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07050130 CITY OF CUPERTINO BUILDING Dxv)s)ON PERMIT PERMIT NO. BUILDINf�QDAQ.ESSN FOOTHILL BLVD VALLEY HEATING & COOLING 07050130 l U 7 U b PERMIT ISSUE DATE OWNER'S NAME: AZEVEDO EDWARD J AND JULIA 1171 N 4 TH ST 05/15/2007 1H (4 08) 2946-6290 SANITARY NO. CONTROL NO. BUILDING PERMITINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 i O OO LICENSED CONTRACTOR'S DECLARATION Job Description Vp I hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL A/C TJNI T AT REAR y in full force and effect License Cl ,-Lle•8 p Aaw Date Contractor 'Ift,9240 ARCHITECT'S DECLA C4.< 1 understand my plans shall be used as public records �yU L U.y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to constructalter,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 q.Ft.Floor Area �5 0 0 0 rF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 of3 2 613 0 6 i` �Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of tie property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does 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.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's 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 Contractor's License Law. ❑I am exempt under Sec B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workcfs Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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 Workeris C m enation I canoe tarsier and Policy number am: Carrier. _�l+ Policy No.:la ,w alk oz CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far one hundred dollars(SI00) 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 Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY F~r►N-+ I hereby affirm that there is a construction lending agency for the performance of fx r7 the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name ]Z Lender's Address U 0 1 certify that I 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 construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. L1. (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. �-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �- SOURC G TI Re-roofs Sign o Appli r areof R sof H OUS MATERIALS DISCLOSURE Type 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)? J^ All roofs!hall be inspected prior to any roofing material being installed. El Yes I No 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 contaminWN. defined by the Bay Arca Air Quality Management all new m iterials for inspection. District? [3 Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requiremc ust el prior to issuance of a Certificate of Gccu cy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authomed age D CITY OF CUPERTINO 7 ITEMS OF 28 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32613066 . 00 DATE ISSUED. . . . . . . : 05/15/2007 RECEIPT #. . . . . . . . . BS000001339 REFERENCE ID # • . • : 07050130 SITE ADDRESS . . . . . : 10506 N FOOTHILL BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER AZEVEDO EDWARD J AND JULIA TRU ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : ORANGEVALE CA, 95662 RECEIVED FROM THINH NGUYEN 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 BREMRECEPT NO. OUTLETS 1.00 1.20 0 . 00 1 .20 0.00 BSEISMICRE VALUATION 5, 000 .00 0.50 0.00 0 . 50 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 161. 93 0 . 00 161 . 93 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITE' OF CUPERTINO URNA E A. CUPEI,TINO PERMIT APPLIECATION FORM () 10 60W # 2� �. 3 Dat O Building Address: COQ O Ow er's Name: Phone#: ZAP f0 IDS C'`uniraci:oa ` Contact: 1 Phone: Cupertino Business License#: v O Building Permit Info. �, / / Bldg ❑ Elect Pldmb Lv Mech ild Job Description: =g -M11.A7"Ot.3 CV- Residential Commercial ❑ For Residential tallations: Attic ❑. l st floor A 2nd floor Adhere to min set back requirement[ . For Commercial Installations: placement same weight E] Additional weight (stnictural talcs) El structural Calculations required for new installation C� New installation Planning Approval Required ❑ Cost of Project: Type of Cons tion: Occupancyoup: ��a VC Strapped ❑ On Platform Bonded Z Sq.Ft. Floor Area: New Location Er Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY EnergyBUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIgHAN A/(:Units <= 10, 000 cfin MECHANICAL BREMRECEPT Re,;ptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elc c Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Blc.g Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ':UPEt�T1N0 Building Department JOB ADDRESS: PERMIT# to 50 a b -r 01 3 6 OWNER'S NAME: V t> PHONE# GENERAL CONTRACTOR: V AX# I am not using any subcontractors: Si;;nature 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 1-7 Tile O / ontractor Signature Dat