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10120005 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10407 VISTA KNOLL BLVD CONTRACTOR:VALLEY HEATING& PERMIT NO: 10120005 COOLING OWNER'S NAME: PATRICIA MCCARTHAY 1171 N 4 TH ST DATE ISSUED: 12/01/2010 ER'S PHONE: 6505438343 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F License Class C.2 U Lic.#_ 2'5�Q �II , MECH f— RESIDENTIAL r- COMMERCIAL r Contractor /fir v at T a a � ()ate 1.21--1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: FURNACE REPLACEMENT IN SAME LOCATION(91 K BTU) (commencing with Section 7000)of Division 3 of the Business&Professions 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:$3074 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32613035.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the 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.(-., ate< f� G c� Signature 41,,,E __ J ��, Date 2� RE-ROOFS: L OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 Owner or authorized ageyf Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save irl-mnify 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 g,...,ring of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10407 vista knoll blvd. DATE: 12/01/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$3,074 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex i rel ri PENTAMATION FURN/AC USE: A, ,° is PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 ..„ Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42JOO LL] L NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolutiofi 09-05I E�E '`1./10) FEE QTY/FEE MISC ITEMS SlIpp", PC _T_T PME Plan Check: $0.00 -17 1 l=.q>f " ,, PME Unit Fee: $126.00 PME Permit Fee: $42.00 77TWork Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 i Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.501 $0.00 TOTAL FEE: F $211.50 Revised: 11/08/2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32613035. 00 DATE ISSUED. . . . . . . : 12/01/2010 RECEIPT #. . . . . . . . . BS000012125 REFERENCE ID # . . . : 10120005 SITE ADDRESS . . . . . : 10407 VISTA KNOLL BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PATRICIA MCCARTHAY ADDRESS 10407 VISTA KNOLL BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VALLEY HEATING&COOL 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 3, 074 . 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICO VALUATION 3, 074 . 00 0 .65 0 . 00 0. 65 0 . 00 1BSEISMICR VALUATION 3, 074 . 00 0 .50 0. 00 0 .50 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 212 .15 0 .00 212 . 15 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 212 .15 #21355 --------------- TOTAL RECEIPT 212 .15 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 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1CItC2 :-�L K,,�ejl j> l✓ PERMIT# f Z6 � OWNER'S NAME: !�� f� U�f PHONE # (.t G - 5 q ) GENERAL CONTRACTOR: t0/j ��k t' ( ;`; BUSINESS LICENSE# 1 ADDRESS: it 71 1.11 4f �7, CITY/ZIPCODE: .z *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: `�` � 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 v O CITY OF 1:2 CITY OF CUPERTINO FURNACE/AC C U P S R ,N O PERMIT APPLICATION FORM APN# � � � � Jam,,.. Date: Building Address: Owner's Name:? Phone#: Contractor:l/ / Phone#: Y 4 fle Yerfr C�o I�/i. Fax#: d , —Zell_ 2t� Contractor License#: Cupertino Business License#: Contact: _ Phone#: �{og-Z Q�f_(p 2 g 6 Fax#: Building Permit Info: Elect ❑ Plumb Mech Residential Commercial ❑ Job Description: I l / /(�,7 �Vl r%l4c [- ' \ ��.ZC For Residential Installations: Attic ❑ 1"floor 2nd floor ❑ 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 Re uired ❑ Cost of Project: Type of Construction (Usage Class): Ll"-/�3 Strapped ❑ On Platform ❑ Bonded � New Location❑ Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: _:X 71 i 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. Revised 01/07/09