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11120096 - CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10684 MARTINWOOD WAY CONTRACTOR:VALLEY HEATING PERMIT NO: 11120096 &COOLING OWNER'S NAME: PAUL BOMMARITO 1171 N 4 TH ST DATE ISSUED: 12/16/2011 OWNER'S PHONE: 4082527479 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION [ r' r- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class[ Lic,N 25,55 0 . r7, e r �lOTrnQ Date IL K&If MECH RESIDENTIAL COMMERCIAL Contractor !/�, JOB DESCRIPTION:FURNACE REPLACEMENT i 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$2200 1 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 AIN Number:36935035.00 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 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 VST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ^I costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. C�i�ra�C 2) �(�/f RE-ROOFS: Signature �/I3a[e All roofs shell be inspected prior to any roofing materiel berg installed.If a roof is installed without first obtaining an inspection,)agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Lew for one of Signature of Applicant: Date: 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) 1,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. 1 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(x)should 1 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 emil 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 25550�0hh5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:a/s�rC`t=Carr Date:1.2 llye4r 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 my manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 inforrnation 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 1 understand my plans shall be used as public records. grunting 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10684 martinwood way DATE: 1 2/1 612 01 1 REVIEWED BY: bobs. APN: BII "VALUATION: $2,200 "PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Dulex PENTAMATION FURN/AC p USE: PERMIT TYPE: WORK re alta furnace at same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 P6aub. Plan Cherk I lec./''/nn Cherk Mech.Permit Fee: 1 MPERMIT 111umh. Termir Fee: lilac Pern:iz I Other Mech.Insp. 0.0 hrs $44.00 ,)Nm F9rnnh hxcp. 011ier 1:1r.;. torp, W•ch.Inv). Fire: /'/unr(r. ln.yt Fa. lilee.Inrp. Fee: NOTE:This estimate does not Includejees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District etc. . These fees are based on the prelinina In ormation available and are only an estimate. Contact the Dept for addn'l Into. FEE ITEMS (Fee Resolution 11-053 Elf 7/bl U FEE QTY/FEE MISC ITEMS A'Icvn (,'hdCl(Fete: PME Plan Check: $0.00 Permit Farr Suppl. hicp I• r PME Unit Fee: $130.00 PME Permit Fee: $44.00 Canso-fletion Tav: Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes (F) No $0.00 d lrrmrx c(A(nrurirl„Pies: Travel Documentation Fee: ITRAVDOC $44.00 Stron , Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.50 Revised: 12/04/2011 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I CUPERTINO (408)777-3228• FAX(408)777-3333•building(ftupertino.ora SIC PI-UMBING NEfMECHANICAL ELECTRICAL EIMISCFLLANEOUS PROJECTADDRESS 1�1^Q ' ^M\ \^\' APNM J(PS/ q_ AI5__03'/) OWNERNAME q&kkkVJv Ur(,f\ PVHONWC- (Il. ( P-MAIL / STREET ADDRESS 11 04 g1C.-r`I FAX CONTACT'NAME Uul "l l(�1 PHONE V E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME \ � LICENSE NUMBER r'YCA� 'l LICENSE TYPE^„ BUS,LIC# an COMPANY NAME E- OSJa V O-v FAX L4O�nl�TH1 VL/7 ON STREET ADDRESS C CITY,STATE,Z �L PHE ;? In�` ARCHITECTIENGINEER NAME LICENSE NUMBER J BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD ar,DUPLEX ❑ MULTbFAMILY PROJECT IN WILDLAND INTERFACE PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING COMMRCIAL URBAN TERFACE AREA NO FLOOD ZONE [I [INO EICHLER HOME? NO DESCRIPTION OF WORK �"� e TOTAL VALUATION: '� RECEIVED BV: r� j By my signature below,I certify to each of the following 1 am the property owner or authorized agent to act on the property owner's behalf. 1 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 to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicamNAgent: SdQr Date: SUPPLEMENTAL INFORMATION REQUIRED "" OFF7CFBE ONLY;.. m OVER-TREdOUNTER 6 ❑ EXPRESS 'r.S ❑ STANDARD .2 II y t ❑' LARCF. I ❑ MA'JO'R� `t,B MEPMiscApp_20/1.doc revised 06121111 CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36935035 . 00 DATE ISSUED. . . . . . . : 12/16/2011 RECEIPT #. . . . . . . . . : BS000015585 REFERENCE ID # . . . : 11120096 SITE ADDRESS . . . . . : 10684 MARTINWOOD WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . .. . . . : PAUL BOMMARITO ADDRESS . . . . . . . . . . : 10684 MARTINWOOD WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM' . . . . : VALLEY HEATING 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 SAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41 . 00 0 .00 41 . 00 0 .00 1BCBSC VALUATION 2,200 .00 1. 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 2,200 .00 0 .50 0 .00 0 . 50 0 . 00 1MFR=<100 UNITS 1 .00 130 . 00 0 . 00 130 . 00 0 .00 1MPERMITFE FLAT RATE 1. 00 44 . 00 0 .00 44 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260 . 50 0.00 260 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL -.4 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESSt-fa PERMIT# OWNER'S NAME: PHONE# DF- 44 2�r Z5 GENERAL CONTRACTOR: Va( BUSINESS LICENSE# ADDRESS: //71 ti. q4A $ CITY/ZIPCODE: 51 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature 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 Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date