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10010154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8080 PARK VILLA CL CONTRACTOR:VALLEY HEATING& PERMIT NO: 10010154 COOLING ^WNER'S NAME: SPENCER SCOTT T AND GAYLE M 1171 N 4 TH ST DATE ISSUED:01/27/2010 %-XWNER'S PHONE: 6508545495 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# a5—,Y5-ye�) REPLACE FURNACE Contractor 2i Date/— I ate —I hereby affirm that am licensed u der 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:$4132 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:35610022.00 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 1 AYS 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 DAY M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, l �f costs,and expenses which may accrue against said City in consequence of the •Issued b Date: granting of this permit. Additionally,the applicant understands and will comply y• with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: '-ignature Date All 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. El 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) 1,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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized age n . Date: " 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. 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 ­)n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION -mnify 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 r the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature /f Date ` CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35610022 . 00 DATE ISSUED. . . . . . . : 01/27/2010 RECEIPT # . . . . . . . . . : BS000009629 REFERENCE ID # . . . : 10010154 SITE ADDRESS . . . . . : 8080 PARK VILLA CL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SPENCER SCOTT T AND GAYLE M ADDRESS . . . . . . . . . . : 8080 PARK VILLA CIR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 41132 . 00 1. 00 0 . 00 1.00 0 . 00 1BSEISMICR VALUATION 4, 132 . 00 0 . 50 0 . 00 0 .50 0. 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0. 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0.00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 304 . 50 0 . 00 304 . 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 304 .50 20189 --------------- TOTAL RECEIPT 304 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO :. FURNACE/AC CITY kT CUPEi�T1NQ PERMIT APPLICATION w1c) APN# Date: 10 6 2-Z BurnAddress: \J , Owner's Name: Phone#: Contractor: Phone#: (1i Fax Contractor I ulense#: Cupertino Business License#: 2 Contact: Phone#: Fax#: Building Permit Info: Elect F-1 Plumb Mech ❑ Residential Commercial ❑. Job Description: For Residential Installations: Attic F-11St floor ©' 2nd floor ❑ Adhere to minimum setback requirement 20e For Commercial Installations: Replacemcnt savnc weight ❑ Additional weight (structural calcsj ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): c9� Strapped On Platform ❑ Bonded ❑ New Location ❑ Replacement Valuation: Green Building: Must attach Green Building Check list to this application s CITY OF CUPERTINO .. .. FURNACE/AC CiT CUPEFEE SCHEDULE kT lNO T Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= IOk 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 moreper outlet. Comn-/Resid 1BRE Residential A/C units <= 10k CFM B 1MIZRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E l 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1 TRAY OC Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO .ti FURNACE/AC CITY OF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURMAC 1 MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed &riot incl in an appliance permit. 1 BSEISMI%O Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 MRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install & not incl in an appl permit. Community Development ;,. 10300 Torre Avenue Cupertino CA 95014 '•` Telephone(408)777-3228 CtTI(OF Fax(408)777-3333 .UPEkTINO Bu*ld*1 D e artm a nt JOB ADDRESS: �'� ����� e PERMIT # 1 C t (D OWNER'S NAME: �-er r/ PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /-=2 Z- -4 i ature Date Please check applicable subcontracts 4domr. lete the following information: R) SUBCONTRACTO 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 /Contractor Signature Date