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10010171 F CUPERTINO BUILDING�.. CITY o G PERMIT PERMIT NO: 10010171 CONTRACTOR:VALLEY HEATING 81, BUILDING ADDRESS: 10211 MILLER AVE COOLING DATE ISSUED:01/28/2010 1171N4THST ""NER'S NAME: STEPHEN THOMAS&ROBERT SHERRY PHONE NO:(408)294-6290 SAN JOSE,CA 95112 t,-vvNER'S PHONE: 4082036286 ELECT PLUMB � LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG E RESIDENTIAL COMMERCIAL MECH License Cl Date JOB DESCRIPTION:REPLACE FURNACE,ADDING A/C UNIT Contractor I hereby affirm that I am licensed under the provisionsvision the Business Chapter Professions (commencing with lscensens On full force ce and effect. Code and t Y I hereby affirm under penalty of perjury one of the following worker's rations: I have and will maintain a certificate of on 3700 of onsent to self-insure for the Labor Code,for the Valuation:$6709 Compensation,as provided for by Sect performance of the work for which this permit is issued. Sq.Ft Floor Area:rovided for by 111ave and will maintain Worker's Cthe the of thempensation insurance, work for which this occupancy Type: as Section 3700 of the Labor Code,for p APN Number:36914020.10211 permit is issued. APPLICANT CERTIFICATION ove IS NOT STARTED ation is I certifythat I have read this application and state thai he eab s and ate laws relating PERMIT EXPIRES IF WORK R with all city and county or IT ISSUANCE O correct.I agree to comply WITHIN 180 DAYS OF PERM to building construction,and hereby authorize representatives of this ree to aver LED INSPECTION. e for inspection purposes. (We)ag upon the above mentioned property 180 DAYS FROM LAST CAL harmless the City of Cupertino against liabilities,judgments, indemnify and keepsaid Cityin consequence of the costs,and expenses which may accrue against1 cant understands and will comply Date:/ granting of this permit. Additionally,the app pertino Municipal Code,Section Issued by: with all non-point source regulations per the Cu 9.18. Date 5;-nature RE-ROOFS: prior to any roofing material being installed.If a roof is R DECLARATION All roofs shall be inspected p agree to remove all new materials for OWNER-BUILDE installed without first obtaining an inspection,I 0 inspection. hereby affirm that I am exempt from the Contractor's License Law for one of Date: I her y the following two reasons: Signature of Applicant: 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.704 , ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE r penalty of perjury one of the following three de h' I have read the hazardous materials requirements under533 and 25534.95 of I willmaintain I hereby affirm un p lth&Safety Code,Sections 25505,25533, declarations: hapter 9.12 and the Health& maintain a Certificate of Consent to self-insure for Worker's CaliforniaCaf with the Cupertino Municipal Code, le hazardous material. I have and will main compliance Com Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle p this permit is issued. ment or devices which emit hazardous air performance of the work for whichP rovided for by Additionally,should I use equip Area Air Quality Management District I will as contaminants as defined by the Bay Chapter 9.12 and the I have and will maintain Worker's Compensation nct of the�work for which this maintain compliance with the Cupertino Municipal Code, Section 3700 of the Labor Code,for the p Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I cern that in the performance of the work for which this permit is issued,I shallgent: not employ any person in any manner so as to become subject to the Worker's kwn o �•/ Date-/—L—Z Y_xk� mpti f exe Compensation laws of California. If,after making this certificate La or Codeol must AGENCY p become subject to the Worker's Compensation provisions o t CONSTRUCTION LENDING forthwith comply with such provisions or this permit shall be deemed revoked. by affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) have read this application and state that the above information relating Lender's Name I certify that I h ordinances and stat correct.I agree to comply with all city and county ruction and hereby authorize representatives of this city to saveer Lender's Address to building const for inspection purposes.(We)agree to i the above mentioned property ARCHITECT'S DECLARATION harmless the City of Cupertino against liabilities,judgments, .nnify and keep m consequence of the public records. costs,and expenses which may accrue against said City plans shall be used as f this ermit.Additionally,the applicant understands and will comply I understand my p granting o p p a Cupertino Municipal Code,Section with all non-point source g ulat s Licensed Professional 9.18. �- �� Date Signature CITY OF CUPERTINO 8 ITEMS OF 22 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36914020 .10211 DATE ISSUED. . . . . . . : 01/28/2010 RECEIPT # . . . . . . . . . : BS000009643 REFERENCE ID # . . . : 10010171 SITE ADDRESS . . . . . : 10211 MILLER AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STEPHEN THOMAS & ROBERT SHERRY ADDRESS . . . . . . . . . . : 10211 MILLER AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VALLEY HEATING THOMAS COLIC # 141 CONTRACTOR . . . . . . . : ATKINSON 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- ---------- ------------- ---------- ---------- ------- 00 0 . 00 1BCBSC VALUATION 61709 . 00 1 . 00 0 .00 1. 1BREMAIRHA NO.UNITS 1 . 00 63 . 00 0 . 00 63 .00 0 . 00 1BSEISMICR VALUATION 61709 .00 0 .70 0 .00 0 .70 . 00 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 iMPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0.00 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0.00 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PPERMITFE FLAT RATE 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 ------ 0_ TOTAL PERMIT 295 .70 00 ------x • 00 295 .70 0 . 00 METHOD OF PAYMENT AMOUNT----- REFERENCE NUMBER CHECK 845 .10 #20193 --------------- TOTAL RECEIPT 845 .10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL -7 4 CITY OF CUPERTINO FURNACE/AC `ITYT CUPF�INO PERMIT APPLICATION FORM APN# Date: / Z J7�� (-P q I 0 . Building Address: Owner's Name: Phone#: C7Z3 L CX98(,e;;0I Contr ctor: Phone#: JC14 �' 41 �� Fax#: �C7�1J�K � Contractor Vicense#: Cupertino Business License#: /q/ Contact: Phone#: Fax#: Building Permit Info: Elect Plumb Mech Residential Commercial ❑ Job Description: For Resictential Installations: Attic ❑ 1 St floor ❑ 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement Sarre weight ❑ Add=+Lllonai weight (structtirai calcs) E] 1 Structural Calculations.required for new installation ❑ New installation Planning Approval Required ❑ st of Project: Type of Construction (Usage Class): `../G Strapped F-1OnPlatform ❑ Bonded New Location [ ^Replacement E&' Valuation: Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO ,.:._.. FURNACE/AC CU PE OF FEE SCHEDULE R.. Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC -I PGASRES Residenfial for ea gas piping system of -p- 1-4 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M l 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type famace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h IMFRN>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 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B y. CITY OF CUPERTINO +: FURNACEAC CITY OF FEE SCHEDULE CU PEkTINO Quantity uanti Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING — 1BCAIRHAN Commercial A/C Units<= 1 O CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMIC0 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 er outlet. Comm/Resid 1BRE Residential A/C units <= 10k CFM B G I 1 MUZAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B 1EPER.MITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1 TRA VDOC Travel Documentation B 1BUSLIC Business License B d r m V L U) ENTER Pi NAME , 4 I U ❑ o o D I7—r,— odes o o apP oP g -Enter description here,and enter points available for measure in r nate cafe Dries to the right _ __..___-.- -.—Enter descriptionhere,and enter points available for measure in appropriate categto then t ---- - - — 9-------- - ---__----....-------- �-_Enter description here,and enter points available for measure in categories to the right _ _ -_____-_____._-.-._____.__ -0 0 0 0 �_ D i ❑ Enter description here,and enter points available for measure in appropriate cateoories to the ng t Y_ Lht Build It GreeChecklists and 4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up tiGuidelines maximum combined total of 20 ts.See Innovation Checklist for su ested measures,usin the link to the ri ____ 0 0 __o___{_o__ o _ o Innovation in Community:Enter description hers,and enter points available for-measure in appropriate categories to the right 0 0 D # D o D__ ❑ 1 Innovation in Energy:Enter description here,and enter points available for measure in appropriate categories to the right __ __ _.. -- _—_-- _-- ❑ o 0 0 _ o_ __o. o Innovation in IAGiMealth:Enter description here,and enter points available for measure in appropriate categories to the right p 0 0 0__ _D— o _ ❑ Innovation in Resources:Enter description here,and enter Dints available for measure in appropriate categories to the right I p __D- 0 j_D D 0 _� ❑ Innovation in Water.Enter description here,and enter points available for measure in appropriate categories to the nghtTotal Available points in-Other=431 D Total Available Points in Specific Categories` 4+ 196+ l 42+166+ , 43+ Minimum Points Required in Specific Categories C 3D 5 6 I 9 7ect has not yet Met the following recornmended minirnurn requirernerrts'. -Total Project Score or At Least 50 Points r- I ._ -Required measures: 4- -A3a: 50% f4taste diversion by N�eight - -JZ:I S°/a-above-�-itle-Z4 -lkl1:Incorporate GreenPoint Rated Checklist into blueprints -Minimum points in specific catepori.es: -Energy(30 points) -IAO IH=a/th(5 points) -Resources(6 points) -Water(9 points) Page 4 of 4 ®2007 Build It Green Single Family GreenPoint Checklist 2007 Version Community Development 10300 Torre Avenue , ;- Cupertino CA 95014 ' w Telephone(408)777-3228 CITY OF Fax(408)777-3333 1UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: 2 3. PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcon ctors and complete the following information: SUBCONTRAC OR 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 Tank Sheet Metal Sheet Rock Tile 11- 2 7—,,o00 C retractor Signature Date