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10060002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20358 CLAY ST CONTRACTOR:PELLE HEATING&AC INC PERMIT NO: 10060002 C 'ER'S NAME: JEFFREY S AND PATRICIA A GLICK 3728 C CHARTER PARK DR DATE ISSUED:06/01/2010 O'vv NER'S PHONE: 4088651234 SAN JOSE,CA 95136 PHONE NO:(408)978-7060 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r License Class� Lic.# T c LcS v � � "ClCH RESIDENTIAL COMMERCIAL Contractor l'' �� t ' l�' CDate �lo I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 10 SUPPLY DUCTS,REPLACE 100 BTU (commencing with Section 7000)of Division 3 of the Business&Professions ADD,FURN TON AC Code and that my license is in full force and effect. DD TO 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$11145 permit is issued. APPLICANT CERTIFICATION APN Sumber:36938029.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section Issued by�1�� Date: — — —E_ Si- mature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All rc ofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: instal ed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Calif)rnia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by comfliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contf minants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Heall h&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption, become subject to the Worker's Compensation provisions of the Labor Code,I must Ow ora flrgri4 �I �vl� forthwith comply with such provisions or this permit shall be deemed revoked. —` Vl/ Date: l CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I here by affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name `he above mentioned property for inspection purposes.(We)agree to save .nify and keep harmless the City of Cupertino against liabilities,judgments, Lend er's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I and.-rstand my plans shall be used as public records. Signature Date Licensed Professional Building Department City Of Cupertino '91 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: PERMIT# C O C �- OWNER'S NAME: (e71L� PHONE# GENERAL CONTRACTOR: dh Ca--h' l BUSINESS LICENSE# $ ADDRESS: '7),q C-1, a( er Pc4,0rX 13 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 CONTRACTAN CONTRAC'Cr($S-HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: — (� Signature Date Please check applicable subcontractors and complete 1 he following information: V 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 CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36938029 .00 DATE ISSUED. . . . . . . : 06/01/2010 RECEIPT #. . . . . . . . . : BS000010522 REFERENCE ID # • • . : 10060002 SITE ADDRESS . . . . . : 20358 CLAY ST SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JEFFREY S AND PATRICIA A GLICK ADDRESS . . . . . . . . . . : 20358 CLAY ST CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4403 RECEIVED FROM . . . . : PELLE HEATING & AIR CONTRACTOR STEVE PELLE LIC # 27593 COMPANY . . . . . . . . . . : PELLE HEATING & AC INC ADDRESS . 3728 C CHARTER PARK DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 978-7060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 145 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 0 . 00 1BSEISMICR VALUATION 11, 145. 00 1 .20 0 . 00 1 .20 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 233 .20 0 . 00 233 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 233 .20 #4359 --------------- TOTAL RECEIPT 233 .20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CITY OF CUPERTINO 12 FURNACE/AC CUP�`rR°INO PERMIT APPLICATION FORM APN # � I Date: Building Address: Oner's Na,*TC Phone #: Contractor: Phone #:`tO<2. c ' g• -7CXoO T C,CL', ��Psv��► l Fax #: AoV•`n'f.. Lf-1 T C7 Contractor License#: Cupertino Business License#: �0ct 4351 '-^ S Contact: Phone #:L-teg. :t 1 g .-1 CSO rl C� C (��I S {-ellL�r �_ Fax #: Building Permit Info: Elect Plumb u/ Mech Residential Commercial ❑ Job Description: 6-C v to SLI-PP Ln C(C� r-� tic. LOG 15-c, f7C�vl �C---/ For Residential Installations: Attic ❑ 1" floor ❑ 2nd 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 Re uired ❑ Cost of Project: Type of Constriction (Usage Class): 11) 1gs. C"-'' \J AC--' Strapped On Platform Bonded F New Location ❑ Replacement Project Size: Express D-----Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include i 1 plan set & the sheet index. Revised 01/07/09 CITY OF CITY OF CU PERTINO Is FURNA(-E/AC FEE SCHEDULE CUPERTINO floor mounted unit beater. Quantity Fee ID Fee Description Fee Permit Type Group 1 MRAPPVNT Residential for the i lstall/relocate/or M replacement of ea appliance vent install &not incl in an a pl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Cl_eck M 1MFR=<100 Furnace Syst<=10Ck BTU install or M relocate ea forced-air/gravity type I furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 1001c BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentat on B CITY OF CITY OF CL PERTINO FURNACE/AC CUPERTINO FEE SCHEDULE 1 BUSLIC Business License B Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C U lits <= 1 Ok CFM B I MCRAA Commercial Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commerciz.l B 1 PGASCOM Commerical for ea;;as piping System P 1-4 outlets 1 PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid IBREMAIRHAN Residential A/C units <= 10k CFM B 1MRRAA Residential Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Permit M IPPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentat on B