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10030034 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7585 PROSPECT RD CONTRACTOR:VALLEY HEATING& PERMIT NO: 10030034 COOLING ^WNER'S NAME: WIPFLER ANNE E AND HERBERT W T 1171 N 4 TH ST DATE ISSUED:03/04/2010 .,WNER'S PHONE: 4089961341 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARAATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Clas �_ Z,Q Lie.# [ REPLACE FURNACE ONLY Contractor Date 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:$2650 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 APN Number:36624035.00 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 �i Date: granting of this permit. Additionally,the applicant understands and will comply Issued by ' i �� ( � CJ with all non point source egulations �thhc pertino Municipal Code,Section 9.18. ROOFS: sany r ignature % ' Da / ( C� All roofs shall be inspected prior to y 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 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) 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 maintain 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 material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 25533,an 34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �� D•ate. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall i 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 C NSTRUCTION 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. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 non the above mentioned property for inspection purposes.(We)agree to save iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION posts,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 regulatio per the Cupertino Municipal Code,Section Licensed Professional 9.18. i Signature Dat �� CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36624035 . 00 DATE ISSUED. . . . . . . : 03/04/2010 RECEIPT #. . . . . . . . . : BS000009877 REFERENCE ID # . . . : 10030034 SITE ADDRESS . . . . . : 7585 PROSPECT RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WIPFLER ANNE E AND HERBERT W T ADDRESS 7585 PROSPECT RD CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5242 RECEIVED FROM . . . . : VALLEY HEATING 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 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 650 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 2, 650 . 00 0 . 50 0 . 00 0 .50 0 . 00 1MFR=<100 UNITS 1 . 00 126 . 00 0 . 00 126 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 169.50 0 . 00 169 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL _ CITY OF CUPERTINO FURNACE/AC CM OF CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone #: 0y)- Vi" Contractor: F Phoneocal #: �i'f, !�7 -vl' �% C ✓ Fax#: — 01 Contractdr License#: Cupertino Business License#: � l 1// Contact: Phone#: (2,f Ll (�; Fax#: Building Permit Info: Elect❑ Plumb ❑ Mech/Fj"� Residential Commercial ❑ Job Description: For Residential Installations: Attic ❑ 1"floor Er 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (str'acturai calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): C, C3-- Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacemen Valuation: Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FURNACE/AC CITY OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC -IPGASRES -Residential for ea gas piping system of-- P--- 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B IMECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and ��'< l�- include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1 1TRAVDOC Travel Documentation B 1BUSLIC Business License B f +� C (35 �- d W RE01 PEntetescript on here and enter points available for measure in appropriate categories to the right. D 0 0 i 0 D D l u Enter description here,and enter points available for measure in appropriate categories to the right D D 0 0 0 0 I L� Enter desoription here,and enter points availablefor measure in appropriate categories to the right 0 0 0 � D ❑ Enter description here,and enter points available to-measure in appropriate categories to the right 0 0 0 D D 0 4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a Build It Green Checklists and maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right. Guidelines Innovation in Community:Enter description here,and ertl-r points available tor-measure in appropriate categories to the right 0 7 — D �-0 -�-D 0 D - i ❑ Innovation in Energy:Enter description here,and enter points available for measure in appropriate categories to the right 0 D 0 0 0 D ❑ Innovation in IAOMealth:Enter description here,and enter points available for measure in appropriate categories to the right. D --D 0 -_ - ------ --- ❑ Innovation in Resources:Enter description here,and enter points available for measure in appropriate categories to the right D D 0_ ( D Total Available-Points in Other=-43 Innovation in Water.Erder d=seri tion here,and enter points available for measure in appropriate tate ories to the fight. 0 0 0 1 0 D D ❑ - P P - categories - 9 -- --------- ---'------- Total Available Points in Specific Categories` 4+ 96+ 142+ 166+ 143+ fkAinimum Points Required in Specific Categories 10 I 30 5 6 I 9 7Pr-j'7-t -' at yet met the following recommended mirilmum requirements: -Total Project Score of At Least 50 Points -.Required measures: -A3a: 50010 ivaste diversion by weight 24 -All:Incorporate Green Point Rated Checklist into blueprints - Minimum points in specific catepories: -Energy(30 points) -IAOIHealth(5 points) -Resources(6 points) 14later(9 points) ©2007 Build It Green Single Family GreenPoinf Checklist 2007 Version Paoe 4 of 4 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ";UPEkTINO Building Department JOB ADDRESS: ��s`' PERMIT # C9 Doc OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # z I am not using any subcontractors: Signature Date Please check applicable subcon actors 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 Ornamental Sheet Metal Painting/ Wallpaper ' Paving Plastering Plumbing Roofing Septic T Sheet Metal Sheet Rock Tile wife / ntractor Signature Date