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10060051 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:VALLEY HEATING& PERMIT NO: 10060051 UILDING ADDRESS: 22901 LONGDOWN RD COOLING 1171 N 4 TH ST DATE ISSUED:06/09/2010 OWNER'S NAME: JEFF SHAG SAN JOSE,CA 95112 PHONE NO:(408)294-6290 OWNER'S PHONE: 4088937511 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION /� � RF PLACE FURNACE&ADD A/C UNIT License Class Lic.# Contractor • % Date I hereby affirm that I am licensed un er 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: 1 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 Valuation:$5495 performance of the work for which this permit is issued. Sq Ft Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this AIN Number:34240004.00 permit is issued. APPLICANT CERTIFICATIONEXPIRES ation is I certify thT STARTED at I have read this application and state that the above d state laws relating PERMIT I8 DAYS IOF PERMIT ISOSUANCE OR correct.I agree to comply with all city and county ordinancesWITHIN to building construction,and hereby authorize representatives of this city to enter 180 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Date: costs,and expenses which may accrue against said City in consequence of the I!sued by: granting of this permit. Additionally,the applicant understands and will comply 'th all non-point source regulations per the Cuperti icipal Cod Section _ 18 /l RE-ROOFS: Date v F 11 roofs shall be inspected prior to any roofing material being installed.If a roof is Signatu� installed without first obtaining an inspection,I agree to remove all new materials for 9 i rspection. OWNER-BUILDER DECLARATION Date: f ignature of Appli I heteby affirm that I am exempt from the Contractor's License Law for one of ALL R F O RINGS TO BE CLASS"A"OR BETTER the following two reasons: 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, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will al I hereby affirm under penalty of perjury one of the following three maintain e Health Safety Code,Section 25532(a)should Istore or handlehazardouer 9.12 s the nt or devices which emit hazardous declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's material.r contaminants as deft should by the BayuAreaipmeAir Quality Management District 1 Compensation,as provided for by Section 3700 of the Labor Code,for the will maintain compliance with the Cuper' o Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sections 533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by Date&} Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen _ permit is issued. ; I certify that in the performance of the work for which this permit is issued,I shall ONS j RUCTION LENDING AGENCY 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 become subject to the Worker's Compensation provisions of the Labor Code,I must o�k,b for affirm hich this permit is construction (Sec,3097,Civ agency for the performance o forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address ertify that I have read this application and state that the above information is ,)rrect.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 ARCHITECT'S DECLARATION upon the above mentioned property for inspection purposes.(We)agree to save 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 understand 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. Date Signature CITY OF CUPERPINO PERMIT RECEIPT OPERATOR: SylviaM 6 ITEMS OF 24 COPY # � 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 3424000Z . 00 DATE ISSUED. . . . . . . 0 RECEIPT #. . . . : BS00001()• " " 1006005E 92 REFERENCE ID # • - SITE ADDRESS 22901 LDNGDOWN RD SUBDIVISION • • • . . . : CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER JEFF SI�:AO ADDRESS : 22901 I,ONGDOWN RD PERT.:NO, CA 95014-2651 CITY/STATE/ZIP . . . : CU RECEIVED FROM VALLEY HEATING & CO 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 7 Up,NTITY AMOLNT PD-TO-DT THIS REC - NEW BAL- FEE ID UNIT 4 -------- 0 . 00 --- - ----------- ---------- ----- -1 . 00 0 . 00 1 . 00 VALUATION 5,495 .00 0 . 00 63 . 00 0 . 00 1BCBSC 1 . 00 63 . 00 0 . 60 0 . 00 1BREMAIRHA NO.UNITS 0 . 60 0 . 00 0 . 00 5,495 . 00 0 . 00 126 . 00 1BSEISMICR VALUATION 1 . 00 126 . 00 42 . 00 0 . 00 1MFR=<100 UNITS 1 .00 42 . 00 0 .00 0 . 00 iMPERMITFE FLAT RATE 42 . 00 0 . 00 42 . 00 - - - 1 .00 --------- -- 1TRAVDOC FLAT RATE ---------- ---------- - 274 . 60 0 . 00 274 . 60 0 . 00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ -------------------- --- ---------------- 507 FINAL PLUMBING 505 FINAL ELECTRICAL 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/ SUBCO]vTRACTOR LIST JOB ADDRESS: G'/ PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE'# ADDRESS: IPJ G r 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 SUB NTRACTOVS HAVE OBTAINED A CITY OF CUPERTINO i BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcon.0 actors and complete the 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 11)0� O r/Contr ctor Signature Date CITY OF CUP ERTIN O L FURNACE/AC LICATION FORM Cin,O PERMIT APP 00 00 CUPEt�TlNO Date: / „ t V APN# 0 _ Building Address: Phone#: Owner's Name: q Phone#: ! "Zs5e,6 contractor: VFax#: Cupertino Business License#: Contractor License#: / 7(LFax#:Phone#44bS Contact: On Building P ermit Info: ❑ Mech Plumb ©� Elect Commercial ❑ Residential Job Description: 1A, 2nd floor ❑ For Residential Installations: 1St floor ❑ Attic ❑ Adhere,to minimum setback re uirement _� cal ❑ additional weight(stnzctulal For Commercial Installations: ❑ Replacement same weight El Structural Calculations required for new installation royal Re uired ❑ Class): New installation P�1�in��Ap T},pe��� lstniction(Usage Cost of Project: � Replacement 4clS Bonded New Location Strapped ❑ On Platform ❑ Valuation: Iication ildin : Must attach Green Building Ch�ck list to this ap p Green Bu g CITE' OF CUPERTINO j FURNA.0 E/A.0 Y OF CUP.ER`TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou AIR FURN/AC _CONDITIO_NING_ 1BCAIRHA_ N Commercial A/C Units <= l0k CFM B 1MCRAA Commercial Mech R,-pair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea ga,piping system P of 1-4 Outlets 1BPGAS For each gas piping; system of 5 or P more per outlet. Conun/Resid 1BREMAIRHAN Residential A/C unit <= 10k CFM B 1MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B I Clasc 1EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERIVIITFEE Plumbing Permit P / 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO `G`s FURNACE/AC crry of FEE SCHEDULE CUPEkTINO Fee Permit Type Quantity Fee ID Fee Description Grou FURN/AC _ _________ �.."s i in s stem of� P - ---------1P�GASRES_ Residential for ea g� p P g y 1-4 Outlets P 1BPGAS For each gas pipir g system of 5 or more Per outlet. B 1BSEISMICR Residential Seismic I ECPLNCK Mechanical Plan C heck M IMFR=<100 Furnace Syst <=1(0k BTU install or M relocate ea forced-air/gravity type f rl)�� furnace/burner, in;l ducts/vents attached to such appliance up to and include 100,000 IWPfl M 1MFRN>100 Furnace Syst> I00 BTU install or relocate ea forced-air/gravity type fumace/burner, incl ducts/vents attached to such ,Lppliance over 100,000 Btu/h E lEPERMITFEE Electric Permit Fee 1MPERMITFEE Mechanical Perr.it Fee M P 1PPERMITFEE Plumbing Permit 1TRAVDOC Travel Documentation B B 1BUSLIC Business Licen;e