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08010171
CITY OF CUPERTINO ? ;nm Y BUILDNG DINTMON PERMIT KCOIY" t2A pR.I1VI:t}RMAU BUILIprSC T9ES$:--_LET PL VALLEY HEATING & COOLING PERMIT08010171 NElR'SS NAME: HMU PERMIT ISSUE DATE WOOD PATRICIA C 1171 N 4 TH ST 01/31/2008 PHONE: SANITARY NO. CONTROL NO. (408) 294-6290 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH too LICENSEDMalIamCONTRACTOR'S DECLARATION ^� 1 ion 70 affirm Nal 1 am licensed under provisions of Chapter 9(commencing lob Description HT1 withSecwe"O'd 1Im(DivhionSaftheBusineoandP%feaiunsCmde.andmylianxis REPLC FURNACE, SAME LOC S in full fort^and elfgn. 21a� License Clw ;t2 47 T Date— CTSD Contreciar ARCHITES DECLARATION I undenonJ my Pow shell M used as public records �yU Licensed Profcstanal vl5OWNER-BUILDER DECLARATION f I hereby alTimt that I am exempt from Ne Commattor's License Law for the Z A O following meson.(Section 103 1.5,Business and Protessians Cole:Any city at county .. $ which requires a Permit to emsmct,sten.improve.Monolith,or repair any someone ZxY prior m its issuance.also requires the applicant for such Permit m file a signed statement F� that he is licensed purmant to the provisions of the Conuactur's License Law(Chapter 9 Sq.Ft. Floor AreaValuation (commencing Business $3770 Scedmn TWO)of Division 3 of Ne Business and Professions Cole)or ERS deo he u except therefrom and the bub for the alleged exmpdmm Any vloladbn of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ypp�Number Occupancy mil mare than R.hundred donam(SSW). 32643059:tlC1' Type ❑I,as owner of the property,or my maployeu with wages as theirmk compensation, will do Bre work,and the structure b not intended or offem l for sale(Sec.7016,Business and Ptelestons Code:The Communes License Law doe not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself ca th esugh his owo employers,provided Wmswh bpmwmemu...E intended arolfemd(cask.If. however,the building or improvement b mid within one yens of eampledon,the^wner- builder win have On burden of proving War M did oat build^r improve for P.M.of sale.). ❑1.as maser of We property,am exclusively convecting with licensed contrxmo W coma Teen the project(Sec.7066,Business and Professions Code:)The Cm wwtoes Li- man taw does not apply m an owner of property who builds or improves Iheremn,and, who contracts for such projects with a conuacmKs licensed Forecast mthe Cmrrwar's Lkewe Law. 20 cl of !3 ❑I we exempt under Sea ,B&P C for this reason ser ZE Vd-. a7 Data WORKER'S COMPENSATION DECLARATION 1 hereby alrmrrn under penalty of perjury ane of the following declass ow: ❑Ihxve and will msintsina Ccnifiumaf Cmnxnuo self-ieumfurWabluesCompen- sation,an provided for by Section 37th of the Labor Code,for the Performance of site work for which this Permit is issued. - ❑1 have and will maintain Worker's Compensation huurnmes,s required by Sccdm 3700 of the Labor Cods,far the Perfarmanw of the work for which this Permit is bound. ' My Worker's Compesatim Insurance carrier and Policy number are: Gnim Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (11osectlmn wed not M completed If the permit Is forma,hundred dollars(SIM) Or 1ss) 1 curtly Wet in the perf rmance of the work for which this permit is issued,1 shall not employ any a mn in any manwrx as k become subject be the Workers Campensadon Laws of California.Data AppBcant NOTICE TO APPUCANT:If.after making this CeAOcate of Exemption,you should become subject m the Worker's Campusdon provisions of We UW Code.you most .J O forthwith comply with such provisions or this permit shall Ise deemed revoked. zZCONSTRUCTION LENDING AGENCY [—� k for by which thi thatthmeba ed(Sec.30 l7,Ch, egenry for the Performance of rl Le work far which this permit b iswd(Sec.J097,Civ.C) W�Q Lender's Name Z)z Lenders Address O Q I certify that l have mud this application and sum that then shrew kfmmatim is correct.I agree to comply with all city and county ordinances and sore laws retailing m .Q building construction.and Mmby authodx representatives of this city to color upon the Liz ahbve-mudoncdudgm progeny for inspection es purposes gat (We)agree m save,indemnify and keep hmnleo the City of Cupertino against r.y rA liabilities f ts,Me congruts ng expenses MMI ch may in anyway accrue against said City V z A APPLICANT of th,UNDERSTANDS of this D WILL 'r/\ '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NO -POINT Issued by: Date SiN 4 REGUICAT7fIJI5.. /�NOV -POINT Y/�✓� Re-roofs �-- Sngn ^ A eciflitconuacker Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicant or future building Occupant slam orhandie heardous material IN dented by We Cupenino Municipal Code,Chapter 9.13,and the Health and Safety e,Section 35333(a)? ❑Ye ON. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or future building Occupant use ea Air ut m rkvana which Pe g emit ha'rardos air contaminants u Jefinctl by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yea ❑No I have road the hvardous materiels requirements under Chapterb.95 of the Califon orb Health&Safety Code,Sections 23503,25533 and 25334.1 unwashed ds ifthe building does no ern ml haw hick be a"nam,that it b my rospomibility Is notify We Occupant of the rcquh must met prior m issuance of a Cmdrie te mf pre . 2� p r Signature of Applicant Date All roof coverin s to be Class"B"or better Owner uI agent Dom' g Diol CITY OF CUPERTINO FURNACE/AC • CUPERTINO PERMIT APPLICATION FORM APN# n _ -IDa G � © 5 q . (3c) Date: Building Address: Owner's Name: Phone#: (k, 7.2-.4 _a7 Contractor: Phone #: W,)g Jaz 1 � ' Contractor ense#: Cupertino Business License#: 'T J /,// Contact: Phone#: _ aN a��a n -- - Fax #: • Building Pzut Info: v Elect ❑ Plumb ❑ v Mech Residential Commercial Job Description: '� GLt1 �u-�'/LR�� S` Gcnti2, �Uel For Reside tial Installations: Attic ❑ 1" floor ❑ 2"a floor ❑ Adhere to minimum setback re uirement '� For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 3 r7 �)o Strapped LJ On Platform Bonded New Location Replacement Valuation: Green Building: Must attach Green Building Check list to this application y ` -� CITY OF CUPERTINO . CTY'" FURNACE/AC CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC TPGASRES —-Residential-for ea gas piping system of- P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or M relocate ea forced-air/gravity type • furnace/burner, incl,ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h 1EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee 1VI 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • CITY OF CUPERTINO FURNACE/AC • CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit-,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. IMCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling • absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of-5or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed ¬ incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, ' cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by ® this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install ¬ incl in an a 1 ermit. CITY OF CUPERTINO • C. - FURNACE/AC OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC _ CONDITIONING 1BCAIRHAN Commercial A/C Units<= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P . 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BREKA-]T HAN Residential A/C units <= 10k CFM B 1MRRAA Residential Mech Repair/alt/add M IBSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1TRAVD0C Travel Documentation B 1BUSLIC Business License B • CITY OF CUPERTINO 6 ITEMS' OF 12 PERMITRECEIPTOPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32643059 . 00 DATE ISSUED. . . . . . . : 01/31/2008 RECEIPT #. . . . . . . . . : BS000003815 REFERENCE ID # . . . : 08010171 SITE ADDRESS . . . . . : 10656 AMULET PL SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER WOOD PATRICIA C ADDRESS 10656 AMULET PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1303 RECEIVED FROM . . . . : VALLEY HEATING & CO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . : -SAN JOSE, CA 95112 • TELEPHONE (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- IBSEISMICR VALUATION 3, 770. 00 0. 50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1MPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40.79 0. 00 1MRRAA UNITS 1. 00 61 .19 0. 00 61. 19 0. 00 IPPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 224 .85 0. 00 224 . 85 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 449 .70 #17251 --------------- TOTAL RECEIPT 449 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- - -------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL _ /D coSb A � -: r fGac,� 64TRF�.� Gs a le o ENTER PR6JECT NAME' y: NMI ® 4.Use Solid Well Systems(Includes SIPS,ICF4 a Any Non-5Eck Frame Assembly) — ❑ a FlDom ❑ b.Wells p ❑ C.Roots D 1 2 5.Reduce Pollution Entering the Home from the Garage ❑ a.Tighty Ssal the Air Barrer between Garaga and Living Area ❑ b.Install George Exhaust Fan OR Build a Devoured Glo e 0 1 6. Design Energy HrJs on Trusses(75%of ANc insulation Height st Outside Edge of Exterior WaID D 1 ❑ 7.Deo n RDof Trusses to Aecommodai Ductwork D 1 e.Use fleryded-ContvR Steal Studs for M of Interior Well Framing D 1 LJ 4 Thermal Marc Walls:SIB-tech Drywall on A0 Interior Walls or Mile Weighing mom than 401Wcuft 0 1 10;Install Overhangs and Gutters .--..—. . .{]- —a Minimum 16-Inch Overhangs andGutbm ❑ b.Minimum 24-Inch Dverhangs and Gob, p 1 Total Poem Available in StrucNial Building Frame and Envelope=36 p E.EXTERIOR FINISH Points.Avallable Fat Measure LJ 1.Use Recycled-Content(No Virgin Pistil)or FSC-Certified Wood Deciding p 2 3.Install a Ron Screen Wall System D 2 3.Use Durable and Nonxmbustible Siding Mai 0 1 4.Select Durable and Noncombustible RDIIM MatedalS p 2 Total Polms Avallable In Exterior Finish=7 0 F.rNSUT-kTION I Painls.Avallable Per Measure I.Install lnsulafipnwhh75%Rerycied Comant ❑ a.Wells endrin Floom —0—b.aellin s D —1—I— . 2.Instal Insulsfion that is Low-Emttiing(Certified Section 01350) ❑ 8 Walls anNor FlDom p ❑ b.callings ❑ 3.Inspect Quality of Insulation Installation before Applying Drywall - p Toal Points Available In Insulation=SI 0 G.PLUMBING PDwdrkvaQ6 Par IA—Ure 1.Distribute Domestic Hot Wafer Efficiently(Maximum 7 Points) ❑ a Insulate Hct Weir Pipes from Water Hooter to KMchen 0 • ❑ b.locum All Hol Watt Floor D ❑ c.Use Engineered Pamllol Piping D 1 )— ❑ d.Use Engineered Parallel Piping With Dernand Gontrded Circulation Loop D 1 ' ❑ e.Use Stuchned Plumbing vU Demand Cmmolled Clmulation Loop p 11 2 ❑ f.Use Central Com Plumbin p — �i 1 2 ❑ I Install Only High Efficiency Toilets(Dual-Flush or 5116 RPI) - 0 ( U) 4 Toil Pointe Avalablaln P1umbing=Totl12 D 13;MATING,VENTILATION&AIR CONDITIONING P Alaitab a Per Measure 1.Design and Install HVAC System to ACCA Manuel J.D,and S Rexmmendation p 4 r VL Infill Sealed Combustion Units a.Furnaces p ❑ I1.Wet=r Hastens I �— D 2 1 9.Install Zoned,Hydrate Rodent Heating with Slab Edge Insulation D ', 1 1 ( I L lnstell HighF Oimry Air Conditioning with Environmentally Responsible RaNgemnts 0 1 I' 5.Design and Install Eftsetive Ductwork ❑ a loved HVAC Ung and Ductwork Whin Condniongd Space D 3 ❑ b.Use Dud Mastic on All Duct Joims and Soares 0 _ 1 ❑ C.Insall Ductwork order Attic Insulation(Burled Ducls) D 1 ❑ J.Pressure Salinas the Ductwork System ❑ e.Pmtect Duca during Construction and Clean All Duds boom Occu sinry 0 1 El 6.Install High Etfidency HVAC Filar(MERV&) p I I I ❑ 7.Don't Install FuePlece or Install Sealed Gas Fireplaces with ERciescy Rating Not Less Then SMA 1 using CSA Standards D B.Install Eftlive Exhaust Systems in Bathrooms and I fchans ❑ a Insall ENERGY STAR BeNmom Fam Voted to the Outside D 1_ I ❑ b.All Bathroom Fans Are on Timer or Humidlstat p 1 ❑ c.install fatchen Range Hood Vaned to the Outside D 1 9.Install Mechanical Venduslion System for Cooling(Maximum 4 Points). ❑ a Instal ENERGY STAR Coiling Fans 5 Light Kiln in living Areas 6 Badmoms p I ❑ b,Instal My-,House Fan with Variable Speeds ❑ C.Automstcally Controlled Integrated System p 2 ❑ d.Adomefically Controlled Integrated System Mm Variable Speed Domml 3 11 Install Mechanical Fresh Air Ventllation System(Maximum 3 Points) • ❑ e Any Wide House ventilation System That Meats ASH.RAE 5522 D _ 2 ❑ b.Insall Alr-to-Alr Hoo Fxchan ar then moats ASHRAE 622 -0 1 2 11.1 Carbon Monoxide Alarm(s) D 1 I Total POlms Available in Heating,Vandlatlop and Ar CDndfiDMng=30 D 02DD7 Build R Green Eingle Family GreanPDIM Cha&..list 2D37 Version Pao=9 of 4 &ITf erg rN oOd i BIT s • ❑ Ener deempt here,antl emer point available fe maesurz In at tela vies b Mrz ri hL 0 OU _ --�' n _ .___.A____-_._____________--__. _ Einar tles;ription hare,and emer point avaMehle for measure In appropnatFc-gatlothe npht_______.._______._.______, D 0_ _0 Enter tle6cnptlon pare antl emer point avalaGe frn mamum 1p app hat cele mi^s to Me tl hL 0 _0 D D D —�--_L___�.____________. __. _.— ___ _ ❑ Einar tl= 'bon here,and emer Im6 evalladle for measure In a --"'-'�'— '— -- - -�n Po pprop ale uheporiea to the ngML 0 _ 4.Innovation:.List Innovative measures that meet the green building objectives of the Guidelines.Enter up to a ire 'Id h r n Ch kl' -r maximum combined total of 20 pts.See Innovation Checkilst for suggested measures,using the link to the right. Guidelines LJ Innovation in Community:Emv des' on here,and emer porn ava0able to measure N appropria cat ones b the ri L T-0-0— _0 0 0 Innovefim in Energy;Emyr dum Ion hem,and enter int avallabls for mneme in t shite Cate Dries to the right. 0 D __ p _ _ 0 0 p ElInnwaMm In IAOMealih:Einar ties' 'on hare,end emer Dints available for measurz in 'ale caL nes to the n ht 0 _0 0 IMwafion In Resources:Einar desvi Mon here,and enter point evalleblefor maasure in appropriate cat nes to the d hL 0 0_ 0 0 _0 _ 0 LJ Innovation in Wats E _mer descripfion hare,antl emu point evaBaDle fa measure m ewBpnue catgone6 N Me right 0 0 0 D D D Total-AvailablePain-in Other=6-3 0 MEMEMEMEM MIR Total Avallable Points In Speolilc Categories' 4+ 96+ 42+ 66+ 43+ Minimum Points Required in Specific Categories 0 3D 5 6 9 r o r t r s Project has not yet met the following recommended minimum requirements; -Total Project Score of At Least 50 Points -Required measures: -Aea: 50% Neste diversion by weight -NI:Incorporate GraenPoint.Rated Checklist into blueprints ldinlmum Points in Specific categories: -Energy(30 points) -1ACWH_—Srth(5 Points) -Resources(6 points) -Water(9 points) • • 02007 Build It Green Single Family GreenPOIB Ch=eMlm 2007 VarsiDn. Pena,4 of 4 Community Development i 10300 Torre Avenue 11 1 9 Cupertino CA 95014 1 °" Telephone(408)777-3228 CI OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: rZ PHONE # Vt _ _ ;- GENERAL CONTRACTO : j1&,j,&U FAX # I am not using any subcontractors: Si tune Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing • Flooring, Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock ® Tile Owner/Contractor Signature Date