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13080034CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22047 CLEARCREEK CT CONTRACTOR: ALLIED AIRE SERVICE PERMIT NO: 13080034 INC OWNER'S NAME: MILPrrAS, CA 95035 PHONE NO: (408)934-8844 JOB DESCRIPTION: RESIDENTIAL COMMERCIALS XLICENSED CONTRACTOR'S DECLARATION License Class C I Q Lic. # I Co QI —.� ADD (N) A/C UNIT IN SIDE YARD AREA Contractor t� &J-40 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 Sq. Ft Floor Area: Valuation: $4400 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 APN Number: 32618014.00 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 DAYS OF P RMIT 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 + 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 b ' Date: g 14 13 granting of this it. dditionally, the. applicant understands and will comply with ail non -p nt our re er 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. ? Signature Date b` J 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 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 th ay Area Airuality Management District I performance of the work for which this permit is issued. will maintain compliance with t e pe ' pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by 3700 Labor Code, for the of the work for which this the Health & Safety Code, Sec ons 5 553 and 25 f Section of the performance Owner or authorized agent: Date: a L 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 �10 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION o MEP 0- 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1' 0 MISC (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org \ ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS ^ O L4"1 C Fjk�_ Ci?_ -K_ /► APN # l OWNER NAME OO�) •� E-MAIL STREET ADDRESS �ac5�� Cu=r�,R CITY, TATE, ZIP ��ataTjga . FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 4#4 le �T imff LICENSE ER —7LI oo � ENSE TYPE io BUS. LIC # COMPANY NAME � �t`=m E- t c. &_Aa.�.tL=�O�� P.t . jai it FAX 'fag qSq-884b STREET ADDRES C CITY, STAT ZIP ^ ` PHO E ^a. `_ggftj 7 `( O ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULT777 BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK •`� f f� ! ' �a C� 1 UM S1,1C Y S T'EA IN S I D C- %KAIL TOTAL VALUATION: EIVEDtBY:: By my signature below, I certify to eac f the following: I am the property owner or authorized agent to act on the property o s behalf. I have read this application and the information I hav :pro id correc . a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uil mg actio I authorize repres fives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER -TBE -COUNTER w F x_ ❑ EXPRESS WU {� ❑ STANDARD Z ❑ LARGE a _MAJOR MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO WNW FF.F, ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $70 TOTALS: $70.00 Mech. Plan Check 10.0 1 hrs $0.00 Phun& Plan Check F_.lec. Phan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Insp.17F Other Elec. Insp.I I Alech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn't info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/12,) 22047 clearcreek ct. DATE: 08/06/2013 REVIEWED BY: melissa JimADDRESS: APN: 326 1$ 014 BP#: *VALUATION: $4,400 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION FURN/A PERMIT TYPE: WORK add n a/c unit in side yard area SCOPE S"uppl. Insp F'ee- . APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $70 TOTALS: $70.00 Mech. Plan Check 10.0 1 hrs $0.00 Phun& Plan Check F_.lec. Phan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Insp.17F Other Elec. Insp.I I Alech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn't info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/12,) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp 1. PC Fees PME Plan Check: $0.00 Permit lee: S"uppl. Insp F'ee- . PME Unit Fee: $70.00 PME Permit Fee: $47.00 Conorfiction Tax. Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Tees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 7 � '� k ��'•A� i3%� D� ��, �. � A:, '1 1 • , ,1 / / / � � ® P a,,. �,1 1 • / Revised: 07/01/2013 pft(L o�Q �� C-T- PLAAb BY 6 vD!3 DATE WUNIMN Gr; DEPT' DATE OLOG. bEPT. eturjl - WrMC'- - Kt+4 /VP�5';a047 CLL--AkC4-Z-Y-Cr A eo t 326 -IL-9 -o1 `1 : Aam� A, L LA N I T T-6 [-: tic i s p M C., FUAqAC4 Sy -::�W W !Z-,( 51t*0kr–'j-- e COMM! -V: -TY PF'.";7-�7!D`V.ENT DFPAPLTMENT L --t$ BUILDI!,qG LiV'ISQiN - CUPERTINO This set of plans and spe'difications MUST be kept at the jc;L s,"M dunn construction. It is unlawful to make any changes Or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to b proval of the violation of an pravmt6n—sof yor nceorState l-aw. BY OL PERMIT NO. 120 03y