06020024 (2) CITY OF CUPERTINO "mom 0 T'`='"
BUILDING DIVISION PERMITCONTRCTORII1�TFfY'RMAT, Q1 *
BUILDING ADDRESS: VALLEY HEATING & COOLING PRRM'TNO06030024
10495 MERRIMAN DR
OWNER'S NAME: PERhffrLSUE DATE
DEBORAH HOLDENER 1171 N 4 TH ST - 03/07/2006
NE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITECT/ENGINEER: UI
E LUMBUMB MECH
0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am Rceraed under previsions of Chapter 9(commencing p
with Section TOM)ol'DlvWon 3 of the Businsu and Profession Congo,and liccneu MAK 2006
m, L eneomnendeRe4 gr REPLACEMENT OF FURNACE
n�x Data cmumseunr ppp
hindersSnJ my pun shall he used u publicrccorN BU I O NG
ytdS Lianed Prolasumal
N OWNER-exempt RDEthe Connote.
on of
i 9 I Mase ,(Sere o n i am exempt from the Cssumis o eLicense Ac I.A.co the '
O o following moon.(Saito 7031.5.str Business and ms.demolish,
Code:Any city m mums $2348
which rcquime Issuance,permit to mnanuc4 sir.,improve,h pe m th,ter e,sig any etrucmn
Sec tprior hathe its nsedpusum to the the applicant afar such permit nteuLnAnatement
(commencing
co me ccewith Sectio m the provision of she Contractor's Lll'Crfeso(ChapterCode)
Sq.Ft. Floor Area Valuation -
fig (cam els exewlNScctlon7000)th basis re,
oldie eged exa andes,fAnyvi Calc)or
Net he u exempt
Nem(renm and the bsats fm the alleged Gumption.Any violation of
Seton 7031.5 by any applicant for a permit objects the Applicant m a civil penalty of Occupancy Type
not mom than flue hundred dollars($500).
❑1,As urns of the Property,m my employes with wages As their Aute compensation,
will do the wars,and the structure is not intended or offered for gale(Sec.7044,Business
and Pretensions Cade:The ConuuWs License law don not appy to an owner of Required Inspections
property who W lila or improves N.mn,and whendocs suchwork himse fmUuough his
awn employ=.provided dant such Improvements w act Intended mortared Russia If.
however,the building or improvement is gold within one year of eompledon.Ne owur-
bullder will have the buten of proving that he did not build or improve fee purpose of
sale.).
❑1,As awns of the property.am exluuvely contracting with licensed coneaconis N
contract Ne project(Sec,7044,Business and Professions Cade:)Tin Cennrruxrl Li-
am Law does not apply in an owner of propeny.who builds or Improves torment.and,
who con0acu for such pm*u with a canuacuer(s)licensed pursuant to dor Conoactoei
License Law,
❑14M exempt under Sec. .B d:P C for this Maven
Owner Dau
WORKER'S COMPENSATION DECLARATION
40 I hereby afnnn under perWry of perjury am of tor fallowing dalwion:
❑I haw and will maintain a Certificate orcoment toxlf-Insum fmwolice compar,
cation,u provided for by Section 3700 of the tabu Cade.for the pedosmena of the
wort for which this permit is issued.
❑1 lave and will mountain Wox e s Compnunion I.,As acquired by section
3700 clubs Latin Cede,far Ne performance of the work fm which this permit is broad.
My Workee amreruin�g�t //ani.and Polity
Carder.
CERTIFICATE
ERTIFlC OF EXEMPTION
tyFROM
WORKERS
COMPENSATION INSURANCE
.
(chis section need notbecompteteJ if Ne permit is furan hundred dalun($10()
or las.)
1 certify that In the performance of The work for which this permit u issued.I shell ret
Cmploy any person In my mmner an AS to became subject to the Worlons Comp.tation
Uwe of California.Dan
Applicant
NOTICE TO APPLICANT:If,after making this Continuous of Exemption,you should
become object to the Workers Compensation previsions of Ne hits Code,yen in=
0 forthwith comply with such prevision or this permit Shalt be domed aerated.
,zea A"' CONSTRUCTION LENDING AGENCY
Fw"�" I hereby affirm that Nem is a connotation lending agency fm tix Mifxrmanceof
E
? use wort for which this permit is iaud(Sce 3097,Civ.C.)
4 Q Iandc's Nana
]Z lander,Address
U Q 1 totally than I Mvo mad this application and Soto to the shove Information u '
F Caren I agme to comply with all city and county andmances and guts laws relating to
O U building convection.and hereby auto' rc unutives of Nu city to order upon the
L3) abovo-mcmio ed prapcny f c pe-1
si s.
0. (We)acme t .Inde and keep harmless the City ar Cupertino against
y liabilities,ud ex nu which may In any way scene against said City
U 7 In canxq of the grmting a is permit
A APPLICA UN AND WILL COMPLY WITH ALL NON-P INT. Issued by:,91(�&o Date
SOURCTION .
Re-roofs
similifumDa
OUS MATERIALS DISCLOSUREIf Type of Roof
pl t uuac buildingaceupanlsiommlundk h.amou matedu
x dell by Un penim Municipal Code.Chapter 9.12.and to Health and Safety
❑ 13 No Code, an 3x0)7 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant six cqutpmat ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haramous air contaminants a defied by the Bay Area Air Quality Management all new materials for inspection.
District?
❑res ON.
I have mW the hens anri quircments under Chapterd95of the Calif.,
nia Hcal"SefctyC d 25 533.425534.Itemarnand thin lftite building
Jas not cum by w A .40 is my responsibility to notify tic ace , of
requirements beret ran usumcwr a Cemnewc of amp Signature of Applicant Date
owner men get n All roof coverings to be Class"B"or better'
CITY OF CUPERTINO
1 of 2 PERMIT RECEIPT OPERATOR: kiexsaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34229057.00
DATE ISSUED. . . . . . . : 03/07/2006
RECEIPT #. . . . . . . . . : 33471
REFERENCE ID # . . . : 06030024
SITE ADDRESS . . . . . : 10495 MERRIMAN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEBORAH HOLDENER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2680
RECEIVED FROM . . . . : VALLEY HEATING & COO
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 HAL
__________ _____________ __________ __________ __________ __________ __________
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
�I
• Olyc�3 w�j—
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN# O❑� ,o Date: c016 .
Building Address:
wner's Name: Pone#:
H-eold2n¢-r 1}�.o0&-U-4b- 41211-0
ContM, l�Qa 11 fi CoOlt Licc.2g 0
Contact Cupertino Business License#:
Nt �Ie� YY�1nol \L --
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
CQ,
Resident al p/ Commercial ❑
For Residential Installations:
Attic ❑ la 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
Cost of Project: Type of Construction: Occupa gro
Strapped U On Platform LJ Bonded L.1 Sq.Ft.Floor Area:
New Location ❑ Replacement 8 '
Qty.if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 elm MECHANICAL
BREMRECEPT Recial,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