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07060143 CITY OF CUPERTINO BUILDING DIVISION PERMIT �1 ` Ltd+ �'1 Z (} M�4TION: BUILDING ADDRESS: PERMIT NO. 10886 NORTHRIDGE SQ VALLEY IEATING & COOLING 07060143 OWNER'S NAME: PERMIT ISSUE DATE MOGHTADER HESSAM 1171 N-1 TH ST 06/18/2007 NE: SANITARY NO. CONTROL NO. (408) 291-6290 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 p p LICENSED CONTRACTOR'S DECLARATIONJob Description V)= I hereby affirm that I am licensed under provisions of Chapter 9(commencing z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD A/C, REPLACE FURNACE Z)y in full force and of n? License sLic. t„,tp Datc Contractor ARCHr1ECPS DECLARATION 1 a< t understand my plans shall be used as public records ;WV m y Licensed Professional t OWNER-BUILDER DECLARATION > I hereby.1-firm that I am exempt from the Contractors License Law for the ip O following reason.(Section 703 1.5,Business and Professions Code:Any city or county Pi which requires a permit to construct.alter,improve,demolish,or repair any structure Z y 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 Sq.Ft.Floor Area t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5600 .. 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 Number Occupancy Type not more than five hundred dollars($500). 3163601B. V V ❑I,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 does not apply to an owner of q 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 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. ❑I am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: v 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. ❑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 Workers Compensation Insurance carrier and Policy number arc: CarieE2t—'-__-I Policy N2, (e- CERTIFICATE CA OF EXEMPTION FROM WO CERS' 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,l 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- C)Z, CONSTRUCTION LENDING AGENCY (~-h rA I hereby affirm that there is a construction lending agency for the performance of �.h> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Z Lenders Address U 0 1 certify that I have read this application and state that the above information is L" r correct I agree to comply with all city and county ordinances and state laws relating to CU building construction,and hereby authorize representatives of this city to enter upon the . �Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rF"r C*� liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by Date S CE GULA S. ` Re-roofs Signature of ApplicanUCo for Date 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 )?fNo Will the applicant or future building occupant use equipment or devices which If a roof is 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 n-aterials for inspection. District? ❑Yes leNo i I have read the hazardous materials requirements under Chapter 6.95 of the Califor- /� � nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand that if the building (((SSS does not currently have a tenant,that it is my responsibility to notify the occupant of the rcquiremcn hic stbe - 'or toi cc of a Certificate of upancy. Signature of Applfc Aa Date 77� All roof coverings to be Class"B" or better Owner or authorized a ew Dare CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT.' RECEIPT OPERATOR: bethe COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31636018 . 00 DATE ISSUED. . . . . . . : 06/18/2007 RECEIPT # . . . . . . . . • : BS000001679 REFERENCE ID # . . . : 07060143 SITE ADDRESS . . . . . : 1O886 NORTHRIDGE SQ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MOGHTADER HESSAM ADDRESS CITY/STATE/ZIP . . . : SU2INYVALE CA, 94087 RECEIVED FROM . . . . : VALLEY HEATING CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE (408) 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 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 5, 600 . 00 0 . 60 0 .00 0 . 60 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 . 34 0 . 00 176 . 34 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 176 . 34 16322 --------------- TOTAL RECEIPT 176 . 34 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO -- - FUWiACETAC CUPE of PERMIT APPIACATION FORM APN# Date Buildins Address: Owner's Name: Phone#: � �s r-�cz:,.�-, rnv �-�►c��- 1e�� -8�b4�- I1 �C, - Contractor: License#: G.00 I l� Contact: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect LAY Plumb Zk- Mech Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ lst floor &-!Pd 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 Construction: Occupancy roup: *ZE�,6 n �) Strapped El On Platform Lff Bonded I 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 cfin MECHANICAL 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 Plumbin Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue W2 "` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: C-C PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: ' Si„ tore Date Please check applicable subcontractors and complete 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/ actor Signature Date