11020099 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1155 HUNTERSTON PL CONTRACTOR:VALLEY HEATING& PERMIT NO: 11020099
COOLING
OWNER'S NAME: MIKE&VIVIAN LAITILA 1171 N 4 TH ST DATE ISSUED:02/25/2011
ER'S PHONE: 4087817055 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
❑ LICENSED CONTRACTOR'S DECLARATION
-1_ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# t�S?G qr—
\I I MECH RESIDENTIAL COMMERCIAL
Contractor -Date
I hereby affirm that m licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT,ADD A/C,&PANEL UPGRADE
(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. Sq.Ft Floor Area: Valuation:$9095
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36221016.00 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 D ROM 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 77 f
with all non-point source regulations per the Cupertino Municipal Code,Section �f C'�v^• /
Issued by• Date:
9.18.
Signature Date 67-1,9,9111
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:
I,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
I 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
Health&Safety Code,Sections 25505,25533,and 25534.
1 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 Worker's Owner r gent: r
Compensation laws of California. If,after making this certificate of exemption,I Date:
_-S�? t I
become subject to the Worker's Compensation provisions of the Labor Code,I must J )
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
i• unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
k and expenses which may accrue against said City in consequence of the
granting 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: 1155 Hunterson DATE: 02/25/2011 REVIEWED BY:
APN: BP#: "VALUATION: 1$9,095
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
wORK Furnace replacement, add a/cpanel upgrade
SCOPE
Mech.Plan Check 0.0 h $0.00Elec.Plan Check 0.01 hrs $0.00
Mech.Permit Fee: 1MPERMIT "-_� .,r �� Elec.Permit Fee: IEPERMIT
Other Mech.Insp. 0.0 hrs $42.00 ) 1�!t: ° t,. Other Elec.Insp. 0.0 hrs $42.00
1!c,b, b�'!" !"c",
""'c'
NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (ree Resolution 09-05I Eff. 7il%IOZ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L J # Mechanical
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $126.00 IMFR=<Ioo Furnace,Forced-Air
PME Plan Check: $0.001= # Mechanical
Permit Fee: $0.00 $63.00 IBREMAIR A/C Units(<=10K cfm)
Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 1 hrs $0.00 200 amps Electrical
PME Unit Fee: $0.00 $42.00 IERT<200 Services
PME Permit Fee: $84.00
(_`r ns1roction 7-ax
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1 TRA $42.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $127.91 $231.00 TOTAL FEE $358.91
Revised: 01/15/2011
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY ## 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 36221016 . 00
DATE ISSUED. . . . . . . : 02/25/2011
RECEIPT #. . . . . . . . . BS000012776
REFERENCE ID # . . . : 11020099
SITE ADDRESS . . . . . : 1155 HUNTERSTON PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER MIKE & VIVIAN LAITILA
ADDRESS 1155 HUNTERSTON PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5068
RECEIVED FROM . . . . : VALLEY HEATING & CO
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 9, 095 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BREMAIRHA NO.UNITS 1 .00 63 . 00 0 . 00 63 . 00 0. 00
1BSEISMICR VALUATION 9, 095 . 00 0 . 91 0 . 00 0 . 91 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1ERT<200 UNITS 1 . 00 42 . 00 0 .00 42 . 00 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 358 . 91 0 . 00 358 . 91 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 358 .91 #21717
---------------
TOTAL RECEIPT 358 . 91
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Building Department
City Of Cupertino
LM 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: .0 ,\;; T'( `("vs'l--PL, , PERMIT# j
OWNER'S NAME: K ZG L A PHONE# f-IC,1S - 51-61 L( _6 a G 0
GENERAL CONTRACTOR:'Okl ktiol I BUSINESS LICENSE# J> "-`- Q
ADDRESS: 1-). 4�h S{ ,o < CSS 13 CITY/ZIPCODE: &v,\ s
*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: S '
Signature Date
Please check applicable subcontractors and complete the following information:
j/ 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:
2 -Z-5
Building Address:
If residential, is house an Eichler? Yes ❑ No If yes, needs planning approval.
Owner's Name: Phone#-
Contr tor: Phone#: WZc-, L`�
Fax#: •y-O. 'M _ Z`4-
4-Contractor Lice se#: �5 Cupertino Business License#:
Contact: 1 ( , Phone#: i406J oAt1-b'9'y 0
V A\kt R Fax/e-mail:
Building Permit Info:
Elect Plumb ❑ Mech
Residential Commercial ❑
Job Description:
o 00 c�C uk
For Residential Installations:
Attic ❑ 1 St floor 2nd floor ❑
Adhere to minimum setback requiremeni"IQ
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: %051-- Type of Construction (Usage Class):
Strapped ❑ Platform ❑ Bonded ❑ New Location ❑ Replacement ry
Project Size: Counter Express ❑ Standard ❑ Large ❑ Major❑
Valuation: (� Oq J
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 12/06/10