10060050 CITY OF CUPERTINO BUILDING PERMIT
1ILDING ADDRESS: 10161 PHAR LAP DR CC NTRACTOR:VALLEY HEATING& PERMIT NO: 10060050
CC OLING
OWNER'S NAME: JOETTA MAIER 1171 N 4TH ST DATE ISSUED:06/09/2010
OWNER'S PHONE: 4087761205 SAV JOSE,CA 95112 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
License Class -- iJ Li .# 2 �// REPLACE FURNACE&ADD A/C UNIT
Contractor �1/ ate `C(/
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:$6150
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 AI'N Number:32639056.00 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 Is iued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
th all non-point source regulations per the Cupertino Municipal Code,Section
18.
RE-ROOFS:
Signature Date 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
inspection.
❑ 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. I will
I hereby affirm under penalty of perjury one of the following three rr aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&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 it 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. H 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 25533,and 25534. ��
Section 3700 of the Labor Code,for the performance of the work for which this C wrier or authorized agent: 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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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.)
I ender's Name
APPLICANT CERTIFICATION I ender's Address
�,rtify that I have read this application and state that the above information is
.orrect.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 I icensed Professional
9.18.
Signature Date
CITY OF CUEERTINO
6 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Iot :
APN 32639( 56 . 00
DATE ISSUED. . . . . . . : 06/09/ 2010
RECEIPT # . . . . . . . . . : BS000010592
REFERENCE ID # 10060050
SITE ADDRESS . . . . . : 10161 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY CUPER-INO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JOETTA MAIER
ADDRESS 10161 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERPINO CA, CA 95014-1113
RECEIVED FROM VALLEY HEATING & CO
CONTRACTOR ATKIN3ON, THOMAS LIC # 141
COMPANY VALLEY HEATING & COOLING
ADDRESS 1171 V 4 TH ST
CITY/STATE/ZIP SAN JDSE, CA 95112
TELEPHONE (408) 294-6290
FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL
____ ----------
---------- -------
1BCBSC VALUATION 6, 150 .00 1. 00 0 . 00 1 . 00 0 . 00
1BREMAIRHA NO.UNITS 1 . 00 63 . 0000 63 . 00 0 . 00
1BSEISMICR VALUATION 6, 150 . 00 0 . 70 0 . 00 0 . 70 0 . 00
1MFR=<100 UNITS 1 . 00 126 . 00 .)- 0 . 00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 42 . Op 0 .00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 - - -42_ - - --
TOTAL PERMIT 00 0 . 00
274 . 70. 0 . 00 274 . 70 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
d(,
V J•
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/ SUBC"ONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: ,r PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE# ' C�
ADDRESS: 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 IVXECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACT RS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. -�
1 am not using any subcontractors: - �J
Signal ure Date
Please check applicable subcontr ctors 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
lei
-• CITY OF C'UPERTINO
FURNA CEAC
OF
CUPERJINO PERMIT APPLICATION FOM
ov o o(9-6-D
APN# Date:
324 95 -9 0 • oc
Building Address:
Owner's Name: Phone #:
woe��- M 0A ar y" "-7 L4P
Contractor: Phone #:
i �a �� Fax #: � , �2-0
Contractor icense#: Cupertino Business License#:
Contact: Phone#:
r. C- done- Fax #: qac;2q4 &ZZ
Building Permit Info:
Elect 2� Plumb Mech
Residential Commercial ❑
Job Description:
For esidentialInstallations:
Attic ❑ 1St floor ❑ 2na floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ /Aditional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval..Required ❑
Cost of Project: Type of Construction(Usage Class):
Stra ed ❑ On Platform ❑ Bonded
WNew Location Replacement
Valuation:
Green Building: Must attach Green Building Chect list to this application
CITE' OF CUPERTINO
FURNACE/AC
CITY OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
--- 1BCAIRHAN Commercial A/C 1Jnits <= 1 O CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial 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 piping system of 5 or P
more per outlet. C omm/Resid
i
IBREMAERHAN Residential A/C units <= 1 O CFM B
1MIU A Residential Mech Repair/alt/add M
1BSEISMICR Seismic Resident:al B
V
1EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
�t
1PPERMITFEE Plumbing Permit P
' 1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
- CITY OF CUPERTINO
FURNACE/A.0
CITY Or
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
IPGASRES -Residential for ea has piping system of- --P---
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seism.c B
1MECPLNCK Mechanical Plan (;heck M
1MFR=<100 Furnace Syst <=1 )Ok BTU install or M
elocate ea forced-air/gravity type
mace/burner, incl ducts/vents
1 attached to such appliance up to and
include 100,000 F,tu/h
IMF 100 Furnace Syst> 1C,Ok BTU install or M
relocate ea forced-air/gravity type
furnace/burner, ir cl ducts/vents
attached to such appliance over
100,000 Btu/h
1EPERMITFEE Electric Permit Foe E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B