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10070065CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19924 WHEATON DR CONTRACTOR: BAYHILL HEAT & AIR PERMIT NO: 10070065 OWNER'S NAME: GRACIELA V PORRAS 262 MAIN ST DATE ISSUED: 07/08/2010 . NER'S PHONE: 4086078417 LOS ALTOS, CA 94022 PHONE NO: (650) 948-5900 ,93 LICENSED CONTRACTOR'S DECLARATION[_ r ELECT PLUMB CY i a:li - Q BUILDING PERMIT INFO: BLDG License Class Lic. # / r— r COMMERCIAL r Contracto,&��4k4t4AVL Date MECH RESIDENTIAL I herebyaffirm that I am licensed under the provisions of Chapter 9 p p JOB DESCRIPTION: ADDING AIR CONDITIONING &MODIFYING 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. Sq. Ft Floor Area: Valuation: $6072 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. J' f"1/ APN Number: 31621080.00 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 re lations per the Cupertino Municipal Code, Section 9.18. �~ Date: �- G Signature Date d J� Issued b ❑ 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) 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 HAZARDOUS MATERIALS DISCLOSURE 1 hereby affirm under penalty of perjury one of the following three 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. I 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 au t ' agent: become subject to the Worker's Compensation provisions of the Labor Code, I must Dater 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 it -nn the above mentioned property for inspection purposes. (We) agree to save Lender's Address nnify and keep harmless the City of Cupertino against liabilities, judgments, ,-s, 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 CITY OF' CUPERTINO FM -7, FEE ESTIMATOR - BUILDING DIVISION AADDRESS: CAPACITY DATE: QTY REVIEWED BY: BP FEES l APN: BP#: -VALUATION: 1$6,072 -� PERMIT TYPE: Mechanical Permit PL kN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: _ 1 1 t3�1Ir� 4,t. APPLICATION TYPE: 1 as PME Unit Fee: 3U PME Permit Fee: $42.00 APPLIANCE / EQUIP TYPE CAPACITY FLE ID QTY BP FEES A/C Units (<=10K cfm) 1BFEMAIR 1 PME Plan Check: $63 Heating Appliance 1 V RRAA 1 $63 PME Unit Fee: $1213.00 PME Permit Fee: $42.00 TOTALS: F Travel Documentation Fee: ITRA VDOC $126.00 Mech. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp.0.0 hrs $42.00 }, ,_,,,.:<,,„ Bld- Stds Commission Fee: IBCBSC NOTE: These fees are based on the Preliminary information 2vailable and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 Elf 71,09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $1213.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item Bld- Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $21' $0.00 TOTAL FEE. $211.00 Revised: 6/30/2010 5 ITEMS OF 5 CITY OF CUPERTINO PERMIP RECEIPT Sec: Twp: Rng: Sub: Blt: Lot: APN ........: 31521080.00 DATE ISSUED.......: 07/08/2010 RECEIPT #.........: BS000010816 REFERENCE ID # ...: 10070065 SITE ADDRESS .....: 19924 WHEATON DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GRACIELA V PORRAS ADDRESS 19924 WHEATON DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: BAYHILL HEAT & AIR CONTRACTOR RICARDO VALDERAMA LIC # 30480 COMPANY BAYHILL HEAT & AIR ADDRESS 262 MAIN ST CITY/STATE/ZIP ...: LCS ALTOS, CA 94022 TELEPHONE ........: (650) 948-5900 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 6,072.00 ---------- 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 1MRRAA UNITS 1.00 63.00 0.00 63.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 211.00 ---------- 0.00 211.00 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 211.00 --------------- 211.00 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #1529 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # a� Date: 0 - l J-2-0 Building Addres `'t 'b` -t Owner's Name: Phon� #�� Contractor: Phone r ' -� V Fax #� cpo- Contractor License #: Cupertino Business License #: Contact: Phone #: R � ORZO • VA L Fax #: Building Permit Info: Elect 9 Plumb ® Mech Residential Commercial Job Description: For Residential Installations: Attic ❑ I` floor E 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): 6, o-:" 4) � StrappedH On Platform Bonded New Location Replacement Project Size: Express ['Standard ❑ Large Major ❑ Valuation: Green Building: Please complete relevant portWi of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet inde<z1--_-� Revised U1/U7/U9 CITY OF CUPEkTINO CITY OF C UPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1MCRAA 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 1-4 outlets P 1PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piling system of 5 or more per outlet. C;omm/Resid P 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M t 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: I q q � /LJ PERMIT # 00 OWNER'S NAME: d2 PHONE#6 GENERAL CONTRACTOR: 41AI✓L BUSINESS LICENSE # ADDRESS: 'O.&P.4,I/�,/A 54. (,4o CITY/ZIPCODE: *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 SUBCONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Si€nature Date Please check applicable subcontractors and complete the following information: 7 -21t 0 er / Contractor Signature Date 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 7 -21t 0 er / Contractor Signature Date