06090259 CITY OF CUPERTINO
i1UILDING'DIVISION PERMIT ° @O R 'AOa N �
6xsdvT^
BUILDING ADDRESS: P COAST MECHANICAL PERMITNo.06090259
21050 MC CLELLAN RD
OWNER'S NAME: PERMIT ISSUE DATE
HOEFLER WALTER S AND MARY R 247 SUNOL STREET 09/27/2006
NE: SANITARY NO. CONTROL NO.
(408) 365-7004
ARCHREC(ENGINEER: BUILDING PERMITINFO
BLDG
00 LICENSED CONTRACTOR'S DECLARATION Job Description
i 1 hereby alarm that l am licensed under provision of Chapter 9(commencing
with Section 7")al'Division 3 of the Business and Profcaeians Code,and my license is
h in ran fare.&adaffect REPLACE (2) HEAT PUMPS - 1/2 THE WEIGHT OF THE
E Leena Class Lu.N' Dam Convenor ORIGINAL SIZE
I ARCHITECTS DECLARATION
1 I undmsund my plans Nall he used an public waturN
3�u
e ted Luxnsed Prof..least
OWNER.BUILDER DECLARATION
i9 1 hcmhy aRrm Nal I am exempt(rem the Com soars Lmcmm haw for the
.00 (.[Irwin&moon.(Section 703 LS,Business am Pmfms ams Code:Any city or county
Sa� which m9ums a permit in construct,slur,Improve,demolish,or mpur my suucmm
2P2 prior ut its aauam,sim Oxidant the applicant forsuch permit m ate a signed statement
�e the he Is licensed putwmt
in me provism"a the Contractors Um.law(chapta9 Sq.Ft.Floor Area VaIU I�p74
@3 0 it,mmenc[ngwiNSeNan7a00).f Division3afthe,Busineumd Profesalom Cade)or
`�3 9 Nel he 0 emmpt demeanors and the bub for toe alleged simulation.Any MolNon of b
Section 7031.5 by my applicant fm a permit aub)ecu the applicant to•civil penalty of 3 pppp N��3e59�5 �0 0 Occupancy Tf pe
man mart Nan five hatched dollars(5300).
0 1,u awoer of gm property.or my csop[aymowith saga u 0mvanmeompenu0m,
win do the work and mesvuctum Is not htmMedmaamnd(arsam(Sec.7ON,Buurcv Required Inspections
and Pmf cialons Cade:The Contractors License Law does rot apply 0 m eq Owner of p
property wh0 builds orimprow theacon,and whodoessuchwarkhimselfor Waugh his
own empmyans,provided that each improvemms art trot Intended molfcred(areola IL
however. buil ding orimprovement or
bald III and
yetiarImprovefarWawnu-
builder II have
the burden of proving Nat ha did rot balm m Improv far puryo¢of /
sale, e
I,u owner of tha prope .8 bravely coma ding with acenced con==to O�
construct me pmjm(Be inns and Prefesslmu Code')M Committee U.
mss Law date mot app[ m of property who builds or tantrum Wm
eon,and,
m
who emcu emmm
far such je i awrb)Iiansedpununtmme COAtr es
Lucre law.
0 1 run uempt un .B• m
P C far this mss
owner Data� �
WO COMPENSATION DECLARATION
1 hereby aairm under penahy of perjury am of the followlnl declamWns:
I have use war munuin scertineau of Consent to calf-iuum fm Workers Compen-
sagon.u provided In,by Section 3700 of dm labra Cade,for the perfomanro of the
work for which this permit is Issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Seeman
3700 of Ne labor Cade.for the performance of gm work for which this permit is intend.
My Workees COmpense0m Insurancea 'm and Policy number w:
CaMer: Policy No.:
CERTIFICATED XEM ONFROMWORKERS'
COMP Ns INSURANCE
(This section wed rat omp fW prwit la(oroec hundred dollen l5lm)
or mss)
1 comfy that In the point of rk for which this pmmit Is issued.I shall not
employ any permn in myna am became,subject in W Workmf Compensation
Laws of Califomaa Dam
Alma ant
NOTICE TO APPLICANT.If.a making this CcNncau of Exemption,you should
become subject m the Workers Ca pawdon provisions of the Labor Cada you must
Qforthwith comply with such provisions m Nb permit shall ha decreed deeed invoked.
CONSTRUCTION LENDING AGENCY
[•-i (hereby arm that them is a construction lending agency for the performance of
rG the cork for which this permit is(sued(Sec.3077.Civ,C.)
QLendces Name
.7 Z Lender:Address
U 0 1 certify that I have read this a fiend.and sou thin the above let..c on is
U. F camect.I at=u comply with tel c county ordinances and sum laws relating m
0 V building construction, snu
end hereby th repretiWSOfthenu
iseitymrupno the
r U shove-mentioned property far i pec a urinous.
(W.)agreem.ve,in mai keep hmmessW City or Cupcnino a&aanat
L~rA Williams.judgment.costs es which may in my way acme againstsid City
(,)7 m COM(pacme of Ne gram g of is rmkt.
A APPLICANT UNDER ST ND A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO
t d Re-roofs
Signmure of Appli
s MATERIALS DISCLOSURE' Type of Roof
Will thee Cupertino
(mum Wal Co occupant e.Chaptsnarea"handle I ealloanmaterial
u dcOwd by gm Cupenim Municipal Cade.Chapter 9.13.and gm HnIN mtl Safety
Cast.Section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
40 ❑Yu YNO
, Will the applicant or future building Occupant sac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha xd.o ter minters u deaned by the Bay Area All Quality Management all new materials for inspection.
Dounct7
Dyes �6.
I have the materials mquimnmms under Chapter 6.95 of the CARfor.
nia HealthBS ctyC 35505.25533am125534.1undmeardthmifgm building
does."a 0 he u ium.that It b my rmpomthility to ma ry the amupanr,of the
mquimmenu nth Ix met ourinissuv¢cOra certifcaeO"Occup Signature of Applicant Date t
ownmmanm.rn,.Ce en, pa 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 . . . . . . . . : 35905133 . 00
DATE ISSUED. . . . . ... : 09/27/2006
RECEIPT # . . . . . . . . . : 36231
REFERENCE ID # . . . : 06090259
SITE ADDRESS . . . . . : 21050 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOEFLER WALTER S AND MARY R
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-6262
RECEIVED FROM . . . . : WALTER HOEFLER
CONTRACTOR . . . . . . . : TORRISI, MARK LIC # 18612
COMPANY . . . . . . . . . . : PACIFIC COAST MECHANICAL
ADDRESS . . . . . . . . . . : 247 SUNOL STREET
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 365-7004
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 749 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BREMAIRHAN NO.UNITS 2 . 00 20 . 52 0 . 00 20 . 52 0 . 00
BENERGY PERMIT FEE 180 . 36 86 . 57 0 . 00 86 . 57 0 . 00
BSEISMICOM VALUATION 10, 749 . 00 2 . 31 0 . 00 2 . 31 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 404 . 87 0 . 00 404 . 87 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----- ------------ ------------ ----------------
OTHER 404 . 87 VISA
TOTAL RECEIPT 404 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
•
SEP, 22. 2006 2. 19PM PACIFIC COAST MECH N0, 911 P. 2
9 ate° ca�icArnz m av
z 3 q 6
• ol�ohm M � y T
z
�
mC' �° a � 'S4• .. cc--tt
g
C
�.�.
1 I^
� 1
. o �
SEP- 22. 2006 2: 19PM PACIFIC COAST MECH NO. 917 P. 3
N
•
•
N
Ci y pl,.
U
0
. a
m
U. sv Q o�j coo'F' ,``
6 Z NS G L v 'r
Z 'd LWON H03W 1Stl00 0IdI0tld M61 :Z 900Z 'ZZ 'd3S
E 'd Cl6 'ON H03W 1SVOO DIdI9Vd Wd6l :l 900t 'bb 'd3S
CITY OF CUPERTINO OL�O?OQ5`/
FURNACE/AC
�UPEfIiTINO PERMIT APPLICATION FORM
APN# 3S'9 — DS — 133 Date: Z 0 6
Building Address:
Z I
() S-0 MC(L0LZJ9.v ROAD
Owner's Name: ho a#:
s . R, /7bJFFLEx? oe 3, y - V i/
Contractor: Phone: License#:
/ ciFic (0Rrr M�F(-H/a.V X63 37Y
Contact: e o P one: Cupertino Business License#:
ak oaa ls-t o� 3&s-- 700
Building Permit Info:
Bldg ❑ Elect Plumb ElMech
Ef11 e.
Job D tion: ( A
�.,MQ h l_
L C� \Z. PL)XSpr IAITT,91LEJ) 1975 r;z
Residential ❑ Commercial erF or,4.;7-s
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor❑
Adhere to min set back requirement E]
or Commercial Installations: '
eplacement same weight ,eg Additional weight (structural talcs) ❑ L FSS 4o w
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy group:
W /6 7 q,3.OU
Strapped On Platform 11 Bonded 11 Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BENERGY Energy BUILDING
BREMFURN 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
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING