10060146 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 10158 RIDGEWAY DR COT`-TRACTOR:SERVICE CHAMPIONS PERMIT NO: 10060146
OWNER'S NAME: GRANT H AND ELIZABETH H GOWER 7020 COMMERCE DR DATE ISSUED:06/22/2010
NER'S PHONE: 4082534621 PLE ASANTON,CA 94588 1 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S
�7DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT I— PLUMB
License Class C ( y 2 U Lie.# 4
MECH RESIDENTIAL r— COMMERCIAL
/'/. �
Contracto.-S PU'Cie (� aM LON S Date
JOl I DESCRIPTION:REPLACE FURNACE&A/C SPLIT 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:$11280
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. �� APT Number:34241011.00 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, 180 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 Iss ied bDate' r'y2'c.,
9.18.
Signature_/ye%Q/ Date
RE-ROOFS:
Li OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
insi ailed 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 inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature 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: 1 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Sa ety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by At ditionally,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 co:rtaminants as defined by the Bay Area Air Quality Management District I will
m:intain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 O. r�utho�riz agent:
Compensation laws of California. If,after making this certificate of exemption,I �_'�t GSW P� Date: rZ
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 t ereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION fa which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is L4 nder'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 D nder's Address
upon the above mentioned property for inspection purposes.(We)agree to save
-rmify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I r nderstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Li censed Professional
Signature Date
CITY OF CL'PERTINO
5 ITEMS OF 5 PERMIT F.ECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34241011 . 00
DATE ISSUED. . . . . . . : 06/22/2010
RECEIPT #. . . . . . . . . : BSO00010692
REFERENCE ID # . . . : 1006C146
SITE ADDRESS . . . . . : 1015E RIDGEWAY DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER GRANI H AND ELIZABETH H GOWER
ADDRESS 10158 RIDGEWAY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : IE INC
CONTRACTOR . . . . . . . : KEVIN COMERFORD LIC # 31833
COMPANY SERVICE CHAMPIONS
ADDRESS 7020 COMMERCE DR
CITY/STATE/ZIP . . . : PLEASANTON, CA 94588
TELEPHONE . . . . . . . . : (925) 444-4444
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 280 . 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. 00 126 . 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 274 . 00 0 . 00 274 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 274 . 00 #3669
---------------
TOTAL RECEIPT 274 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10158 ridgeway dr. DATE: 06/21/2010 REVIEWED BY: building
APN: BP#: `VALUATION: 1$11,280
R�PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex 10,11 APPLICATION
USE: 1 c")��f= � ,�;, TYPE:
�d areplacp fijrnqrp add AG unit
00
3C.)
APPLIANCE/EQUIP TYPE CAPACITY FEE Il) QTY BP FEES
A/C Units (<=1 OK cfm) 1BREMPIR 1 $63
Furnace, Forced-Air 1MFR=<'00 1 $126
TOTALS: $189.00
Mech.Plan Check 0.0 hrs $0.00 ;z,,
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs 1 $42.00717 -
NOTE. Thesefees are based on the preliminary information avaibrble and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef' 7//,%09) FEE QTY/FEE MISC ITEMS
ry tX
PME Plan Check: $0.00
F.
t r
PME Unit Fee: $189.00
PME Permit Fee: $42.00
"t Id,
rt%
Travel Documentation Fee: ITRA VDOC $42.00
1 ioh, Select an Administrative Item
Bldj4 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.00 $0.00 TOTAL FEE: $274.00
Revised: 5/27/2010
M
CITY OF CUPERTINO
FURNACEAC
CITY OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 MRAPPVNT Residential for thy;install/relocate/or M
replacement of ea appliance vent
install ¬ incl �n an a pl permit.
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
-1-4 Outlets
1 BPGAS For each gas piling system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standarc.s Commission Fee B ALL PERMIT
TYPES
/ 1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=I 00k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, inial ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> 10)k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permit Fe.; E
1 MPERMITFEE Mechanical Permi-. Fee M
/ 1 PPERMITFEE Plumbing Permit P
I 1TRAVDOC Travel Documentation B
1 BUSLIC Business License B
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (jl S� Ad Dr PERMIT
OWNER'S NAME: &Pa'A t owe/- PHONE #
GENERAL CONTRACTOR: !a-7fL>(4'e. d4'C"w, rou 5 BUSINESS LICENSE# l7(1yU
ADDRESS: '70zU Cvoytvt2 ice P/ CITY/ZIPCODE: P6;?c 5,cxt4 tvvr (f)a ?y721
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete i he following information:
6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date