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10060052 CITY OF CUPERTINO '3UILDING PERMIT UILDING ADDRESS: 10295 PARKSIDE LN CONTRACTOR:VALLEY HEATING& PERMIT NO: 10060052 COOLING OWNER'S NAME: SUNG MIN TAO 11,1 N 4 TH ST DATE ISSUED:06/09/2010 OWNER'S PHONE: 4087185531 SA4 JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL 1 �C REPLACE FURNACE& ADD A/C UNIT License Clas ,1 1cc... Contractor �G� Dat 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: 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4250 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 Al'N Number:36904022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by Date: granting of this permit. Additionally,the applicant understands and will comply th all non-point source ulations per the Cupertino Municipal Code,Section 18. �� RE-ROOFS: Signature Dat A I 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 in 3pection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three n aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: F ealth&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's n aterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the a r contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. m ill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 ,oe 2553 , 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:% tis��- Date permit is issued. I 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's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. v,ork's for which this permit is issued(Sec.3097,Civ C.) bender's Name APPLICANT CERTIFICATION bender's Address rtify 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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION 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. Signature Date CITY OF CUFERTINO 6 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 36904(22 . 00 DATE ISSUED. . . . . . . : 06/09/ 2010 RECEIPT # . . . . . . . . . BS000(,10592 REFERENCE ID # 10060052 SITE ADDRESS 10295 PARKSIDE LN SUBDIVISION . . . . . . CITY CUPER-INO IMPACT AREA . . . . . . OWNER SUNG 14IN TAO ADDRESS 10295 PARKSIDE LN CITY/STATE/ZIP . . . : CUPER'CINO, CA 95014-3193 RECEIVED FROM VALLE'( HEATING & CO CONTRACTOR ATKIN3ON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS 1171 :A 4 TH ST CITY/STATE/ZIP . . . : SAN JDSE, CA 95112 TELEPHONE (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- --- 1BCBSC VALUATION 4, 250 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1BSEISMICR VALUATION 4, 250 . 00 0 . 50 0 . 00 0 . 50 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 274 . 50 0 . 00 274 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------ CHECK 1, 098 . 30 20761 --------------- TOTAL RECEIPT 1, 098 . 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino is 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: _ IPERMIT# OWNER'S NAM o 1J ONE# d GENERAL CONTR CTOR: BUSINES LICENSE# ADDRESS: of L" ell CITY/ZIPCODE: *Our municipal code requires all businesses working in the -ity to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS''ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTfiLACI'OR�S� HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Si ature Date Please check applicable subcontracto and complete the following information: 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 C'UPERTINO FURNACE/AC CUPCITY OF EkTINO PERMIT APPLK- ATION FORM pOl�Gb�� APN# `, Date: Cod 2 .O Building Address: Owner's Name: Phone#: 7 '��✓ Contra or: Phone#:� 50 0-,j g;,� Ua � � s� Fax #: �414- 8�z Contrac r License#: Cupertino Business License#: S 51-10 /�W Contact: Phone#: - y0�- -62-5'C- Fax#: Building Permit Info: Elect R-Iol�- Plumb Mech ❑,-- Residential Commercial ❑ Job Description: For Resi ential Installations: Attic El1St floor ❑ 2nd floor El Adhere to minimum setback requirement 0� For Commercial Installations: Replacemcrit same weight ❑ tidditional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: - Type of Construction (Usage Class): Strapped El On Platform L1Bonded New Location ❑ Replacement Valuation: Green Building: Must attach Green Building Checl: list to this application CITY OF C'UPERTINO FURNACE/AC CITY OF CUPER`TINO FEE SCHEDULE Quantity Fee ID Fee Descriptio.l Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1MCRAA Commercial Meeh Repair/alt/add M 1BSEISMICO Seismic Commeicial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas pi])mg system of 5 or P more per outlet. C-onun/Resid I 1BRENiAHUiAN Residential A/C 1 znits <= l Ok CFM B 1MRRAA Residential Mech Repair/alt/add M / 1BSEISMICR Seismic Residenlial B 1EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Pear it M 1PPERMITFEE Plumbing Permit P 1 TRA VDOC Travel Documeni ation B 1BUSLIC Business License B ;__Ntau CITY OF CUPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC --TPGASRES -Residential for ea gas piping system of- P-- 1-4 Outlets 1BPGAS For each gas piling system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, ir.cl ducts/vents �G(lf lvx e� attached to such Eppliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/burner, ir.cl ducts/vents attached to such �ppliance over 100,000 Btu/h 1EPERMITFEE Electric Permit F,-,e E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documen:ation B 1BUSLIC Business License B