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13110124 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10337 COLD HARBOR AVE CONTRACTOR:SERVICE CHAMPIONS PERMIT NO: 13110124 OWNER'S NAME: LU,YING&GENG 7020 COMMERCE DR DATE ISSUED: 11/19/2013 OWNER'S PHONE: 4085178832PLEASANTON,CA 94588 PHONE NO:(925)444-4444 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class (✓2b Lic.# 11 r7tt REPLACE 10 SUPPLY DUCTS Contractor 5pc�1te, CHa vjpl:on Date ' 61401_13 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:$4790 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:36910007.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIjE11 RES IFWORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating �,ITHDAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAOM 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 Issued by: Date: 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. h �, n 6 RE-ROOFS: Signature t 1�%Ljt^ Date 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. ❑ 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 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 hisurance,as provided for by the Health&Safety Code,Se t, 5505,25533,and 225534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agend 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 GAL PERMIT APPLICATION MEP { } \ misccuQER�xo � \� FLUS MG, 31dE£�E4NICAL ��g-sgsraF i T AIN# r -I b C)CLl- mmrA00=E% -hao 9501 V FAX CONrA r SI$ETADBi2FS.5 +SIY,�TA z FAX ❑owrm 0 awms&samnEm II awmaLwkzms' VcmmLmzm l3cmnzAcrcxAaawII wRcmm= (Clawaimm 0 Q rm+ar 3MrICs iLz �h r S CMCAWYXAb0 L FAX NASA 0CM&EKYALp:a ASA g FL=zME g*o aas 13.0 EesomynaNcip TarALVA.L37A33M L(`j -1 D r 00 - $7tmT ig :EY�a�ko£ Fameiaaigocva¢� 3t�trai$�casFsI+.Icr�d aapfra �aad dx ISraoemav ed is C.-acL j rm-ad$tnIMS=Ia+wsit 211 Cl=21 Ssasaiss�lavis��. i _ fin +1� F amreafAp Dam 1 1� 2i✓l e� Dr Sf3PP�. ��$�O$�AT�O�F�QtIIIi._.D o�scg�arc�Y � C3 be U � g iT�N�3,lA[3 U < P LARGN CE a ��3�Scf�?�1Zd.doc revised 06ldIlli CITY OF CUPERTINO FEE.ESTIMATOR-BUILDING DIVISION ADDRESS: 10337 cold harbor ave DATE: 11/19/2013 REVIEWED BY: Mendez APN: I BP#: *VALUATION: 1$4,790 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1 RMAP7 USE: SFD or Duplex PERMIT TYPE: i WORK re lace 10 supply ducts SCOPE 5 g i N r �I 5 {`a y Meeh Plan Check 0.0 hrs $0.00 .Phwib. Plarr Check F_lec..Plan Chuck Mech.Permit Fee: IMPERMIT P&imb.Permit Fee; Elec. Permit Fee: [Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Islec.Insp. ech.Insp. Fee: Plumb. Insp.Fee: P2��j Elec,Insp.I,ce: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are onL an estimate Contact the Dept-for addn7 info. FEE ITEMS Lee Resolution 11-053 E . 7ff 11/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Mechanical Suppl.PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $104.00 1BREMVENS Ventilation System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. ®OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: _T_T $47.00 Conswuction .Tax Administrative Fee: IADMIN $44.00 Work Without Permit? .® Yes No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.00 $139.50 $104.00 $243.50 Revised: 10/01/2013 �CVMc�stz 21 Cod l'�DIt IUia m _ 0 Isk=UffGab (� -Is f DIM GR3 KSI- €. . ' ewe omweAff -s ' -F-._- A '' • s ate'' � � sfir—mdM-� ., f�e _. � cowIf� 32mnd{ - fiI --� cd parnz= >300 $-w,SOW-Aws�D 15 - packaga U Dudc 3'q Myr. j wodcmmmfed tabaw lesilf=40. gr Farm= _ r CFS mE dCH2 . U aaaetaio�s - a For spat is C > €" For EFackmml _Okady H��ryyl amm *aaf Im mails NAM= MEBROOKS l l fig•-�?� e.sx San ton