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14120027CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1173 STAFFORD DR CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 14120027 OWNER'S NAME: PINAKI & MEENAKSHI MUKERJI 7020 COMMERCE DR DATE ISSUED: 12/04/2014 OWNER'S PHONE: 4088737302 PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 0L`D REMOVE AND REPLACE FUNRACE LicenseClass `-7 � ii(� Lic. # ss ,_�� `` Contractor � QW i LP2 449� PCWP, 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: $3776 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36206027 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 WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 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 DAYS FROM LAST CALLED INSPECTION. 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: r/2 granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code, Section RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 9 18. Signatur Dat 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, Sections 25505, 2 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: � 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 APPLICATION -k ME P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 v (408) 777-3228 • FAX (408) 777-3333 • buildingCmcupertino.org MISC MDT rrn,runar_ bfiMFPNANTr-AT. MRT.FrTRTCAL F INUSCELLANEOUS PROJECT ADDRESS APN # t ^ O Zig ' OWNERNAME ,� �ULLIGe'i/y PH, g -73-7 70Z, F-MMAIL STREET ADDRESS ap5d Fury,STATE, ZIP e - i n D q5 b I FAX CONTACT NAME i, , �1 P OD -13-'7.30 Z J E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX 1P OWNER ❑ OWNER BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEr �� r n ` V C/ LICENSE NUMBER C1l r�1 Ly LO LICENSE TYPE q w BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESIF S ^ JJ CITY STATE, ZH Y� Gµ /a�S�� `� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LICC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ZSFDoDUPLEX ❑ MULTI -FAMILY BUILDING ❑COMMERCIAL PROJECTINWIIaLAND ❑ YES T�� URBAN INTERFACE AREA ❑ NO JECT IN ❑ YES OD ZONE ❑ NO IS THE BLDG AN ❑ YES EICBLERHOME? ❑ NO DESCRIPTION OF WORK r � ✓ � � /� TOTAL VALUATION: -T76VO RECEIVEDB By my signature below, I certify to each of the following: I am the property owner or authorized agent to a6t on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating b 'Iding construction. authorize representatives of Cupertino to enter the above-iden ed property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED f 'i OFFICE USE ONLY UU a a OVER-THE-COUNTER GD EXPRESS STANDARD LARGE P MAJOR MEPMiscApp 2011.doc revised 06121111 CITY OF CUPERTINO UUU UQrP-Fl%4 A'TnlD — RTTTT .T11Nf DIVIgION imADDRESS: 1173 Stafford dr DATE: REVIEWED BY: Mendez UNITS APN: BP#: *VALUATION: 1$3,776 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex # PENTAMATION FURN/AC PERMIT TYPE: USE: File: tti?t 1. IP7;' ?1"', WORK remove and replace furnace PME Unit Fee: SCOPE PME Permit Fee: APPLIANCE / EQUIP TYPE FEE ID - QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 File: tti?t 1. IP7;' ?1"', PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: i Travel Documentation Fee: ITRAVDOC $143.00 StronV Motion Fee: IBSEISMICR Mech. Plan Check 0.0 hrs Mech. Permit Fee: 1 Other Mech. Insp. 0.0 1 hrs $0.001 ll hl bl Pkw'l C.'Yec4 Phimb, Perm!I`r'e. I C ,l"'.. $48.00 oilier Plumb Trap. Insp. 1'Itsrut�, ht�p. Fee 1'dec. if i ]",'C: n: C„b....l NOTE: This estimate does not inctude,jees true to otner vepartments (l e. rtuninng, I "Utt, .. �•��, < •• ��•••��•y -_, __.__ __ _r•_v_ ,.._,a . -I., ,. . r..,, .r, t^n••tant tho DOW Mr add"'] inin_ Ulstrlct, etc . mese ees ure auaeu urt <•ao •cso•,u•ow. FEE ITEMS (Fee Resolution 11-053 E(f�. 7/1/13) FEE - QTY/FEE ---- -- MISC ITEMS Plan PME Plan Check: $0.00 File: tti?t 1. IP7;' ?1"', PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 i Travel Documentation Fee: ITRAVDOC $48.00 StronV Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 i �� S $285.50 $0.00 TOTAL FEE: $285.50 Kevisea: iuluu/_u i•+ *Ork STA OFCAUFORMA , -A A MTIC*M - MVAC C*MWA-M OF CDMPWWCE Ipage i of 1) M�mtom - HVAC C7- 1,3 JD 7 and 16 (ftum* CF-lR-ALT-HVAC) Address: 11-75 Mw Duaft FkmM MASO CCMMJMW Type"Emdmq PAm*WRAmbe PAW Area Wftl O *VM l3amparalorca CZ1.3-7) Dim:ts � 13" ( Smed by OSdbo* ff 1W df"* El gotem I [3CDndmmftUnft —SM —Wp 13 R40 (CZ1Q Ducts OR-6(OUWS)MMUM ft pusatmost 0 Lblesot M — _HWF MR-SarFa.SL%BSW ueamtrafeeee . hv&Mw wmkW beeOnUtleted 0-4 jmtd> es too one oftm apdom below- Atpomi* appiketion 1 this Wft-empmmWCA& I CIM MEOWL MK""M L Duct system regIstered wIlth HIM pnwkkras pregoUslyseakA or 2.There lsimUM 40kmrfmt Of ductin uncOrAftbned Neer Neat dru'sMdtlt & fepbwft or nista ftAl tim dud one or mom of thefdbr&im UM DUCt I ducts In mmoddOmd AN tilow, Omft' baNkandtafwFliuk WRMEMM MECH-20-HERS, MEGI-M or 24) -HERS OMMECH-204M LI, aoqdred to Cod kdaM (SAM OGS.M to OdAM% Qrsm 13 Boapted*am .duet kdqpUstLniledsftduct!g�nwecon*um4madaudarseabdvvMadmft& n dractlng R4 regdr+ad wtren moretlwf 4oftkmmWmWR-6wlmbmd=40ftkmtded. 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W Item of Tide 24, ftrtr, 1 and 6 qf 10 c&VM ft Caft of R q MbWns (C C F4. 4 I'm n so ngdMfW COMPOr Wdmuwfaduraddwimsfbrthebugftdesipor 51 lbotteerafffutwIl mWperfomWmq'PqflFI Ants, xVsb"dWp** we on#& Colon" of Corolowe conform to the nwkmmnts ofTdis 24, hart I and Part 6 offt CM The bWWk*dos%pfnwnorsystem design fbWjmWoftWonthbcargacmofConVOwmamcwawmtwathe bAwnvdion provided ort odwapplcWftqxnpbnindocwneiftvxwkdmmftcdtubdons,place and spKjpcdkmsubmitted totheerdbmemeM I - MOM -.- - 94MWArC Dmo* vmrpu-u� v I ;� - lv\&,41 ft A, 15r6ox-5 C(opay: DF 718attmiu, OwAbWAX rq-&SILIg -qq�l ""L-. -0 mftI4WD-77A4lM