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060201411 C U� �J CITY OF CUPERTINO T,NFOhRMAT�IQN BUILDING DIVISION PERMIT ;CONTI2ACCOR BUILDING ADDRESS: VALLEY HEATING & COOLING PERMITNo.06020141 22821 MERCER RD OWNER'S NAME: PERMIT LSSIIE DATE DIANE CARTER & DARRYL OQI 1171 N 4 TH ST - 02/23/2006 NE: SANITARY NO. CONTROL NO. (408)294-6290 ARCHITEC (ENGINEER: BURRING PERMIT INFO BLDG ELECTO PLUME MECH O i LICENSED CONTRACTOR'S DECLARATION Job Description o 1 hereby affirm Nat I am limomme under provision, of Chapter 9 (commencing. 3 with Section 7")of Division 3 of the Business and Prafertlum Code, and my license is In fall fame sad affil. — ' INSTALL 2 HEATING/CQOLING SYSTEMS Llan ate uc.R J4 DeG uismar AND 2 TANKLESS WATER HEATERS lo TS DECr ARCHITECT'SATION I understand my plansshall W used u public records Licensed Professional 3 OWNER -BUILDER DECLARATION p I o1Tvm Lew for the 1 am exempt from the CenlmnCo Business and Profession Cade: Ansi tiny county follo` mus on 703 : Any c mason. any structure to eonmme,, alae improv, demolish, ur s e which t unter which re permit its issu n e. sh0 e a sig fonuehpemi's Lieasignedsummenl e,dantto minutes rWisio toou Sq. Ft. Floor Area Valu 1/316875 dpoor of IhalheleBaNedpurWanl b Ne pmvlYOR nl thee hei.,ccmd 6Ne1Jmat Codner9 f 7 of Business vi Cantle)or Buinrss and Preon. withbandoned S butian anal M . req %l my • Thal W 4 asemph dtere(rom and dr buts (ter dr a11egW cumptioo. My violation of and APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of trot short than five hundred dollars (M). 34222090.00 ❑ 1, a owner of the properly, army empiayco with wages as theirsok compenssdon, Required Inspections will do the work, and the sWnpm isnotincaded oroffered formic (Sec. 7044, Business and Profession., Code: The Convectorsss License Lew donot apply ane an owner of 9 P property who built or im prover thenen, and who doessuch work homelier through his own employms. provided dude such Improvements tae vert Intended orm0emd fordo. if, however, the building or improvement Is sold within one year of completion, the owner- bullda wi0 hew Our When of previna tha he did ned build or improve for purpose of sale.), ❑ I, u ower of Ne property, am exclusively contracting wit flamed contractor u conswn the project (Sec. 7044, Business and Promssioe Cott The Contender Li- cense law does not apply in an owner of property who WOds or improve Merton. and who convects for such projects with a contractor(s) licensed pursuant to the Carmichael License Law. ❑ 1 am exempt under Sec. . B & P C for this name Ower Dam WORKERS COMPENSATION DECLARATION I hereby air= under penslry of perjury tee of the following daWuons: I haw and will crsinuln a Certlfiate a(Cemsem to self -Insure far Wmares Cempen- ' len, u provided for by Satan 7700 of the labor Code. for the perfomunce of site rk for which this permit Is Issued. 1 have and will maintain Worker's Compensation Insurance, a required by Semon 1;37"00 of the Labor Code. for the performance of the work for which Nis permit i/s I_ssued. yWcrkcespmccda •I carrier and Policy bbe�r a/rt•]�Oi�lrrier. I V1 Polid Ne.: `--`-r' - CERTIFICATEO�Pnob FROM WORKERS COMPENSATION INSURANCE ffbis=im need not uncompleted if the permit is parous humheddollan (5101) or lees.) I mortify that In the performance of the work for which this permit Is issmd, I shell not employ any person In any manner an as in became abjnet ro the Workers' CompemNon Laws of California. Dam Applicant NOTICE TO APPLICANT: IL spier making Nb Certificate or Exemption. you shwld become subject u the Workers Compensation provisions of six labor Cot, you mum >. fornwilh comply with such provisions or this permit Nall W deemed revoked. yCONSTRUCTION LENDING AGENCY I herby ichtrm Ne there Is a lending agency for the performance of ed (Sm. 3W7, � sire work fur which Nle permit Is Issued (Sne. 7097, Civ. CJ ' Lender's Name Lenders Addmns I mortify that 1 haw mad dila application and sum Nu the above infoenmun it ' contrast lag= se comply with sin city and county ordinances and mite him mladng in Wilding convection, and hereby anthorire mpmsenwives of this city M cater upon the o shove -mentioned property for Inspection puryates (We) agree to saw. inde fy and keep harmless the City of Cupertino against 141 Ilabifiia,judgmen oma a useswhich may in any way acme agunslddCity >' inconmque rand o(Nis pennll. APPLI UN RST DS AND WILL COMPLY WITN A NON -POINT Issued by:9 Date�- SOU R 4 1233 Re -roofs Type of Roof Sr n s nurator BOGUS MATERIALS DISCLOSLI D pi 1 or It. Wilding aecupant morembui lc harndoa serial U define b Cupenno Municipal Cade, Chapter 9.17. and the HNth and Safety ode. Seemmnn53afa)7 y, All roofs shall be inspected prior to any roofing material being installed. ❑Ya No If a roof is installed without first obtaining an inspection, I agree to remove Will site eppllmanl or future Wilding wcuponr sea equipment or devices which II haarmus air contaminants u dcMcd by the Bay Amo Air Quality Managcmcm all new materials for inspection. Dimness? ea�� Yu quiremenu under C7upter6.95oftheGlifor- I have read dieWbwor nuHcalth&Safe .337em1753M. 1 undrmmrd Nui(thc Wilding does etc Mwas rtspurWhilityumxify NC Ott art of Nc rcyufecme his muamc rte cenrmm or Ocw Signature of Applicant Date All roof coverings to be Class "B" or better ower a ant Dmte s aTYOF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building De artment JOB ADDRESS: '2 cda1 meRCEp eS �CPQ PERMIT # 06 zi -z 0 1 OWNER'S NAME: —r �- g1Z\ BUSINESS NAME PHONE # 469- 1 - GENERAL CONTRACTOR: \J O FAX # t i I am not using any subcontractors: Q1.).:2 D S, Dat Please check avvlicable subcontractors an co net a following information: Contractor Signature ,=Pz3Oco Date 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 ile Contractor Signature ,=Pz3Oco Date CUPEkTINO Assessor's Parcel Number: Name of owner. Project address. 2? -9-21 Leder' 2d Contact person. Y e-2 E- -OZ iho-i Q Phone. Fax. 2 `7 K g- 2 C-/ 7 Net square footage of lot. Existin Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project? On what floor(s) is work being done? Proposed Brief description of work. A old, eL- ACyY% �1'S wyFcr- l��a_r-1' Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC ®N) 2001 CPC dV N)2001 NEC N) Effective 11/1/02 Book Page -8 -Revised 4/28/04 C" OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM N # 3 y a� as 6 9(� Date: Oo`Z o2/ / (C2 2 z'nAc�dresge�Ce�EsO�%� Mailing Address (if different from building address): ner's N e. 1� d ( k Phone #: MECHANICAL I 4tr ( : 1 � eo�X13 OO Ii eV Yl License #: o`���S o tact: Phone:lq V6 Cupertino Business e se#: S —& Y.)ClZ Fax: 90E<- c;q`q - 7 wilding Permit Info: / BldgEl Elect Ls� Plumb 2-' Mech lei Job Description: Cpp iiJ� STPv'>1 w o� Residential El111}T i TWO C=berci�lSN ❑ ex,Tz Sq.Ft. Floor Area: q.Ft.: . Cost of Proiect: o^ Occupancy Group: Type of Construction:' tij-- Please check this box if the project is a second -story addition: ❑ ro'ect Size: Standard Lar e ❑ Major ❑ BBOILERS I� u uant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BB..OILER3. Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 yr CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstaBlAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAUGAN A/C Units <=10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREN9 UM Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL 13REMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL iJ 2 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Sob Specific Plan _ BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMTTFEE AZech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUIIIBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commet Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 1 J s