06100063 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS: VALLEY HEATING & COOLING 06100063
1625 JAMES TOWN DR
OWNER'S NAME: PERMIT ISSUE DATE
RENWALD JUDITH T 1171 N 4 114 ST jo /in/2nor,
INE: SANITARY NO. CONTROL NO.
(408)294-6290
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p 0O LICENSED CONTRACTOR'S DECLARATION Job Description
LU I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zwith Section 70(10)of Division 3 of the Business and Professions Mlicense is
y in full force and effect REPLACE FURNACE & ADD A/C
? License Cl s - Lic.S
Date t Contractor
ARCHITECTS DECLARATION
Cd—,Cl I understand my plans shall be used as public records
tqU
U.in Licensed Professional
H OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
'MO following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to consuucG alter,improve,demolish,or repair any structure
Zy 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 any applicant for a permit subjects the applicant to a civil penalty of r. 00 Occupancy Type
not more than five hundred dollars(1500).
❑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 ns Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of �l 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 Contractors Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and
who conuacts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
n I have and will maintain a Certificate of Consent to self-insurc 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_
❑I have and will maintain Workers Compensation Insurance,as mquired by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Cp soon Insura ce carrier and Policy nwalter are: .
Cartier. Policy No
CERTIFTCATE OF EXEMPTION FROM WORT R
COMPENSATION INSURANCE
(This section need not be completed if the permit is Cor 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 Workcrs'Compensadon
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 mus
2 forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(ter 1 hereby affirm that there is a construction lending agency for the performance of
.yr> the work for which this permit is issued(Sec.3097,Civ.C.) -
W Lenders Name
az ).enders Address
U 0 1 certify that I have read this application and state that the above information is
LI.►. correct.I agree to comply with all city and county ordinances and state laws relating to
C U building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
G5, (We)agree to save,indemnify and keep harmless the City of Cupertino against
0-4 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 UNDERSTANDS AND WI L OMPLY WITH ALL NON-POINT Issued by:
S4
SOURCE REGULATIONS.
Re-roofs
Signature ofApplicantlCot
T of Roof
HS MATERIALS DISCLOSURE Type
Will the appl' t orbuilding occupant store or handle hazardous material
as defined by the upeninoi al Code.Chapter 9.12,and the Health and Safety
Code,Section 2 32(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or furore 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?
❑Yes u
1 have read the hazarculf s materials requirements under Chapter 6.95 of the Califor-
nia Health&SafelyCode,Sections 25505,25533 and 25534.I undersand that if the building
does not currently have a e at it is my res ility to notify the occupant of the
requirementsich f a Certifi
requirements whocate of eupancr• Signature of Applicant Date
All roof coverings to be Class"B'r or better
Owner or auth rc gc arc
CITY OF CUPERTINO
:m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36610101 . 00
DATE ISSUED. . . . . . . : 10/10/2006
RECEIPT # . . . . . . . . . : 36372
REFERENCE ID # . . . : 06100063
SITE ADDRESS . . . . . : 1625 JAMES TOWN DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . - : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RENWALD JUDITH T
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
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
--------- - ----- -------- ---------- ---------- ---------- ---------- ----------
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
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 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 177 . 44 0 . 00 177 .44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- -- ---- -------- ------------ ------------------
CHECK 177 . 44 15320
TOTAL RECEIPT 177 . 44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------
301 ROUGH ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*TPEkTINO
Building Department
JOB ADDRESS: z /n r S � �2 PERMIT #
06-,l400 O C�
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
ignature Date
Please check applicable subcontractorand com lete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
IIectrical
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
Contractor Signature Date
i
aaC00609
CITY OF CUPERTINO
= A FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# 10—
Date:
Q
• B ildin Address:
Owner's Name: Phone#:
=��d rR¢ �ct9 cl mss-ate 3 2C%4
Contractor: C�t+ License z#:
- -
'�lac�l 41v r C-340Contact: Cupertino Business License#:
Building Permit Info:
Bldg Elect Plumb f�� Mech [�
Job Description:
V�rl Gu_2_- v' 1 Cil CfZ M�z►-�- t- A t�G� G�f L
Residential C211, Commercial ❑
For Residential Installations:
Attic ❑ Is'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 Project: Type of Construction: Occupancy roup:
Strapped On Platform Bonded Sq.Ft.Floor Area:
New Location ❑ Replacement
Qty.if
Applicable Fee ID Fee Description Fee Group
BENERGY
E
TELECTRICAL
UILDING
BREMFURN Furnace ECHANICAL
BREMACOVER ,000 cfm ECHANICAL
BREMAIRHAN 10,000 cfmECHANICAL
BREMRECEPT h&Outlets
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE VBld
rmit Issuance ELECTRICAL
MPERMITFEE rmit Issuance MECHANICAL
PPERMITFEE g Permit Issue PLUMBING
BPERMFEE mit Fees BUILDING
BPLANCHK ck Fee BUILDING
BUSLIC Business License BUILDING
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