06030025 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,aCONTTRA,CTOR,.INFOMATIOPI .
BUILDING ADDRESS: VALLEY HEATING & COOLING PERMITNo'06030025
10492 MERRIMM RD
NER'S NAME: PERMIT ISSUE DATE
BETTY TOPP 1171 N 4 TH ST - 03/07/2006
NE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
ua� LICENSED CONfRACIDWS DECLARATION
w Job Description
1 hereby atOrm Net 1 am li¢lued under Provisions of Chapter 9(commencing
with Sarco 7011117ucDlviaiov 3ofthe Butlrcst aide Pref"•a" Code,anemylmnlsets REPLACEMENT Gr' FURNACE F'��p E®
L
W full force and cRal �✓P
jnz Lt.. CLican• rx_,�
�'Jq Dam
Can-
7th AR rMCTS DECLARATION
ItEd send y plans dull M rue u public Teeth u
a S Licensed Pmfeuional rl�rt LQUV
OWNER-BUILDER DECLARATION LY V
I I hereby 4111me that I am exempt from the Conloorm's License Law far.the
O O following reason.(Section 7031.5,Business and Profeeslum Code:Any city or county
$ which requlms a permit to construct,alcor.mpmw,demolish.or repair any structure Eli III
prier to Its lauanee,also mquires the applicant rorsuch Permit o file asigned sulemcnt
p <
ficas Im I.licensed intranom to We innevisions of the Cmancure.Lumns,Law(Chapter 9 Sq.Ft. Floor Area
Y (commencing with Section 7000)of Division 3 of the Business and prolesaians Code)ot
- 3 that he is exempt dmrtf errs and the butt for the alleged exemption.Any rlolal(on of TUV
Section 7031.5 by any appimant fora permit subjects the applicant an a civil penally of er Occupancy Type
sal mart Wan that handball dollar,(55003
❑1,uvvnerof Wepmpmy.mmyemployeeswithwwgauthe4mlemmpewdon;
will do the wah,and the structure amt intended oroQerW forule(Sm.7044,Business
and Profesdam Code:The ConracwYs License Law does rot apply be an owner of Required Inspections
property who builds cr improw,Wemon,and who dmsaah wm k hirm elf or though his
own employees,provided astsmh improvements see rot intended unaltered for ole.IL
however,the building or improvement is sold within me year of completion,the owner-
' builder will have We burden of proving that he did not build or improve for purpose of
ac.).
❑1,a owner of the property am exclusively conuacting with licensed mnuumn to
construct the project(Sec.7014,Business and Prefudou Code:)lin Cmusat ar's U. -
ese Law does not apply w an owner of properly.whe builds or immowa thereon,and.
who contracts for such projects with acommusb r(0licensed pursuant to the Comncwr's
License Law.
❑I am exempt under Sec .B k P Cfm this mace
Data
WORKERS COMPENSATION DECLARATION
1 hereby•flim under pevlty of perjury,arc of Use following declwimx
Q 1ban and will maintain aCenfiate of Cauenlbeself-insumfarWorker'sCompcn-
sulon,as provided rear by Sedan 3700 of the Vher Code,for the performance of the
work for which this permit is ist
❑I have and will main n Worker's Compensation Insurance;u required by Schon
370D of the Labor Cade,rest the performance of the weel'for which this permit is issued.
My Worker's(',p pensation�Insyylna a 'es and policy n mbc are:
Garner. N Policy No.: 1 /
CFJm�PITON FROM WORKERS
COMPENSATION INSURANCE
(Thu mcdm need nothecamplemd ifthe permit I.foram hundendellan(SIM) -
mWIL)
I unify that In the performance of the work for which this permit is issued.I shall not
employ any person in any manner m as to became subject to the Worben Compensation;
Laws of Caitfomia.Dan
Appllcam
NOTICE TO APPLICANT:If.after making this Cenincam of Exemption,you should
become subject w the Worker's Compensation provisions of the Labor Code,you must
�O forthwith amply with such previdems or this Permit shall W deemed rewind.
Zy CONSTRUCTION LENDING AGENCY
EI tremblyalliin that them i,s construction lending agency for da pe normana of
> the work for which this permit us iumd(Sc,3(Y97,Civ.C.)
w Qlender's Natne ,
Lender's Addrea
U C 1 unify that I lou mid this application aed two that tint show Information U
Ly P morn I acne in comply with all city and comfy ominames and sum laws mining w
DU building comtmctim.and hereby sutheanm mpmsenmiws or this city to coast upon the
LL7 above-mentioned property for its "313,
(We)agre w itw,Inde ray an kap hatmless see City of Cupertino against
t,y y liabilities.Indigence d Penxe+ hick mayln anyway aeenbaaminst aid City
U Incon¢que ng rthispemch.
APPLIC U S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC IONS.
Re-roofs 3 '�—
Signaut ten Da
H RDOUS MATERIALS DISCLOSURE Type of Roof
m fuwm building oceupanl nom afimndle havudous mammal
u de by upe tied Municipal Cade.Chapter 9.13,and the Health and Safety
Code. 53$87 All roofs shall be inspected prior to any roofing material being installed.
-40 E3 Y. ❑No ,,,a q
Will ft applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haseudnus all comamWams as,de0md by the Bay Ana Air Quality Mamgcerent all new materials for inspection. ..
Daniell
❑R, ❑Nu
]hewmad them le •mqui menuunderChapmr6.95oftheCalifor-
niaHcolmkSarety 5.255336d25534.Imdeamdthuifthebuilding
does not cu • t. It u my ieapoulhillty w ratifyoaupant of the
mqulmmc u me toinwceoraCertificate panty, Signature of Applicant Date
le Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
2 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34229057.00
DATE ISSUED. . . . . . . : 03/07/2006
RECEIPT #. . . . . . . . . : 33471
REFERENCE ID # . . . : 06030025
SITE ADDRESS . . . . . : 10492 MERRIMAN RD
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BETTY TOPP
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2680
RECEIVED FROM . . . . : VALLEY HEATING 6 COO
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING 4 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 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 2,348.00 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
----------------- ------------ ------------------
CHECK 329.56 14408
TOTAL RECEIPT 329.56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---'--'--------------------- --------
301 ROUGH ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 501 FINAL MECHANICAL
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEP,TINO
Building Department
J B�A�D�DRESS;^ e.R 1 PERMIT Z!5,036Q 2,S'
OWNER'S NAME: PHONE # — —
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: 7 d
gnature D e
Please check applicable subcontracto s co Tete 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
i Q J CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# -4- Date:
Building Address:
I Ci a. roc�cfl .
Owner's Neme: Phone#:
�-rLl l Tv Lkcxa -36b-
Contractor: License#:
2
VGCAI 1� Gt,*W -'t- CvaB
vlt -5 ,5LF0
Contact: Cupertino Business License#:
Nt CO 1z, �l!'10✓ )
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: .—
r 1 GiC�Gr✓tGl1r} �-'t-L.f/lGi G2-
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1"floor ❑ 2nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs)❑
• Structural Calculations required for new installation ❑
New installation Planning Approval Required ri
Cost,ofProject: Type ofCapstruption: Occupa !y:
Strapped 0 On Platform Bonded LJ Sq.Ft.Floor Area:
New Location ❑ Replacement �" ^
Qty.if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfrt MECHANICAL
BREMAIR14AN A/C Units r- 10,000 cfm MECHANICAL
BREMRECEPT Rec tl,Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
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