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10100194 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10510 LARRY WAY COI`TRACTOR:VALLEY HEATING PERMIT NO: 10100194 &COOLING NER'S NAME: LINDA LEE 1171 N 4 TH ST DATE ISSUED: 10/27/2010 OWNER'S PHONE: 4088884118 SA14 JOSE, CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C 2 G Lic.# [-; Z 51_f o 'f MECH RESIDENTIAL COMMERCIAL Contractor J141/r v ¢-11te Date t%l �G -� JOE DESCRIPTION: REPLACE FURNACE IN SAME LOCATION I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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:$3050 1 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 APi1 Number:31602023.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 F PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter ALLED INSPEC ION. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS indemnify and keep harmless the City of Cupertino against liabilities,judgments, /� ^ costs,and expenses which may accrue against said City in consequence of the Issued by: Date: f 1 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. / '�77 RE-ROOFS: nature e /U/2 7�fGL 6 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I h ive read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's ma terial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. wi 1 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by thi Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 01✓ner or authorized agent: permit is issued. 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 Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w<rk's for which this permit is issued(Sec.3097,Civ C.) Lc nder's Name APPLICANT CERTIFICATION Li rider's Address 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 building construction,and hereby authorize representatives of this city to enter _pon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I i nderstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: J$3,050 ;;�PEMIT TYPE: Mechanical Permit PLAN C HECK TYPE: Alteration /Addition / Repair PRIMARY 7"��' �L PENTAMATION FURN/AC USE: SFD or Duplex _ �� ;� �,�.1 ; 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 0 '`' Mech.Permit Fee: IMPERMIT "o `` Other Mech.Insp. 0.0 �hrs $42.00 tt , ,''t �?r%'` f '`'; ; 1, F Lic( Crop,1""' 11t I,�_.�, t . NOTE. These fees are based on the preliminaryin ormation avai(able and are onl an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 09-051 L . '%1.%/l)j FEE QTY/FEE MISC ITEMS Pl oir C'hch 1"C"': PME Plan Check: $0.01) 1"zi-IYItt /`c'c'' Stipp/. hl'�p Fcc ED=—=— PME Unit Fee: $126.0) PME Permit Fee: $42.0) C.'E��tztr'tjr`ttr=it ell 16'1'lcllFCC, Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: 1 TRA VDOC $42.0 0 i Strong;Motion Fee: IBSEISMICR $0.E0 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.(10 SUBTOTALS: $211.E)0 $0.001 TOTAL FEE: $211.50 Revised: 10/17/2010 CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: lot : APN 31602C23 . 00 DATE ISSUED. . . . . . . : 10/27/2010 RECEIPT # . . . . . . . . . : BSOOOC11855 REFERENCE ID # . . . : 10100194 SITE ADDRESS . . . . . : 10510 LARRY WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LINDA LEE ADDRESS 10510 LARRY WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 AMOUVT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3 , 050 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3 , 050 . 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 12 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 12 . 00 0 . 00 42 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 211 . 50 0 . 00 211 . 50 0 . 00 METHOD OF PAYMENT AMOUNT ZEFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 423 . 00 21230 --------------- TOTAL RECEIPT 423 . 00 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: 1050 Lir : �^ PERMIT# OWNER'S NAME: 1-«c�a Le,e- PHONE# GENERAL CONTRACTOR: V((ly � f„u, �'o�,(;, BUSINESS LICENSE # ADDRESS: / �J, q f4 CITY/ZIPCODE: ,,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 INS'ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC'T'ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 16 Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS 1`AME 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 C UPERTINO III FURNACE/AC CUPERTINO PERMIT APPLICrATION FORM i6/oo/, APN # I CO 3 . Date: Building Address: 1� �1 d to wry (� Owner's Name: Phone#: . Contractor: ` Phone#: t{t)5- Valle 6C r Fax#: SIG"6,-2,'4- 7 Contractor License#: Cupertino Business License#: ty Contact: Phone#: fag-Z4q-&,z 67 F r. c e' Fax#: Building Permit Info: Elect❑ Plumb ❑ Mech Residential Commercial ❑ Job Description: f—_arn c-c r�ei>(4c e - e- < <�c4 7�`%- For Residential Installations: Attic ❑ 1st floor 2°d 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 Required ❑ Cost of Project: Type of Const-action(Usage Class): Strapped ❑ On Platform ❑ BondedEl New Location❑ Replacement ❑ Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: �o S a 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