10120029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 STOKES AVE CONTRACTOR:VALLEY HEATING& PERMIT NO: 10120029
COOLING
OWNER'S NAME: POPOV MICHAEL L AND JILL 1171 N 4 TH ST DATE ISSUED: 12/06/2010
ER'S PHONE: 4084463025 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
❑ LICENSED CONTRACTOR'S DECLARATIONr F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C 2 0 Lie.# 2 5$5 0
r,^ MECH RESIDENTIAL COMMERCIAL
Contractor ✓�y dee, L(&'/,LDate l 7 I&Z�ro
kJ
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE,A/C&DUCTS;ALL IN SAME
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,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 provided for by Sq.Ft Floor Area: Valuation:$13900
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32647011.00 Occupancy Type:
APPLICANT CERTIFICATION
I 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 building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAY FRO LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
n - j
Signature ,a/Gd� _�iti!yBate !2
L� OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner or author'wed—agent;
become subject to the Worker's Compensation provisions of the Labor Code,I mush!� �'- = ? ate:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i 7nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
A" Licensed Professional
Signature '-v""` � e
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32647011 .00
DATE ISSUED. . . . . . . : 12/06/2010
RECEIPT #. . . . . . . . . : BS000012151
REFERENCE ID # . . . : 10120029
SITE ADDRESS . . . . . : 10300 STOKES AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : POPOV MICHAEL L AND JILL
ADDRESS . . . . . . . . . . : 10300 STOKES AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1232
RECEIVED FROM . . . . : NICOLE MINOR
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13, 900 . 00 1 . 00 0 . 00 1. 00 0 .00
1BREMAIRHA NO.UNITS 1. 00 63 .00 0. 00 63 . 00 0 .00
1BSEISMICR VALUATION 13, 900 . 00 1 .39 0. 00 1.39 0 .00
1MFR=<100 UNITS 1. 00 126 .00 0 .00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 275 .39 0. 00 275.39 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 275 .39 VISA
---------------
TOTAL RECEIPT 275 .39
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 10300 5t ,✓p PERMIT# /0/Za 0 2-7
OWNER'S NAME: T l I Po P.o PHONE # liof- y`f& -,34.15
GENERAL CONTRACTOR: V (p;,l' c. BUSINESS LICENSE# ill
ADDRESS: /l7( f4, g4-1t ,C+. CITY/ZIPCODE: Y�54 2
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 3 f:'/-.&
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: /', 7(,
Owner's Name: Phone#: `
Contractor: Phone#: q0$'-2i'j^e 67-gC
Ylq t e gerttf-%l �' t.190 �r�, Fax#:
Contractor License#: Cupertino Business License#:
2- r4C
Contact: Phone#: qa9'-24,f-(a246
�r'�� JortGS Fax#:
Building Permit Info:
Elect E/ Plumb � Mech d
Residential Commercial LJ
Job Description: -� _,�
ro C e
r :' (! iii Z
For Residential Installations:
❑ I'floor [� 2nd floor
Attic ❑
Adhere to minimum setback 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(Usage Class):
Strapped ❑ On Platform ❑ Bonded New Location❑ Replacement
Project Size: Express Standard ❑ Large ❑ Major❑
Valuation: ({f
I _>1LU
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable,include in plan set&the sheet index.
25�-
Revised 01/07/09