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13100213CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19190 TILSON AVE CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 13100213 OWNER'S NAME: PATRICK MORENO 7020 COMMERCE DR DATE ISSUED: 10/31/2013 OWNER'S PHONE: 4085254769 PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Clas{{sL ZV Lic. # j 70 y 0 REPLACE 8 (E) SUPPLY DUCTS & 1 RETURN Contractor .7U « fi (A, b� f Z9 l S Date 10 - r— l 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: $5590 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37540062.00 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 PERMIT EXPIRES IF WO NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 X�S�I IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAI OS INSPECTION. 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 Date: b 3 granting of this permit. Additionally, the applicant understands and will comp) with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �O �� RE -ROOFS: If is Signature Date �. All roofs shall be inspected prior to any roofing material being installed. a roof 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 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 (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, Sectio s 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 10 y '13 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 GENERAL PEPS U "PUCATION ��MEP 5o&ff-dUNFTY DEY�DEP-13LEDNG DMSION DV 10300 TOPURE VENUE - Ct3PS:FIINO, CA 9x35 =-3 misc�j�O 008) 7T7-3228 r� 228 - FAX (A8) -3333 • bc:�na�_am, ` J CUPERi'INO � Mmtnr.�rzrr_ 7 MhA- rrTAWMAT ! Ir3-Fr-MC4L MMSMIAT EOUS 3�P3sscf zor l.doc, es+sed 06n_I/I f AAFN - i fG . p6 Z OVINER �,r, ��r14, �U1 �� ✓� r� � - �t7�, �� B44A SCSE'c'TADDRESS -� `� alv�?sru 'vt-C� � � V / � FAx CONTACT ?(AM--- G✓/V _ PHS wrz SIBS- Al RPM (Z.M. SPAT=, TMM iA7G ❑ owma n awtimzma a AtirNi MI Mi AC= ❑ .. o � a 13 13 cu�t � �� i -70 `ICS � (' 7 r� CCWANYNAbO EM. i FAX c 9 NAME fE RMTIC 4 CQb4PANY NA3G"+ FAX STS AIDE M C.TIY, STATE, m? FECRIE aF IRSM=DUPEMC Q mmx.-eAaw--f ; xsr, 3ta_�ts a Y= tomAN wr-ERFAC AM PROM=r,-.x n TM R 140 TMAN a ya � �: ❑ No rftrrr rrnar 0CMALatmAL aEsc7mwrmNGr-wcam lay ce �� . , � !�� c f� r�,,.f �l l ��;�-c�-✓� =,AL VALUwicUDF: � � DO tl- - �esckof out rrsd d dx is I have is �,-- N ..xexd ate - �_ ++^r ai �i = J s ='�'�r= IrsfF wilt aLt zsalicztiie lo��i agpficmd. ami =oviexd a[saudsulebflvst�ta �� &Vmft= of SPS R4—VOnfATIO�T &EQU F ofnnm � any o U 0 SLAaII u < ❑ IAAG£ 3�P3sscf zor l.doc, es+sed 06n_I/I f CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 19190 TILSON AVE DATE: 10/31/2013 REVIEWED BY: MELISSA UNITS APN: 375 40 062 BP#: *VALUATION: 1$5,590 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p $24 PENTAMATION 1 RMAP8 PERMIT TYPE: USE: Supp/. lnsp FiA, WORK REPLACE 8 E SUPPLY DUCTS & 1 RETURN PME Unit Fee: $24.00 SCOPE $47.00 APPLIANCE / EQUIP TYPE FEE ID Ph,?W, QTY UNITS BP FEES Pt, rig l��e Ventilation Fan 1BREMVENF Onc�>, Gr��c_ My,Ilc'ti2. 1 # $24 Peanut Fee: Supp/. lnsp FiA, PME Unit Fee: $24.00 PME Permit Fee: $47.00 C'nn,�t1-ncirorz l cra: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: 1TRAvDOC $24.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, SamtarySewer District, School bd fl.elimina in ormation available and are onl an estimate Contact the Dept or addn'1 info. District, etc . These ees are ase on e r FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) Mech. Plan Check 0.0 hrs $0.00 Ph,?W, MISC ITEMS Mech. Permit Fee: IMPERMITfr,=n. Pc;,n,ir P� c- Pt, rig l��e Other Mech. Insp. 0.0 hrs $47.00 Orh�, T'Ir mi, h""t� Onc�>, Gr��c_ My,Ilc'ti2. In u. 1.c: 1''?urrrl�. lisp. 1'cc, 1"VO, bnfp, Pcc: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, SamtarySewer District, School bd fl.elimina in ormation available and are onl an estimate Contact the Dept or addn'1 info. District, etc . These ees are ase on e r FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fce: Srfppl. FC' Fee, PME Plan Check: $0.00 Peanut Fee: Supp/. lnsp FiA, PME Unit Fee: $24.00 PME Permit Fee: $47.00 C'nn,�t1-ncirorz l cra: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 "I'lti'cruccd F'klrrrtirlt� A Travel Documentation Fee: 1TRAvDOC $47.00 Strong Motion Fee: IBSEISMICR $0.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $163.561 $0.00 TOTAL FEE- $163.56 Revised: 10/01/2013 le ddHV Cy--IR-.ALT-HV.AC Cts of Com 2US �R--4&X-A ACA W&M j_ Tt I E; F-,Ck3r-d UMI 0 hm&w coff 13 O&W 'r —c=GM me ovw va ft of &Cts; e -&d Mr, k 7.%S=Uft* -M *=-&3St=Cdu!r 07-L JIMEIgg. lie is, J= 3Ed -V-,MM CAT=q SU3C&ARYT isted bdcw z --Sys HVAC obNaCUM q�t� a d== wb& vic3m me ofile 4pmpeocc 09dem EM-- optku ism dc zz� x=wa= *at be zoadwcd. A vVy ZE --brX' be I=- M SiM *r 7N-- - A: H&SL j= -IS:!= wai-I lstcd:n ff3is:lxm wu k %d!5c ..d Sri-- 0 I-HVALC G=dm= cog Bod kr -%d= cog aw-I I= red FWINW- i I� v4R jx= AJECS- 21 wd rlr wOr Saar� :rte =--6i &zMx MSCEI-21-Hao aflaq rr -?a &-,.s==, lo -m -FMw,- Aoaml- 21 wd -gspa 7,sftm) �-M-44rT-*-IA-H F4W_StM DM ICAMP < 15 Pm -----It; Far Pmkoged U-Nifts: Dud kakmgz <I 5;pm-zwA- B=,3F$r-- ftm dad iE M L Doc"Ja= w%F I ... =ad tbw 11M 211i"Irf =d" -4"d ='flr=c:E Mww j -_-t in -.mamffdcncd 4=c-, 0 2- Dw:t SYSOMS -kb ks-- *M Basting du-, msulaL-d ori with asbesms =11'4— - - 2,—New HVAC System C&,r Spa U-Ec----v --ots'-s-E Mold Ic—za 25 ww c7 -4R MECH ---o, wd t&r SPE: SY�AGKE--7-7 MW no - Fsr SOM 3yst� Dud k*kBgc < 6 RC, MA 2! MC I -WD ndAf-t � aid --Ifs=-'NPP For pack2ged Unk= Dwt k9kage < 5 0 3. New Duct wiik Repbcewe9t Reawk-ed Forms: �iER MEC_ AffiCE 2- jaclud= Mph=jIg or ksnLwmg an CF -4R X wd � pct f AOCH-25 =if mdror waff a=zt RC� Mik 2t For Sprxt ;��Icukw < 6 p For P=kapd D—%Dam katw-- <6 P=C—CM 'M 4.vver - 40 Imt - - i�� 40 padoga gma= Dt=ticakagr- < 15 P=CZC Fair spfit 575t= firl a EXCEMM Jud -Yulcm coosauctod, j=Qlwcdws=.kdwkh cAubmelor {mew Awdw% Maqpmul)k Dex%wr-s des k~stea -d =-Fkt- Jaca �r 411M j=j1p 3o *ir. =Sam y The amiss *xwMjdmdSld as the -HISAW"S 10-31-13 March 2" Awj,� CMW&w= r W'M