07060026 CITY OF CUPERTINO
BUILDING 61VISION PERMIT � i� �R '� '
PERMIT NO.
1111-I i� f31F�1TE AVE VALLEY HEATING & COOLING 07060026
tS O 7{Ci/1DtS PERMIT ISSUE DATE
OWNER'S NAME:
DONALD LINDEN 1171 N 4 TH ST 06/05/2007
SANITARY NO. CONTROL NO.
,NE:
(408) 29'1-6290
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
pO LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Uw with Section 7000)of Division 3 of the Business and Professions Code goy license is FURNACE REPLACEMENT, ADD A/C
mC1. in full force and of C
License lass Lic•
f p Datc c Con
a
A CHITECTS DECLA A O
i a a 1 understand my plans shall be used as public records
)yU
w H Licensed Professional
OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's License law for the
'00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county
m which requires a permit to conswct,alter,improve•demolish,or repair any swcture
J z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.FIOOr Area $10383
.EnI-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 692704 Number Occupancy Type
not more than five hundred dollars($500).
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactor's License Law docs 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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves dhemon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
0 1 am exempt under Sea B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers 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 mppensano{n-Insurance carrier and Poli num�be / l
Canter: ang L'�. Po1iry rly �( (,/t;4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
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 Codc,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z''" CONSTRUCTION LENDING AGENCY
E•r►�-. I hereby affirm that there is a construction lending agency for the performance of _
> the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
z Lcndees Address
U 0 1 certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding conswction.and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments•costs and expenses which may in any way accrue against said City _
U Z in consequence of the granting of this permit. Date ��
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
S CE ULA NS/./��
A*Wt
• I'�.L_ `S Re-roofs
ignature of ApplicanU ntrator Dae Type of R OOf
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant 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.
[-]Yes No
If a roof i s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? %k.-
0 Yes ONO
I 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
docs not current) have a tenant,that it is my responsibility to notify the occupant of the
re menta hpri
must or issnanee era certificate or OSSignature of Applicant Date
on All roof coverings to be Class"B"or better
Owncr or authorized_aW1 Date
CITY OF CUPERTINO
8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: B1}:: Lot:
APN . . . . . . . . : 36S,27046 . 00
DATE ISSUED. . . . . . . : 06/ 05/2007
RECEIPT #. . . . . • • • . : BS000001545
REFERENCE ID # . . . : 07060026
SITE ADDRESS . . . . . : 86E, BETTE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA
OWNER . . . . . . . . . . . . : DONALD LINDEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4548
RECEIVED FROM . . . . : VALLEY HEATING
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 11-1 N 4 TH ST
CITY/STATE/ZIP . . . : SAPS JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-6290
FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- ------ ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
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
BREMRECEPT NO. OUTLETS 1 . 00 1 .20 0 .00 1 .20 0 . 00
BSEISMICRE VALUATION 10, 383 .00 1 . 10 0 . 00 1 . 10 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 176 . 84 0 . 00 176 . 84 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL
r CITY OF CUPERTINO
-
_FUIVIACETAC -
CUP S TINO PERMIT APPLICATION FORM
APN# Date: _
BuildinR Address:
Owner's Name: - Phone#:
C4 L—A
Contractor: License 4-c7>
Contact: Cupertino Business License #:
Building Permit Info: ,
Bldg ❑ Elect E�' Plumb Mech ffl'
Job Description:
Residential Commercial ❑
For Residential Installations:
Attic ❑ 1" floor ❑ 2nd floor ❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(3tructural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project: Type of Constru,tion: Occupancy group:
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY -.E-nergy BUILDING
BREMFURN -','elocation of Furnace MECHANICAL
BREMACOVER VC Unit> 10,000 cfm MECHANICAL
BREMAIRHAN VC Units<= 10, 000 cfin MECHANICAL
BREMRECEPT Rec tl, Switch&Outlets ELECTRICAL
- ---BSEISM1CRE - ___-__--Seismic Fee Res_ _ __ --__-__ _-- ._---- BUILDIN ---.
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE :Mech Permit Issuance MECHANICAL
PPERMITFEE ?Iumbing Permit Issue PLUMBING
BPERMFEE 3ldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING