060201411
C
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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