08110067 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kwe0 t1CTOR.*Il l.''4 'I`tk`CIOAI`
vz wlpa�t- d'4 T= ?I;4 T� ;sig§
BURRING ADDRESS: PERMIT NO.
21825 BENETTI CT BAYHILL HEAT & ATR ogiinn07
OWNER'S NAME: FStNur ISSUE DATE
KATHV TT
A CONTStOL Nth.
INE:
(650) 948-5900
ARCHITECT/ENGINEER:
BURRING PERMIT INFO
BLDG FJ.ECr PLUMB MECH
seep LICENSED CONTRACTOR'S DECLARATION Job Description
F U F 1 bemay afford dust 1 am licensed under pmvisimu of Chapter 9(commencing P
wiN Section 70M)ofDivkion 3 of NC Business and Professions;Code,aml my license is
"oedninfmrdefl
lfoetoea- C� ( ' S• FURNACE REPLCMNT 110, 000 BTU
j�j? License Clur G% LW g
'-� Dem —Conmeac, Ui(L N~5! a'-
AH
ARCHITECTS DECLARATION
U 1 micnund mY plane shall be used u public mcaNs
Mu
G t; Licensed Profeasia ul
5 OWNER-BUILDER DECLARATION'
iw I herby affirm that 1 am exempt from the Contractor's L.ieenm taw for tW
i 0 0 following Masan.(Sada.7030.Busimu and ProksaiaM Code:My city or wanly
_ which do sires a permit to cm dardcL alter,improve.demolish,or mpair any suaium
Zi- prim,du ids issuance.alfa requim sec applieau forted pennil to file a signed sutemwt
ESG
that heulicensed puresmLWuse pmvisimuafthe ConuacMYslic nmlaw(Chaina9 Sq.Ft.Floor Area Valuation
ser- (commencing with Section 7000)of Division 3 of the Business and Profcssiov Code)m
1,52 sew ha is exempt t-drrmm and the has.for the alleged esmnpum.Mr vlalauon err $2200
Session 70313 by arty applicant for a Permit aubjecu tete appfcanl M a civil pmully of APN Number Occupancy Type
not mor wan five Wished dmlam($MU 32649031 . 00
❑L u n,wou Of sex propos mus m outfou dedwith wgn u ain(See.
Buadw,
will dowework.ands, souuurssides undedwOwdo for sak(Sec.]Oso Bmunea Required Inspections
and mywho u code:mToopr CanumMfs red who Law dam tet appy if an owner of q P
Own nywlMWiprovidmpmves thaeocandvho doesswhwoekhinueacul for
his
awnem.th buiproHdWthattechimpmwmwlsartnot intendedmoRered far owner,however.thou building or improvement ts cold within ow year of completion,the ore of
builder will love dm WNco Of proving that ha did not build or improve for purpose of
❑1.as Owner of the property,am exclusively canumling with licensed conmams In
convect the Mica(Sec.7041,Business aha Professions Code:)The ConoaeMYs U.
come Law does out apply to an owner of property,who builds or impm.thereon,and,
who comment fm arch projects with a eonua rare)licensed pmmam W due Conoacmr's
Lice.taw.
❑lamaxcmptunder See .B&PCfmthu Macon
Owner Dau
WORKERS COMPENSATION DECLARATION
I herby slim under perulty of perjury arc of the following dedemoimts
I ba,e aha will msinism.Certificate.(Coosem to mlf-rococo fa WorkersCOmpcn-
on,u provided for by Section 7700 of the tabor Code-for the performance of use
work for which this permit is issued.
]00F I haw and will maintain Workeh Compensation Insurer¢,u Mquird by Section
of dte tabor Code.for the,periarmma of the wmk Ire which this .it u Issued.
My Worker's Compmeadw Laron¢carrier and Policy number an:
Carrico:9-visg-'F1 WD Policy No.:x-13-Go 21055r
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ibis smith read not W completed If tha pemitts fmow honored dollars(SIM)
or less)
I certify that in the peeformenec of the work for which this permit is issued.l shall not
employ my person its my mmrterm as M become subject M sea Wortcn'Compcnsulon
Laws of California.Data
Applicant
NOTICE TO APPUCANT.IL after making this Cernficax of Eumplion,you shouW
became meeet M we Wooten',Compcussit provisions of the LsWI Cade.you mwt
.,0 forthwith comply with south provLVaw or thus permit shall W doomed molded.
Z 7) CONSTRUCTION LENDING AGENCY
[-+ 1 hroby snide WI Wert is a communion lending agency for the perfdmama of
!Yithe work far which this permit u issued(Sec.309'1,Civ.C.)
W Lander',Name
0.
,0 z Undoes Address
U O 1¢rtify Nat I haw read this application W state most the above information is
Ix. F corral 1 agree M comply with all city and county on .and sum laws rtlating ut
-0building construction.sad hereby authorise rprescroadI ofthu city Mater upon the
UAleve-mentioned property for Impetuouspurpenes.
(We)agree to nth,indemnify and kap harmless we City of Cupertino against
tiy liabilities.judgments,casu and expends which may in any way amuse against said City
U AeonmgwT ofthe RSw NOS thisPermit.WILL
j�
APPLICANT UENDS AND WILL COMPLY WITH ALL NON-POINT issued by: Date
SOURCE R 0
Re-roofs `
Sign re of ApplinnoComncmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or for=building mcupwtsmr or haudlc hvWous material
as panned by the Cupertino Municipal Code.Chapter 9.13,and the Hcalth and Safely
Code,Sadao 25532(a)+ All roofs shall be inspected prior to any roofing material being installed.
0y. ETN
Will the applicant or future Wilding oavpant um equipment err devices which If a roof is installed without first obtaining an inspection,I agree to remove
.,It hadardnw air conuminanu as defncd by do Bay Arta Air Quality Management all new materials for inspection.
didaria?
DYca I<
1 haw rad ons heard.materials requhcmcw umerchapter&95 of theGlifor-
nu HcrN&SafctyCode,Sectiow 255(15.25533 am125S3/.T urWenwW waif dx Wilding
older not currently haw a Iwant.tha it is in,responsibility to notify the occupant of dx
rcquimnxnuwhk m W met prior W inwmce ofa certificate of 9ximsemy Signature of Applicant Date
/l try
ownand agent Dai. All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32649031 . 00
DATE ISSUED. . . . . . . : 11/18/2008
RECEIPT # . . . . . . . . . : BS000006642
REFERENCE ID # . . . : 08110067
SITE ADDRESS . . . . . : 21825 BENETTI CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KATHY LI
ADDRESS . . . . . . . . . . : 21825 BENETTI CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1221
RECEIVED FROM . . . . : RICARDO P VALDERRAM
CONTRACTOR . . . . . . . : RICARDO VALDERAMA LIC # 30480
COMPANY . . . . . . . . . . : BAYHILL HEAT & AIR
ADDRESS . . . . . . . . . . : 262 MAIN ST
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
TELEPHONE . . . . . . . . : (650) 948-5900
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
--- ---------- ----------
TOTAL PERMIT 224 . 85 0 . 00 224 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------------- ---
CREDIT CARD 224. 85 VISA
---------------
TOTAL RECEIPT 224. 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4W-UPEkjIN0
Building De artment
JO�Ai lgoR&SPERMIT #
�S: �-1-M 6);-
OWNER'S NAME: ' !j PHONE #
GENERAL CONTRACTOR: P (L FAX#
I am not using any subcontractors: 11 ao a
i 4tuxe Date
Please check applicable subcontractors and om lete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
O 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
7r Contractor Signature Date
0?//
CITY
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTiNO PERMIT APPLICATION FORM
APN 432 , �,^C) 3 I Date:
Building Address: ol
Owner's Name: ,� 11 � / (•� Phone #
Contractor: I ( Phone # -
I12 Fax #: Cl
Contractor License#: Cupertino Business License#:
G� tl
Contact: Phone #
Rv Q2P V K l Fax #:
Building Permit Info:
Elect Plumb Mech ❑�
Residential Commercial
Ask
Job Description:
T ,WA,,
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural c_alcs) ❑
Structural Calculations required for new installation ❑ _
New installation Planning Approval Required ❑
Cost of Project: 40-12 of Construction(Usage Class):
�r Oo \./ C
Strapped On Platform ❑ Bonded New Location ❑ Replacement
Project Size: Express [-r Standard ❑ Laze ❑ Major ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/AC
CI O
CUPER,TINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
IMCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
IBPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT .Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit. _
IBSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
r cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
IMRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M •
replacement of ea appliance vent
install ¬ incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type