06080235 (2) CITY OF CUPERTINOa .777777777777777777=,,'"
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amLDINGDIVISION PERMIT CONTRAGTnRII�F�ORMACION
BUILDING ADDRESS: VALLEY HEATING & COOLING PFR"7ND06080235
10121 PHAR LAP DR
OWNER'S NAME: PERMR ISSUE DATE
ROD HOO 1171 N 4 TH ST 0
SANrTARY NO. CONTROL NO.
(408) 294-6290
7-71-c
TIENGINEER: BUILDING PERMIT INFO
BLDG 0= PLUMB MECH
iOz LICENSED CONTRACTOR'S DECLARATION Job DCSCiIphOn
aaC 1 Wrathy affirm that I am licensed under provisions of Chapter 9(commencing
�iW wiNaIX1U
Suon 7 )of Div 'on]ofNC Busiass an ofcssiun+
. Codc.and u
myl"ccnx
<a mrnnmrz anderree 7/� —G7S1IT/ REPLACEMENT OF FURNACE AND ADD A/C
Liccnx CI ` ✓ Lk.N A
ar
;F:Q. Dale •— used a pis
j A HITECI•SDECLARATION
i s< I understand my plans shall W acted as puM1li<menrds
:.0
Licensed Professional
g OWNER-BUILOE0.DECLARATION
IE I hereby aTifm Nm I am axempt frum the Contractors License Law for the _ •Y
.ct O following muon.(Section 7031.5.Business and professional Calc:Any city or manly V
�: which lequires a permit m construct,alone improv,demolish,Or repair any owetum $7841
.z i prior m its issuance,also"Ohms dm applicant for such permit m File a signed summenl
< that be isli emodpursuant toNcprovisions ofthe ContrazuriUeense Law(chapmr9 Sq. Ft. Floor Area Va nation
ii-0
(commencing with Section 7000)of Division]of the Business and Professions Code)or
? _ that he is exmpt themfwm and the beau for the saged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects de applicant ro a civil penalty of r Occupancy Type
net mom Nan five handled dollen(SSW).
❑I,u owner of tW property,a mY employers with wagea u thew tele campevation,
will dothcwork..adthatercture is notinsandcdoroRered fartak(Stt.701/,Business Required Inspections
W uac
and Panfasslons Code:TConmes License Law does not apply W an owner of 9 P
property who WildsorimprovrstWrmn,and who dmasuch work himselfor through his
awn employees,provided ornament improvements art not hamaked walferrd for We.If,
however,the building or improvement is said within ate year of completion,the owner.
builder will have Ne burden of proving that he did Out Wild or improve for purpme of
sole.).
0 1,as Owner of Ne propenY•am exclusively contracting with Bcenxd contractors to
construct the project(Sec.7014.Business and Pmfaevons Cade:)The Con onand's V
cense law docs not apply to an owner of property who Wilds or improves tW rem,and
who contracts for such pmjem with a contractor(s)licensed pursuant to the Conuacmrs
License law.
r]1 am exempt under See .B&P C for this muon
owne, Data
WORKER'S COMPENSATION DECLARATION
40 I batch, from under penalty of perjury We of tW following declarations:
I haw and will maintain a Certificau of Consent to salt-insure for WorkcraCompen-
salion,as provided for by Section 37W of the labor Cade,for the performance of the
work for which this permit is issued.
r-I 1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the Labor Code,for Ne performance of the walk for which this permit is issued
My WOr s ompeasWarta eartfm and Policy are:
Carrier, policy Na'
TIFlCA 0 EXEMPTION FRO WORK S•
COMPENSATION INSURANCE -
C1Tu section need oat W completed If the permit is fortune hundred dollars($100)
Lar kat)
I certify that in one pe,finar .of the work for which thio permit u issued.I shall nm
employ any person in any manner an as to became subject to the WmIcuri Compeuxtion
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject m the Walker's Compensation provisions of the Lane Code,you must
.J2 forthwith comply with such provisions or this permit shall W deemed mokcd.
z CONSTRUCTION LENDING AGENCY
(~� k for by which
North is acamuea3097.funding agency for the performance of
UQ Le work for which Nis permit ts tsaad(Sec.3097,Civ.C.)
6W.z Lenders Name
7 z Lenders Add.
U 0 1 canify Nat 1 have read this application and au m that the aWm in(armadun Is
ty E correct.1 agree to comply with all city and county ordinances and sue laws Minting m
O V building construction,and hereby authorim representatives of this city to curer upon the
LU alcove mentioned property for inspection purposes.
C. (We)agree to save,indemnify and kap harmless the City of Cupcnino against
nFa fA liabilidetjudgmcnts,coos and expenses which may in any way accrue against said City /f
of th,goal
C)z AVPLICANf UNDERSTung of thlND onIL LL
0 LTH ALL NON-POINT Issued by: Date _ 'LgrU
SOURCE REG ULA/0
Re-roofs
Sigmumaf ApplfcanVCo `Det
H AR USM AIS DISCLOSURE Type of Roof
W'f tW applicant or mart Wilding oaupant smM or lundk hvaNam mamrial
as deft d by flue Cupertino Municipal Codc.Chapter 9.H,and the Health and Safety
COde. oda^25532(a)? All roofs shall be inspected prior to any roofing material being installed.
41 Yea
Will the applicant car rem Ob iIJing acupant x equipment car kviw which If a roof is installed without first obtaining an inspection,I agree to remove
andit hanranu air comarninanta fired by tW Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yes
07K—
I have mad the heard.,maeli ds Mq.i.ments undo Chapter 6.95.(Ins Califon
Mia HcalN&Safety Cade,Scetims 25505.25573 and 75534.1 understand than ilthe Wilding
id.let cunenllY am,dual' my resile ' 'lily Id notify the meap rt of thertme ace ¢ateafoc cy. Signature of Applicant Date
ros ham agcm Dam'
All roof coverings to be Class"B" or better
_ - Community Development
m t 10300 Torre Avenue
rye. Cupertino CA 95014
Telephone(408) 777-3228
CITY Of Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
o _a23S
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: �T
tgnature Date
Please check applicable subcontrto s d com lete 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
er/ ontractor Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32618012 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35811
REFERENCE ID # . . . : 06080235
SITE ADDRESS . . . . . : 10121 PHAR LAP DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROD HOO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JEFFREY FAULKNER
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 BAL
------- --- ------------- -------- - - ---------- ---------- ------ ---- ---- - -----
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38. 37 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 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 176 . 54 0 . 00 176 . 54 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- - - - ------- - -----------------
OTHER 176 . 54 MASTERCARD
TOTAL RECEIPT 17G . 54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
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CITY OF CUPERTINO
l FURNACE/AC
CUPE(_TINO PERMIT APPLICATION FORM
APN# I ^L Date:
.'
Buildin!Aldress: 29�(
IU1 1 V1G1.✓(- ' f'/
Own s Name:
� Phone#:
Contractor; —aS�—
}�cp License#:
Contac[: Cupertino Bus' essss License#:
Building Permit Info:
Bld ❑ Elect 9� Plumb ❑ M ch
Job Description:
¢— -A
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1"floor ❑ 2nd floor❑
Adhere to min set back reuireme
For Commercial Installations:
• Replacement same weight ❑ Additional weight(structural calcs)❑
Structural Calculations required for new installation ❑
New installation Plannin A roval Re uired
Cc t of Pro'ect: Type ofnstruction: Oro
-� �i - (v ccupan g_
Strapped On Platform Bonded Sq.Ft.Floor Area:
New Location ET— Re lacement
Qty.if
Applicable BENERGY Fee ID Fee Description Fee Group
Ener y BUILDING
BREMFURN Relocation ofFumace MECHANICAL
BRE COVER A/C Unit>
BREMAIRIIAN 10,000 clot
A/C Units r— 10,000 cfm MECHANICAL
BREMRECEPT Rec 11, Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue
BPERMFEPLUMBING
E
Bad Permit Fees BUILDING
BPLANCHK Plan Check Fee
BUSLIC BUILDING
Business License BUILDING
•