10070064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20206 NORTHBROOK SQ CONTRACTOR:BAYHILL HEAT&AIR PERMIT NO: 10070064
OWNER'S NAME: MARCUS WEI 262 MAIN ST DATE ISSUED:07/08/2010
NER'S PHONE: 4086881762 LOS ALTOS,CA 94022 PHONE NO:(650)948-5900
43 LICENSED CONTRACTOR'S DECLARATIONr-
('� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class�1 Lie.# '1 ( 9 9 (_ f— (— r—
^, MECH RESIDENTIAL COMMERCIAL
Contractor �3AYWL(.W*r Date 0-1 0'8 la
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD AIR CONDITIONING TO AN EXISTING FURNACE
(commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES**
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:$4031
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31639025.00 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 DAYS FROM 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 Lv
9.18. Issued Date:
Signature Date 0-1 0fflp,�-
LJ 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.
I,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)
1,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 auth agent: /1
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: fl (r v
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
unify 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.
Licensed Professional
Signature Date
r
CITY OF CUPERTINO
4 ITEMS OF 5 PERMI'C RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl.c: Lot:
APN . . . . . . . . : 31539025 . 00
DATE ISSUED. . . . . . . : 07/08/2010
RECEIPT #. . . . . . . . . : BS)00010815
REFERENCE ID # . . . : 10 )70064
SITE ADDRESS . . . . . : 20206 NORTHBROOK SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . MARCUS WEI
ADDRESS . . . . . . . . . . : 20206 NORTHBROOK SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BAYHILL HEAT & AIR
CONTRACTOR . . . . . . . : RI:ARDO VALDERAMA LIC # 30480
COMPANY . . . . . . . . . . : BAYHILL HEAT & AIR
ADDRESS 262 MAIN ST
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
TELEPHONE . . . . . . . . : (650) 948-5900
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 031 . 00 1 .00 0 . 00 1 . 00 0 .00
1BREMAIRHA NO.UNITS 1 . 00 63 .00 0 .00 63 . 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 148 . 00 0 . 00 148 . 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
RECEIPT NUMBER: BS000010815
RECEIVED BY: PATRICIAG PAYOR: BAYHILL HEAT & AIR
TODAY'S DATE: 07/08/10 REGISTER DATE: 07/08/10
TIME: 11:15
5
1BCBSC 10070064 $1 . 00
1BREMAIRHA 10070064 $63 . 00
1MPERMITFE 10070064 $42 .00
1TRAVDOC 10070064 $42 .00
BUSINESS LICENSE TAX RNEW-BAYHI�L HEAD&AIR $114 . 00
----------------
TOTAL DUE: $262 . 00
CHECK $262 . OJ REF NUM: #1528
TENDERED CHANGE
$262 . 00 $ . 00
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,031
RPERMIT TYPE: Mechanical Permit L?.N CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex ,h r Il. APPLICATION
USE: p I I "� %ft =r r TYPE:
xw
a, a
00
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES
A/C Units (<=10K cfm) 1BR=MAIR 1 $63
TOTALS: $63.00
Mech.Plan Check 0.0 1 hrs $0.00
FMech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hr $42.00 T7
NOTE: Thesefees are based on the preliminary information mailable and are only an estimate. Contact the Dept for addn7 info,
FEE ITEMS (]-'f-,e Resolution 0.9-051 F_lf' 7/1%091 FE1, QTY/FEE MISC ITEMS
PME Plan Check: $().00
3
PME Unit Fee: $6:3.00
PME Permit Fee: $42.00
f➢
Travel Documentation Fee: ITRA VDOC $42.00
;; .. Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1413.00 $0.00 TOTAL FEE: $148.00
Revised: 6/30/2010
s
CITY OF CUPERTINO
4 FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date: s
Building Address:
, a�
Owner's Name: , PhoX11 NO,em, n Z/oz)#
Contractor: Phone i( G—le-?g
'PA r L�-- �� Ai j�- Fax #:
Contractor License#: Cupertino Business License#:
Ci � �- � �
Contact* Phone i�- � j �( -6(ir-�
R-tC�C� V �rZ�� l�'� Fax #: 7`�
Building Permit Info:
Elect [ Plumb [�] Mech
Residential 0 Commercial
Job Description:
(�
Am) �C.c� �iy �,�In r S i�hJ� �CZk -&JA c`
For Residential Installations:
Attic ❑ 1` floor FRI 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 Construction (Usage Class):
Strapped ❑ On Platform Bond,;d New Location Replacement ❑
Project Size: Express ❑ Standard ❑ Large [] Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, incll.ide in plan set & the sheet index.
Revised 01/07/09
CITY OF C UPERTINO
FURNA.CE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= 1 Ok CFM B
IMCRAA Commercial Mec:i Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commer,;ial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1 BPGAS For each gas piling system of 5 or P
more per outlet. C'omm/Resid
1 BREMAIRHAN Residential A/C units<= l Ok CFM B
f
1 MRRAA Residential Mecb Repair/alt/add M
f 1BCBSC Cal Bldg Standar is Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Perrr it M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documen ration B
1 1BUSLIC Business License B
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
Please indicate below which modification(s) are planned for your property. Provide
brochure(s) if possible and a copy of any proposal(s), including the contractor's
license number. Any modification not expres:;ly listed herein, or not conforming to
the restrictions and requirements listed herein for that modification will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for apr roval. Satellite Dish installation has a
separate form to be completed and submitted for approval.
IN44if cation Restrictions and Reguirements
Air conditioning unit Unit will be designed for quiet
residential use. Unit will be
located within the enclosed yard
of the property. There will be no
part of the unit visible to common
areas. Installed by a licensed
contractor.
Replacement window/ Must be same size aperture and
Sliding door location of existing window or sliding
door. Any necessary touch-up
painting is the responsibility of the
Homeowner. Installed by a license
contractor.
Garage door �. , . � Must be windowless and in conformity
t E< h general architectural style of the
mplex. Repainting to conform to
By: exterior color scheme is responsibility
of the Homeowner. Installed by a
-� licensed contractor.
Any damages caused to property as a result of modifications will be the homeowner's
responsibility. Ali prohibitions, restrictions, conditions, and rights of the Association
enumerated under Article V of the amended and restated Covenants, Conditions and
Restrictions of the Northpoint Homeowners Association are applicable to modifications
Contained herein. City permits may be required.
Please Prr,7t
Homeowners Name(s). (je-i
Property Address: Ge 0r' j(�L-u�� Pho4q(*' 6Y -! 7
Date of Notification: (b Date of Completion: �J
Homeowner has 6 months to complete the desigrated modifications and is responsible for
notifying management upon project completion.
o use Inly
Notification received by: 'ti y Date:
Completion verified & approved by: n��,.� Date:
Form adopted 8/10/1999 Revised 5/00