06100219 CITY OF CUPERTINO s>.:c°r;::::::_:•..:; :.:::<..`r.>:'s;
I V ISI O Nk71'l
BU[LDINI,D PERMIT
,
BUILDING ADDRESS: VALLEY HEATING, & COOLING PERMIT NO-06100219
10510 AINSWORTH DR
PERMIT ISSUE DATE
OWNER'S NAME:
! MARK & CRISTIN VAUGHAN 1171 N 4 TH ST 1.0/3312006
)NE: SANITARY NO. CONTROL NO.
(4 08) 294-6290
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p LICENSED CONTRACTOR'S DECLARATION Job Description
U P I hereby affirm t1tat 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
y in full force and effect. r- , , FURNACE REPLACEMENT
t ? License Cl i Lie•S `
o
Date (� _31 ()Co Contractor 111tV r Yflle ►. ��
t– 1 1ARCHITECTSDECLAR I tV
a< I understand my plans shall be used as public records
)yv
tL y Licensed Professional
h;
OWNER-BUILDER DECLARATION
j I hereby affirm that I 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
'Z9 which requires a permit to construct,alter,improve,demolish•or repair any structure $3918
!z- prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
F$ (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 arty applicant for a permit subjects the applicant to a civil penalty of .5 AP1#NurwRi, U U Occupancy Type
not more than five hundred dollars(5500).
❑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 does not apply to an owner of q P
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.
C3 am exempt under Sec. B de 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 Worker's 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 Wor mpeasatio�In�r^a nce carrier and Policy umher are:Cartier. C ' Policy No: 2-_
C V 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,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.T)
Applicav
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
[~r►rA. 1 hereby affirm that there is a construction lending agency for the performance of
{Y> the work for which this permit is issued(Sec.3097,Civ.C.)
W C) Lender's Nam^
Z Lender's Address
V C) I certify that I have read this application and state that the above information is
ly correct.I agree to comply with all city and county ordinances and state laws relating to
Q U building construction,and hereby authorize representatives of this city to enter upon the
C a above-mentioneANDND spection p rposeS.
(We)agmnify a keep harmless the City of Cupertino against
tF"y liabilities,judgm rid xpe s which may in any way accrue against said City
V Z in consequence f thi permit.
■+ APPLICANT D WILL COMPLY W TH ALL No -POINT Issued by: DateSOURCE l0��/
�ORe-roofs
�Z!Do MATERIALS DISCLOSURE /Date Type of Roof
Wit building occupant store or handle hazardous material
7a-sdefi ne by C vino Municipal Code.Chapter 9.12,and the Health and Safety
Section (a>? All roofs shall be inspected prior to any roofing material being installed.
p Yes pate''-
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
:mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Aistrict?
❑Yes moo.
Aafw
otu atcrials requirements under Chapter 6.95 of the Califor-
nia 6 25505.25533 and 25534.1 understand that if th e building
doethat it is my responsibility to notify the occupant of the
req be et rior to issuance of a Certificate of up Signature of Applicant Date
`v � r All roof coverings to be Class"B"or better
O rat J Da
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
pCITY OFlA+ Fax(408)777-3333
Building Department
IJOB ADDRESS: PERMIT #
` r_ n �t
OWNER'S NAME: _ PHONE #
GENERAL CONTRACTOR , q 0 . FAX #
I am not using any subcontractors: -i�3 fQ��� ��,
tore /Da
Please check applicable subcontractors an o lete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
ICement Finishing I
IElectrical
Excavation
IFencing I I
I Flooring. Carpeting
Linoleum/ Wood
I Glass/ Glazing
I Heating I
II Insulation
I I Landscaping I I
I I Lathing I I
II Masonry I I
IOrnamental Sheet Metal
I Painting/ Wallpaper I
Paving
IPlastering I
IPlumbing
Roofing I I
Septic Tank I I
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
4E�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32645005 , 00
DATE ISSUED. . . . . . . : 10/31/2006
RECEIPT # . . . . . . . . . : 36623
REFERENCE ID # . . . : 06100219
SITE ADDRESS . . . . . : 10510 AINSWORTH DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER MARK & CRISTIN VAUGHAN
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RAY LINDEN
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
- -- - ---- -- - - ---- - ------ ---------- ---------- ---------- ---------- ----------
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 3 , 918 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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
---- ------ ---------- ---------- ----------
TOTAL PERMIT 164 . 78 0 . 00 164 . 78 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ----- ------ ---- - ------ - ----- ------------------
OTHER 164 . 78 AMEX
TOTAL RECEIPT : 164 . 78
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
�l5(�00�2J�
-�, CITY OF CUPERTINO
" FURNACE/AC
CUPEf_TINO PERMIT APPLICATION FORM
APN# I Date:Sa L—40 ' CC)5
Building Address:
Owner's Name: Phone#:
Contractor: License#:
Contact: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect CII/ Plumb L9'� Mech
Job Description:
Residential ❑ Commercial ❑
For Residential Install aligns:
Attic ❑ 152 floor 2"d 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 P�r�oj 1 -e^ Type of Constr tion: Occupancy,group�
Strapped ❑ On Platform LfT Bonded ❑ Sq.Ft.Floor Area:
New Location ❑ Replacement
Qty.if
Applicable Fee ID Fee Description Fee Group
/ BENERGY Energy BUILDING
BREMFURN Relocation of Fumace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN I A/C Units<=10,000 cfm I MECHANICAL
BREMRECEPT Recptl,Switch&Outlets I ELECTRICAL
BSEISMICRE Seismic Fee Res I BUILDING
/ I EPERMITFEE I Elec Permit Issuance I ELECTRICAL
MPERMITFEE Mech Permit Issuance I MECHANICAL
I I PPERMITFEE I Plumbing Permit Issue I PLUMBING
' BPERMFEE I Bldg Permit Fees I BUILDING
BPLANCHK I Plan Check Fee BUILDING
BUSLIC I Business License BUILDING