07080033 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � 7CLQiTIfl�1'
PERMIT NO.
BUILDING ADDRESS:
21984 MC CLELLAN RD VALLEY HEATING & COOLING 0033
PERMIT ISSUE DATE
OWNER'S NAME:
SITYR TING LI AND LI YU 1 71 S A CONTROL NO.
IE171DTTCr71 LCL'
(408) 294-6290
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
z LICENSED CONTRACTOR'S DECLARATION Job Description
FI hcrcby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 70(10)of Division 3 of the Business and Professions Codc,and my license is 2X FUR1,AC E REPLACEMENT & ADD 2X ALC S.
N in full force and clfe
z_ License s Ltc
o Date Contcaet
ARCHITECTSDECLA�01
{ I understand my plans shall be used as public records
Ci
y Licensed Professional
j OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct.alter,improve,demolish,or repair any structure Valuation
y prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $13569
o (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of -. 00
p Occupancy Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of 3560804:3 . 0 N Number P Y yP
not more than five hundred dollars(5500).
p 1,as owner of the property,or my employees with wages as their soic compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
constrocL4he project(Sec.7044.Business and Professions Code:)The Contractors U.
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractofs
License Law.
❑1 am exempt under SeB&P C for this reason
Sec.
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
2]have and will maintain a Certill..of Consent to self-insure for Workcfs Compen-
ion,as provided foe by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker' mpemsation I ranee,amici and Policy number are:
Cartier. 1 Policy No.:
R CATE OF EXEMPTION FROM 0 ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars(5100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed revoked.
0 CONSTRUCTION LENDING AGENCY
r--+ I hereby affirm that there is a construction tending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
a Q Lender's Name
Z Lender's Address
1 certify that 1 have read this application and state that the above information is
r.
correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments,costs and expenses which may in any way accrue against said City /tee
Z in consequence of the granting of this mil. Date l
►- APPLICANT UNDERSTAND W LL CO Y WITH ALL NON-POINT Issued Ey:
SOURCE REGULATIO /
Re-roof; v
Signature of App" VC r ale Type Of Roof
H US MATERIALS DISCLOSURE yP
Will th appli t or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Cl Yes
'05If a roo is installed without first obtaining an inspection, agree to remove
Will the applicant or future ilding occupant use equipment or devices which
,mil hazardous air contaminants�y ,fined by the Bay Area Air Quality Management all new materials for inspection.
District?'
❑yes u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant or the Date
rcyviremenLs which must met prior to issuance oC a Certificate of Occtrpancy' S 1 nates re of Applicant
All roof coverings to be Class"B" or better
Owner or auth 7 c a are
Community Development
` 10300 Torre Avenue
Me
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
''UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # -
GENERAL CONTRACTOR: 4&& �e•Ci. FAX #
I am not using any subcontractors:
c-ignature Date
Please check applicable subcontracors and coni 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT' RECEIPT OPERATOR: Patg
COPY # : 1
Sec: Twp: Rng: Sub: Bll:: Lot:
APN 35608043 .00
DATE ISSUED. . . . . . . : 08,106/2007
RECEIPT #. . . . . . . . . BS )00002260
REFERENCE ID # . . . : 07 )80033
SITE ADDRESS 21384 MC CLELLAN RD
SUBDIVISION
CITY CUPERTINO
IMPACT AREA
OWNER SITYR TING LI AND LI YU TRUSTEE
ADDRESS
CITY/STATE/ZIP CUPERTINO CA, 95014-4058
RECEIVED FROM VPLLEY HEATING & CO
CONTRACTOR . . . . . . . : A'IKINSON, THOMAS LIC # 141
COMPANY VALLEY HEATING & COOLING
ADDRESS . 1171 N 4 TH ST
CITY/STATE/ZIP SIN JOSE, CA 95112
TELEPHONE (908) 294-6290
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
___ _ _
-- ---------- - ---------
---------- --
BENERGY PERMIT FEE 1. 00 34 .86 0 .00 34 . 86 0 .00
BREMAIRHAN NO.UNITS 2 .00 20 .52 0 . 00 20 . 52 0 .00
BREMFURN NO UNIT 2 . 00 28 .62 0 . 00 28. 62 0 .00
BREMRECEPT NO. OUTLETS 11 . 00 13 .20 0 . 00 13 .20 0 .00
BSEISMICRE VALUATION 13, 569 . 00 1 .40 0 .00 1.40 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
PPERMITFEE FLAT RATE 1 . 00 38 .37 0 .00 38 .37 ------0_00
---------- ---------- ----------
TOTAL PERMIT 213 .71 0 . 00 213 .71 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------
--
CHECK 213 .71 #16566
---------------
TOTAL RECEIPT 213 .71
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
��a� oa33
CITY OF CUPERTINO
FUI RACE AC
CUPER,TfiN0 PERMIT APPLICATION FORM
APN# Tate-
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Building Address:
Vy-� _b X110-,v-\ w2x--A
Owner's Name: Phone#: ='
Contractor: License#:
LA
Contact: Cupertino Business License #:
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Building Permit Info:
. Bldg 2r Elect C Plumb C Mech E�—
Job Description:
a C--t� X
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2°d 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 Constriction: Occupancy group:
Strapped LJ On Platform Bonded 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 cfm MECHANICAL
2 BREMAIRHAN A/C Units<= 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