08120122 CITY OF CUPERTINO � °�r� �k�z�`"�.r' � ""�� --�� ��- �
em�o�rvc orvisiorv pERMIT CONsTR[�GTOO R�INI�'ORMATIO�V.��
e.��� ��� <� > ���a=�� _< �R
BUIIDING ADO0.E55: PFRM(f NO.
10319 BRITTANY CT A & H HEATING '
OWNER'S NAME: PE[LWf I4UEDATE
PHONE: . A . COMROL NO.
(408) 279-0722
ARCHRECf/ENGINEER:
BUIIDING PERMIT INFO
BLDG ELECf PI.UMB MECH
� 0 � �
uo LICENSEDCONIItAC10R'SOECLARATION ' ,TObD05CfIpIlOI1
�� 1 krcby iffiem Nai I vm li¢vcE wuler pmNxions nf CNqcr 9(<ommcncin`
w wiNScc�on'/IXIU)ofDivialon]of�ACBusm:u�nEProfessiuiuCodc.�nEmylkenxie
d ��r�nro�,�aerca RMV&RPLC FURNACE
">'q i uavc �w —L� tJc.t ��O Z— . •
"n F q Da¢ 2- Conuurnr s--
e W ARCHIIECfS DECLIRAT N
?�U I uMuvanJ mY Piw sAYI bc ussd u Public rtcord�
�a� LicemedNufessional '
5 OWNE0.�BUILDERUECIARATION
�i 5 I hcrehy aRnn Nni 1 em cxcmpi Gum Nc Canlranoff Liccn�e law far Nc
O O follawinp muon.(Secuun]0713.Businrss anE Pmfeuions Cak:Any ciiy m coumy
5$� which rt9uims a pcmiit m consw0.�Imr.impmve.EcmnlL h.m¢pair my swcwrt '
_Z� p110f LLl i13IYYiKt.iLW RQuiRS NC i�I1C1111(Of SUCII Ptflllll b f IC i SIL�5�11[RICnI
E o ,n„n��rK,,,,w��,p,.��m���.�sm�or�co���r,ua��.ccn.��v Sq.FL F1oorArea Valua[ion
x� (rnmmcMingwi�h5¢tian7000)of0ivuion7afNeBurinevonEProfusiomCoUe)or
i�� uw ne u eump�inurtmm�na uc rosi�rm ine��cew c.cmc�oti��y.�o�.da�er 2 4 8 5
Stt�w'/O113 Eq ury appliunt fw t pumi�mbjccu Nc�pplicm m a civil pcnalty af ppN Number Occupancy Type
na�mart Wn five 6und�eE dallva(t500A 3 6 9 3 0 019 . 0 0
❑I,u awar of the qvpaty,a my cmpl%cu wil�w+5e�u ilie'v wle compew�on,
will Ea Ne wo't�nE Ne�vuclu�e It wt intended or oRertE far��le(Sa.]1/46.Businw
md Rofuvom CaEe:The Can�acmY�Lia�ue Law Eon not apply m m awncr o( Required Inspections
pmpenywhopuilAiaimproavNemon.andwhoCoessucAworkhimselforNmughhu
own emplayce�,pmWOed iAai iuc�impro�emenU ve not in¢nOeA arolfemA forale.l[, �
howevv,Ne WilEing or impm`smcn��wIC wi�hin orc�ev a(compleuan,Ne owKrv
puilEm will luve Jr huNen of pmNnp Nat he EiE m�buiW m imp(me far P�of
ule.L
❑I.u awxr ef Jic qopcnY.��ucluvvcly conuec�ne aiN IittveE mnu�non�o
� coiut�uc�Uie pmjett(Sec.]OCd.9u�in¢s anE Pro(eeda�u Code:)'ITe Caovac�oYs Li� .
�ciue[�w Eou no�epply io�n aww of peopeny who EuiIE�or impmms Nerton,'nA
who conmcu(orsuch O�leeu wiN aeonuanoKs)IittnxE pumwnt m ihe Convacmr'e
Lkenee law.
❑IunuemptunderSee ,BkPCforNurtvon
Owner D��e
WORKFR'S COMPENSATION DEClAMT10N
1 bucby�Rim unEer peodtY o(perjicy orc of Ne follawini��o�:
Q IhsmandwillmunuinaCutifinmolCoventwxlGimurtlmWmluYsCompcn- '
mion,u pmvih0 Por Ey Sttuon 7100 of Ne I�bor Co00.(or Ne pcAoemaMe af Ne
wark(or rhich Ihi�permit is issucE.
ave md will munitin Workele Compevatian Imunnce,u syuirtE by Secuon
'10 of Ne I�Cor COEe,far Ne peeformence af Ne vrork for w�ich Ni�pe�mi�i�iuueQ � '
Worke-YT�Co�mpemla�uo�nWuM�¢.�c/a�rticraMPalicynumberw: � �
� mcr. /�C..��1� �/�/-1 Poliry No.: !QL I D 7
CF.RTIFlG'fEOFE%EMPfIONFROM ORKERS �
COMPENSATIONINSURANCE .
'('ITu}enlan rced no�M canPlc¢tl ilile pcemii I5 fa onc hunNW Eollus(SI001
nrleei)
1¢Nfy Nat in Nc perfa�mancc of Nc work for which Nie permi�u iuuetl.I shNl m�
cmpioy any person in my manner.w v b bcmme subjecl m Ne WorYcn Compematlan '
I�wiafGlif ia.Due •
AVVlinnl
N017CE79 APPIJGNT:If,aMr making Nu Cenifin¢o(ERemp�ion,you.Nau1J
become iuLjen b Ne Woheri Gmpcwuon pmWions of Nc lapor CaAe,you muv
.J O foMwiN romplr wiN such pmribom or Nu perni�s�ali Ec dreme4 maked.
? "' CONSIRpCfIONLENDINGAGENCY
'r� 1 M1ertAy aRrm Nsi Nue u�comvucunn knGin{��nu.y for ihe perfofinenm uf
CL � Ne xvrk for which Utis pamit is ivueE(See 309'1,Civ.CJ '
a� Lcndcr'sNunc ,
� z l<ndersAEEm..
V� 1 anifY'�+�I have rteC Ni��ppliwion vM su¢�hu iAe ebove infwmauan u '
�y F cortcn.l aya a complY wiN JI ciir�nE cow�y oNinentt�and su¢lam rtlaun8 ta
�0 U WilEin�eovwnion.�nE6embywNoeirertpmsenuJ�esofNuciiy�ocn�erupnnNe
� a aM`c-menuorcA pmpcny far iiupcNoo pmpaxi
(Wc)ag�ce lo vve.indcmnifY�d ta0�Im ihe Ci�Y af Cupenina egumt
ti p� Ii�bili0q.ju45menb.cosU�ndexpcnmswhic�meyinmyway�ttmeagvmtuidCiry
V z in eanxquenee o[Ne gran�int of Nu permil //f—� `�
� APPLICANT UNDERSfANDS AN�WILL COMPLY WITH ALl NON-POIM Issued by: Date ( i
SOURCE REGULATONS.
Re-roofs �
Signuurt of ApplicanVCanuvcior Da¢
xnznnDous ma'rewats oiSaoSuaE Type of Roof �
Win ux,Pyucant or ro�wc wilEine occuaa^�aort an.nmc waaous maa,;L �
u EcfincE bY�Cupenim Municipal CoEe.CTap�cr 9.1].xE Jx HeilN m0 S�fe�r
Cade,SccGon255J2(e)? All roofs shall be inspec[ed prior to any roofing marerial being installed.
❑Yes Na
Wili ihe applicant or fumm building occupam ux cyuipmrn�ar devi�rhicA If a roof is installed.wi[hout first obtaining an inspection,I agree to remove
emi�hurallous air conumimnu u dcfncd hy Ne 8ay Ama Air Qualiry Mana6�mcm all new ma[erials for inspection. �
o�.u��n /
❑Yu [jNO
I have eeal Ne IwvCuus mverialsmquirtments unJcrCTup�er6.95 o(Ne Ulifor�
'i FkaIN k SafnyCa4.5auau 25505.25511 vW255Ja.1 wWcrsuntl Nazi(Ne WilJin�
�na�curtenJy ha.e a�aunl Wt i�u Y� w�iliry w roufy Ne occupan�nf Ne
.q irtmcnuwhichmuuEcmel{vior o�a 'fcemo a��. Signature ofApplicant Date
Ow arm omsaageni o„�� All roof coverings to be Class��.��Ui bCICOI'
CITY OF CUPERTINO �
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: pdtg
COPY # : 1
� Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36930019 . 00
DATE ISSUED. . . . . . . : 12/19/2008
RECEIPT #. . . . . . . . . : BS000006859
REFERENCE ID # . . . : 08120122
SITE ADDRESS . . . . . : 10319 BRITTANY CT
. SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PARNII.EY RICHARD T AND TEDDY L
ADDRESS . . . . . . . . . . : 10319 BRITTANY CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3101
RECEIVED FROM . . . . : DALE W PHELPS
CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A & H HEATING
ADDRESS . . . . . . . . . . : 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 279-0722
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --------- ------ ---------- -------- ---------
• 1BSEISMICR VALUATION 2, 485 . 00 0 . 50 0 . 00 0 . 50 0 . 00
lEPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1MPERri2TFE FLAT xaTE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1MFtRAA 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 MC
---------------
TOTAL RECEIPT : 224 . 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- --------------------------- ------- -----------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
` v�la �faa
-� � CITY OF CUPERTINO
�- '��-�`` FURNACE/AC
�
' cuPEr�Two PERMIT APPLICATION FORM
APN # � � 3 ��.,, 1 �� Date: �Z ' l C "� (�
Building Address: �
/d 3/ IZ-t I l�
Owner's Name: Phone#: �^. ?� Z
Z.i � ZV�L.(`\, Z✓ ✓ — / �l���
Contractor: ' Phone#: z-7(� _�7��
� �� !
� � Faac #: z � —/(�/
Contractor L cense#: Cupertino Business License :
�� � 7Z
Contact: Phone#: g'L?j _� (
t�G4-(—t`�. �l-{��L 1-� S F� #: Z -/p
Building Permit Info:
Elect � Plumb � Mech
Residential Commercial ❑
Job Description: (
/� � f Z ���G�` �
or Residential Installations:
Attic ❑ ls` floor � 2"d floor ❑
Adhere to minimum setback re uirement ❑
For Commercial Installations: -
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structwal Calculations required for new installation ❑
New installation Planning A roval Re uired ❑
Cost of Project: Type of Construct�(Usage Class):
v �
Strapped On Platform Bonded New Location Replacement
Project Size: Ex ress ❑ Standazd ❑ Lar e ❑ Major❑
Valuation: .Z��.�
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plau set & the sheet index. ���-}-
C/
Revised 6/16/08
•
, '
, CITY OF CUPERTINO - �• '
��p FURNACE/AC '�
��„-o '
CUPEI�TINO FEE SCHEDULE � t
Quantity Fee ID Fee Description Fee Permit Type •
Group
F'[JRNACE • 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.
1MCREPALT • Commercial for the repair of alUadd 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.
1MCSUSHTR Commercial InstalURelocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P `
1-4 outlets •
1BPGAS For each gas piping system of 5 or P
more er outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
ermit.
1BSEISMICO Commercial Seismic 'B
1MRRAA Residential 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.
1MRSUSHTR Residential InstalURelocate 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 & not incl in an a 1 ermit.
Quantity Fee ID Fee Description Fee Permit Type •
f.'r