14100077CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 7505 PROSPECT RD I CONTRACTOR: DOVE'S SERVICES INC I PERMIT NO: 14100077 1
I OWNER'S NAME:
SAN LEANDRO, CA 94577 PHONE NO: (510)376-6543
C9'---- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
License Class CAS C ZVLic.# v Q 6*5y ^ 52- REMOVE AND REPLACE FURNACE IN SAME LOC
ContractorDate D
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.
hereby affirm under penalty of perjury one of the following two declarations:
have and will maintain a certificate of consent to self -insure for Worker's
as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
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.
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
to building construction, and hereby authorize representatives of this city to enter
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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source re s per the Cupertino Municipal Code, Section
918.
Signature Date /
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
Compensation laws of California. If, after making this certificate of exemption, I
Sq. Ft Floor Area:
APN Number: 36615002.00
PERM XPIRES IF VI
WIT 180 DAYS OF
180 DAYS FROM LAST
Issued by:
Valuation: $1800
Occupancy Type:
IS NOT STARTED
IT ISSUANCE OR
Date:
RE -ROOFS:
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.
Signature of Applicant: Date -
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 5533, and 25534.
Owner or authorized agent: Date D
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I 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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9 18.
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature.
Date
CITY OF CUPERTINO
7W FRE ESTIMATOR - BUILDING DIVISION
,
7505 prospect rd
DATE:
REVIEWED BY: Mendez
1wADDRESS:
APN:
BP#:
'VALUATION: 1$1,800
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
PENTAMATION
PERMIT TYPE: FURN/A
WORK
furnace replacement
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$143
TOTALS:
$143.00
Mech. Plan Check
0.0 hrs $0.00
Phinib, Plan €711ec'k
�'k�r�- Plan I,.`n,2ek
Mech. Permit Fee: 1MPERMIT
Plarmb. Permit Tee:
F'16(Po:mi" Fc
Mech. Insp.
0.0 hrs $48.00
Otlrer� Plumb 1n.sL_J
(Jrht�r Li les. ling,
Fl,her
It°sn.lrc°:
Plumb.Irrs��.I`ee:
rlc>c.lnifJ
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rutUttc works, rtre, 3anttary newer vtsrrtct, acnoot
n:-1-.1 ../.. 1 TG...... F .,o n n l.nond n.� sbn nroliw, nnnr ininrsnntinn nvnitnh/O nNd nl'O /1/ftU ah O.C11nfQ1P_ Cantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan C h'l ck f`z,cs:
PME Plan Check:
$0.00
Insp I `ee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
(_IciFf,lirufzrion 1 IX.
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes No
$0.00
A('/-`oncecl Pl<Irillin£r Fees:
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$285.50
$0.00 -.� .TO'1AL FEE:
$285.50
Revised: 07/10/2014