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06090274
CITY OF CUPERTINO " �rrwey "' '6771 BUILDING DIVISION PERMIT .�'Vq�`h�' :�w' .", RilyO � � ;xl$d BUILDING ADDRESS: A & H HEATING rohmir N0.06090274 10511 CASTINE AV OWNER'S NAME: PElthlrf roam DATE PLOUSE 770 CHESTNUT ST 09/29/2006 NE: SANITARY NO. CONTROL NO. (408) 279-0722 ARCHITECfyENGINEER: BUILDING PERMIT INFO BLDG. ELECT PLUMB MECH a ,op LICENSEDCONTRACmR'S DECLARATION lob Description I ion 76 affirm that 1 am Ifaacd under provisions or cone, 9(commencing P but SecWn7IXk fofDivWao7ofWBudress and Pro(udoa Cado,aed mylkenala REMOVE AND REPLACE FURNACE s in full fora and c(fea 2�? Lkenm Clue _ Uc.g r Dab _ ARCHITECTS used as,public e DECLARATIO r, I understand my plans soil be usedu public rtearN / I e w Licensed Professional -o OWNER.BUILDER DECLARATION i1 hereby affirm that I am exempt from the Conlracroes License Law for the Q` D o following tinea.(Sadao 703 omern Business;and Improve. dem ll Cade:My coy or county $3800 5$� Wni[n Reu1rtJ a petioli m eanilme4 Alla,Improve,dem1111M,or mpalr any aWebm prior to its issuance,also require the applicant for men permit to file reigned rulement o "the is 1ccmedpursuant tothe provialunofMeConuucmraLiamuLaw(Chapter 9 Sq.Ft.Floor Area Valuation pq H (comm.reing with Sedan 70D0)of Division 3 ofthc Bednar and Profeulom Code)or C that k la exempt lhmfrove and the nab fo ted alleged exempEon.My vlolatfon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of r Occupancy Type end mom than five hundred dollars ISSDO). ❑1,as owner of the property,or my employees with wages as their sok compensation, will en Ne work and W suuaum 4 m ainbnded"offend forces(Sec.70s4.Business and Profession Code:The Conuames Luxor Law dorm mm apply in an owner of Required Inspections propertywho builds an impromes thereon,and wWdoesrah work hlmselfor Waugh his _ owacmpioyva,provided the such improvements sae ret intended wagered rotation.If, however.the building or improvement 4 sold within oro year of compim on,W owner• builder will haw the Emden of Moving that he did vet Mid o improve for purpose of sec.). Q 1,as owner of tie Property,am exclusively contracting with licensed conuanmsa b conal.1 Ne projea(Sec.7044,Buineu and Profusion Code:)The Commaeh Li- ve Law does not apply to an owner of properly who builds erimproves Wmon,rod, whoconu ma for such projects,with a cont acto(s)Rotated purmwd m W Can hoube, Lice.Law. ❑I am exempt undo So- ,B Q P C for this,maser Owner Dau WORKERS COMPENSATION DECLAMTION 1 hereby Niterunder potslty of perjury on of W following da does: 1 ham and will maintains CeNOcam of Content m mlFi,ure far Werk.Ys Camp.m radar,u provided for by Section 3700 of the Lebo Code,for Ne performuee of the work for which this permit b issued. ❑1 have and will mainum Workers Compensation Immonce.as mquired by Section 37[K)of the Labor Code,for the performance of the work for which this permit is Issued. My Workers Compensation hourana carrier and Policy'number am: Carol.,�Cf C6-11— //0S Policy N..'14,4 rD ZO 97 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need ami ecmnplcu l dtie permit 4 faonc hundred dollars(5100) or Irma.) 1 certify Net in Ne puformana of W work for which Nis permit is issued.I this out employ any person in any mannerso a to become subject to the Workn'Compcuadon Lowe of Celifamia Dam Applicant NOTICE TO APPLICANT:If.afar making this Certificate of Exemption,you should become subject to the Wurkcrr Compensation provisions of the Leon,Code.you must .JO forthwith comply with such providaa or this permit shill be deemed revoked. z► CONSTRUCTION LENDING AGENCY [..l I hereby efiml that Wm 4 a construction lending agency for the performance of L>: the work for which this permit 4 issued(Sec.3097,Civ.C.) aQ Lenders Name , Z Lardcesmeray C) 1 Certify that 1 have read this application and sale that the above information is Correa I agree m comply with all city and county eminances and sou laws misting to 0U building construction,and hereby authorim repme.matiera of Nis city to cmcr upon the �[aI above-m rationed property for inspection pugebs. (We)agree to save,indemnify and kap harmless the City of Cup.nie.against tiCri liabilides,judgmonts,Cosa and expenses which may In anyway acme against had City U Z in consequence or W granting of this permit a.r APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOMU-LTNS. Date -214i5 Re-roofs Sigo ppli anns HAZARDOUS ✓� MATERIALS DISCLOSURE Type of Roof Will tie applicant or forum building necupantsmm er handle bawdom mecrie as,defined by the Cupertino Municipal Cod..Chapter 9.12,and the Halth and Safely Code,Section 25532(47 All roofs shall be inspected prior to any roofing material being installed.❑Ya '0 No Will the applment on future building MCupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ..It hauNnv air canuminnts an defied by as Ray Area Air Quality Management all new materials for inspection. Diedcl7 ❑Yes erfro — I have mael W hvard.r aterials requ emus mu under Chapter 6.95 of the Califo. hie Heal"SafmyCode,Settle,2550525533 and 25534.1 undcnrend t u if thC building docs not currently ham a maam.Net It 4 my responsibility m MMIy N.occupant of W mgai mentswnknmoft bemust armaaanaafaC, r, of cupavy. Signature of Applicant Date Owecrorauthomedagem D,b All roof coverings to be Class"B"or better CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32644038 . 00 DATE ISSUED. . . . . . . : 09/29/2006 RECEIPT # . . . . . . . . . : 36257 REFERENCE ID # . . . : 06090274 SITE ADDRESS . . . . . : 10511 CASTINE AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PLOUSE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : A & H HEATING & AC CONTRACTOR . . . . . . . : PHELPS, . DALE LIC # 12079 COMPANY . . . . . . . . . . : A & H HEATING ADDRESS . . . . . . . . . . : 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 279-0722 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT ' THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 164 . 78 0 . 00 164 . 78 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ---------------- - ------------ ------------------ OTHER 164 . 78 VISA TOTAL RECEIPT 164 . 78 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL I • Community Development acir 0 Torre Avenue CuOp ertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# L O O 2 S 1 j 1� OWNER'S NAME: P L ,1 S PHONE # z— Q-' GENERAL CONTRACTOR: FAX # I am not using any subcontractors: -�i/1/L_ —Zcl Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing 9 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 CITY OF CUPERTINO FURNACE/AC OUPEI�TINO PERMIT APPLICATION FORM IN# 32 6 ' q7— 03'y Dater• v ZcZ —© r Building Address: `1 X5S(/11 CAi4 Ve Owner's Name: Phone #: 7 -37- yD 7 PLO vS 15 Contracto • � Phone: License #: Contract'k t -7q- (9 7a;L. -;!70q 47 z- Contact: Phone: Cupertino Business License #: l)j L6 o??q-07;La Building Permit Info: Bldg ❑ Elect LY Plumb CJS Mech Job Description: 2 lZ (=Ct ��cv v4 Residential Commercial ❑ For Residential In tallations: Attic ❑ 1" floor LJ 2nd floor❑,dhA dhere to min set back re uirement❑ R=, or Commercial Installations: ` Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Project: Type of Construction: Occupancy group: Strapped Y Xxi( I Sq.Ft. Floor Area: New Location ❑ Replacerrientx Qty. if Applicable Fee ID Fee Description Fee Grou BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10; 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING