10070201 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10823 WILKINSON AVE CONTRACTOR:A&H HEATING PERMIT NO: 10070201
OWNER'S NAME: CAROLINA MUELLER 1170 CHESTNUT ST DATE ISSUED:07/30/2010
ER'S PHONE: 4088651897 iAN JOSE,CA 95110 PHONE NO:(408)279-0722
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C_1Z cs Lic.# 3GYY7 F
MECH RESIDENTIAL COMMERCIAL
Contractor Date �� 3�'—��
JOB DESCRIPTION:REMOVE&REPLACE FURNACE TO EXISTING 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.
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:$6100
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
permit is issued. /tom APN Number:35613019.00 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 so gula ons per the Cupertino Municipal Code,Section Issued b Date:77_0
9.18.
Signature Date
RE-ROOFS:
Li 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)
I,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. 1 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. 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'sOw4�,,_
horiz
Compensation laws of California. If,after making this certificate of exemption,IDate:
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
-!mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
s,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
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot :
APN . . . . . . . . :35613019. 00
DATE ISSUED. . . . . . . : 07/30/2010
RECEIPT #. . . . . . . . . BSC00011031
REFERENCE ID # . . . : 1OC70201
SITE ADDRESS . . . . . : lOF23 WILKINSON AVE
SUBDIVISION . . . . . .
CITY CUFERTINO
IMPACT AREA . . . . . .
OWNER CAF.OLINA MUELLER
ADDRESS lOE23 WILKINSON AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : REINHARD PERLHEFTER
CONTRACTOR PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A L H HEATING
ADDRESS 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE (408) 279-0722
FEE ID UNIT QUANTITY ],MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ---------
1BCBSC VALUATION 6, 100 . 00 1 .00 0 .00 1. 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 211 . 00 0 .00 211. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 211 .00 VISA
---------------
TOTAL RECEIPT 211. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
CITY OF C'UPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$6,100
;PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex APPLICATION 1 RMAP6
USE: p : i �< fF' TYPE:
as
00
3UO
APPLIANCE/EQUIP TYPE CAPACITY FEL ID QTY 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 $42.00
NOTE: These fees are based on the preliminary information available and are onjV an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 09-051 F_ff ? 1.719) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $126.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (D No $C.00
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bld�_, Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $211.00 $0.00 TOTAL FEE: $211.00
Revised: 7/27/2010
CITY OF CUPERTINO
FUWiACE/AC
CUPEkTINO PERMIT APP]:JICATION FORM
APN# .., , Date;
Bding Address:
7�il
g 2 3 . blj I L KC)P4
Owner's Name: Phone#:
Cf BL<< 'M � L L 1ST`7
Contractor: Phone#: 27 q 6 2 2
0 /J Fax#: ??S /01--)
Contractor License#: Cupertino Business License#:
Contact: Phone#:27 07 2 Z_
0414—:2 P�d S Fax #: 27 V /G
Building Permit Info:
Elect Ls Plumb Mech
Residential 9 Commercial
Job Description:
� r�d v-2 A o e .s;
For Residential Installations:
Attic ❑ 1St floor [] 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) F-1Structural Calculations required for new installation
New installation Planning Approval Required ❑
C t of Project: Type of Construction(Usage Class):
k/0
Strapped On Platform Bond-,d ❑ New Location M Replacement
Project Size: Express ❑ Standard ❑ Large [] Major❑
a ion:
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 6/16/08
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes Z IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 31AQ/Health pts y=yes 0
p
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF t•IAQ/Health is Y=YeS 0
P
8.Use FSC Certified Materials for Interior Finish 1 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yesi 0
1 1
N.Flooring EM im,
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl E IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
■ 1 i 1
Total Points Availab e: 1 01 1301 57
Total Points Project Received: 01 01 0
G:data/progs/greent uildingguidelines/remodelers/greenpointsfinal2.12.04proteeted.xis
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/ SL BCONTRACTOR LIST
JOB ADDRESS: > X0..9— PERMIT# 106V7 0
OWNER'S NAME: .SLC-•ti— PHONE# Z71- 0-77--Z—
GENERAL
7g- G'722GENERAL CONTRACTOR: V)�-p V BUSINESS LICENSE#
ADDRESS: -2 ,j �T� CITY/ZIPCODE: Quit G
*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 SUBCONT A.CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Sid nature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINES'S 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