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07060027 7777777777777777 CITY OF CUPERTINO BUILDING DIvisibN PERMIT PERMIT NO. BUILDINfo pD,pRESSy ESTATES DR VALLEY HEATING & COOLING 07060027 l 11 U 4 U P� PERMIT ISSUE DATE OWNER'S NAME: MRS BOWMAN 1171 N 1: TH ST 06/05/2007 SANITARY NO. CONTROL NO. 'NE: (408) 296-6290 BUILDING PERMIT INFO ARCHrMCr/ENGINEER: BLDG ELECT PLUMB MECH 0 0 o a 00 LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is REPLACE FURNACE, ADD A/C t'y in full force and e t sL\�iC�tS License Clan Lic.N� Date Contractor ARCHITECT S DECLARATION i C< 1 understand my plans shall be used as public records >0.0 'm Licensed Professional H OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Liecnse Law for the 3 00 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 Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation S G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl $10000 t— (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 airy applicant for a permit subjects the applicant to a civil penalty of3 6925019 �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 Contractor's License Law dos 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 thereon.and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. 0 I am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 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 Worker's Compensation Ins ranee,as requited by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workers Compensation Insurance carrier and Policy num am: Carrier. 7>Y_.4 r �[�. Policy NA4256�41 I? ER CTE VP CKEMPTION FRO 0 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.Dale 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z'-" CONSTRUCTION LENDING AGENCY (tet CA I hereby affirm that there is a construction lending agency for the performance of (Yy> the work for which this permit is issued(See.3097,Civ.C.) Wcs� A Lender's Name Z Lender's Address U O 1 certify that I have read this application and state that the above information is LZ ►' correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding conswction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. GL (We)agree to save,indemnify and keep harmless the City of Cupertino against t) liabilities,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 U DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO CER ON . AIN Re-roofs tgnature o Applic ontrac or Dale Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp 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,hall be inspected prior to any roofing material being installed. 0 Yes Will the applicant or future building occupant use equipment or devices which If a roof i� installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new in iterials for inspection. District? 0Yes Nu 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 Molding docs riot cure y have a tenant,that it is my responsibility ro notify the occupant of the re i men ich mu et p' r o issuance of a o-fificate quxcuparley, Signature A Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blki: Lot: APN . . . . . . . . : 36S25019. 00 DATE ISSUED. . . . . . . : 06/ 05/2007 RECEIPT #. . . . . . . . . : BSC00001545 REFERENCE ID # . . : 07C60027 SITE ADDRESS . . . . . : 10(40 E ESTATES DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER MRE BOWMAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : VALLEY HEATING CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : llil N 4 TH ST CITY/STATE/ZIP . . . : SAD JOSE, CA 95112 TELEPHONE . . . . . . . . : (4C8) 294-6290 FEE ID UNIT QUANTITY PMOUNT 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, 000 . 00 1. 00 0 . 00 1 . 00 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 . 74 0 . 00 176 . 74 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 353 .58 16307 --------------- TOTAL RECEIPT 353 .58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL WA CITY OF CUPERTINO Sryao . _- ---__ -_ ___ -FURTN[ACElAC CUPEINO PERMIT APPLICATION FORM APN# 3/ � � Date: Building Address: Owner's Name: Pho l#C G C 1 1 1CA Contractorl Lice e#: r wtw OwAin � � �� ' S4'S L t t: \ Cupertino Business License #: Building Per1nit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: t)VoLaZL �L X V n(A_C_�_ i Residenti 1 Commercial ❑ For Residential Installations: Attic ❑ 1" floor ❑ 2"d floor ❑ Adhere to min set back re uirement 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 Construction: Occupancy oup: .00 V� Strapped LJ On Platform LJ Bonded LJ Sq.Ft. Floor Area: New Location ❑ Re lacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY E nergy BUILDING BREMFURN relocation of Furnace MECHANICAL BREMACOVER jVC Unit> 10,000 cfm MECHANICAL BREMAIRHAN QVC Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL - ---BSEISMICRE-- - _ _ Seismic-Fee Res___ --_ BUILDING—---- EPERMITFEE UILDIN - EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE I Ilumbing Permit Issue PLUMBING BPERMFEE l3ldg Permit Fees BUILDING BPLANCHK ]Ilan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 pCITYDOF Fax(408)777-3333 Building Department JOB ADDRESS1a 60 rC 9{' J;: t'C, e'S PERMIT# 4 e,Kf 6' Ae f-f-e ?0 OWNER'S NAME: -e L t`�1 G -P� PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Sig, afore Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSIrfESS 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 ontractor Signature Date