MAMA 3Ep.& r,t 0IZ.doc revered 0612I/Ii CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10670 MERRIMAN RD DATE: 10/16/2013 REVIEWED BY: MELISSA APN: 34216140 BP#: "VALUATION: $4,065 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTA.MATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK REPLACE E FURNACE SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 $139 00 TOTALS: _ - , - Mech.Plan Check 0.0 lirs $0.00 Phimb. Plan(_'heck Floc.Plan(;hack Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: t_lec. Permit Fee: Foiln,sp. Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Ek_,c.Insp. Fee: Plumb. hrsp. Fee: Elec.Insp.fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are onl an estimate. Contact the Dept for addn'1 info, FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Sul�pl. Insp Fee PME Unit Fee: $139.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131da Std s Commission Fee: IBCBSC $1.00 �� $278.50 $0.00 $278.50 Revised: 10/01/2013 Csmate zona isisis q Pe. -V-mr.4ddFM= 10-1b-15 Dea ( � ,msscop- in Tc 113 0-R--jsud3c-1 € ��pcAekliv � 3r?zc-W.:as Vim e v cs4m 5; #ms s �3Cr ix 2ba ant=9& pupa -- l-Mf� of IIe CF-IR Rod IF-iR sha Elm be an Me kr ISI unpacdox. 3_HVAC CkamMeent RequhvdFwmw a sa dw= fia amd or C`-€1$3T= x.++-21 1 $sr-I��rn VR s 3 Cod3sdjcr :7-IR'u -71 jad l IEV----25 rqma= 7�r�i�'-e�ei-er=r.3 F ".^=a-= 1 4-A F G g RC _ E Dud I_� �10 wd �T d Farm= j?NE's FAC- 1' 3y �-�k-c-��a' .WE �}ta u_- �- fait 3 CF-4& ffi�-.his X mdtbr 3F.e ww cqs4mmdBSWFwSW4rWD7i < 3s - - For PtekWd U I Ducts Wilk Raqukzd Forms: mall IF— NECF�r2awICrur ��= spa.— coomdbr �"r' _ Fore_ w mqmtcbgnuw--It=48 frd tst' I� dohimubc&ge Awfiabes # r c5sm -- � _ ; slwda4Sie€ �iie - ai:asaad - - �c40.04E BROOKS - PE-PNICE CFAAWKWS 07-0 COMMetc e P �? q.. t -lao-lan tort ��F � I-