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10010170 F CUPERTINO BUILDING PERMIT ..-� CITY O PERMIT NO: 10010 170 CONTRACTOR:VALLEY HEATING& BUILDING ADDRESS: 10560 STOKES AVE COOLING DATE ISSUED:01/28/2010 1171N4THST "NER'S NAME: MARTIN JENNINGS PHONE NO:(408)294-6290 SAN JOSE,CA 95112 UvVNER'S PHONE: 4082534994 ELECT PLUMB 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG E COMMERCIAL Lic.# MECH RESIDENTIAL License Cl .- DESCRIPTION:REPLACE FURNACE,DUCTS,l 1SUPPLYS 2 RETURNS Contractor Date JOB er 9 I hereby affirm that I am licensed un er the provisions of the Business&tProfessions (commencing with Sectio ns On full of Division force and effect. Code and that my license 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 Code,for the Valuation:$6670 provided for by Section 3700 of the La Valu Compensation,as p t is issued. Sq.Ft Floor Area: performance of the work for which this pe�ation Insurance,as provided for by I have and will maintain Worker's Comp ::: Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32648007.00 permit is issued. APPLICANT CERTIFICATION IS NOT STARTED ation is I cern that I have read this application and state dinan ethe s and stavu te laws relating ' coun or PERMIT EXPIRES IF WORK NCE OR correct.I agree to comply with all city and county IT ISSUANCE coon and hereby authorize representatives of this city save WITHIN 180 DAYS OF PERM INSPECTION. to building c above m for inspection purposes. (We)agree the above mentioned property p liabilities,judgments, 80 DAYS FROM LAST CALLED upon 1 indemnify and keep harmless the City of Cupertino againsaid City st consequence of the costs,and expenses which may accrue against cant understands and will comply Date:/ d=�-� granting of this permit. Additionally,ter the Cupertino Municipal Code,Section Issued by: with all non-point so!#&regulat' p 9.18. r-�v F:--atur Date/ RE-ROOFS: of All roofs shall be inspected prior to any roofing material being remove all installed. ew materoialslfor OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to � inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Date: the following two reasons: with wages as their sole compensation, Signature of Applicant: 1,as owner of the property,or my employees ill do the work,and the structure id s not intended or offered for sale(Sec.7044, COVERINGS TO BE CLASS"A"OR BETTER �'�' ALL ROOF CO 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 penalty of perjury one of the following three r I have read the hazardous materials requirements 25533,andnder Chapter 25534.95 of the I will maintain I hereby affirm unde p h' Code,Sections 25505, declarations: Chapter 9.12 and the Health& a Certificate of Consent to self-insure for Worker's Califor the Cupertino Municipal Code, h hazardous material. I have and will maintain compliance should I store or ha Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a) p perm is issued. dditionally,should I use equipment or devices which emit hazardous air performance of the work for which this p rovided for by A the Bay Area Air Quality Management District I will p ensation Insurance,asp contaminants as defined by Chapter 9.12 and the I have and will maintain Worker's Co ep perform ance 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. that the performance of the work for which this permit is issurker'shall Owner gent: -�z I certify P Date: not employ any person in any manner so as to become subject to the Wo Compensation laws of California. If,after making this certificate of bo exemption, must AGENCY Comp provisions of the i become subject to the Worker's Compensation p CONSTRUCTION LENDING ked with such provisions or this permit shall be deemed revoked. there is a construction lending agency for the performance of work's forthwith comply I hereby affirm that APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information relating Lender's Name correct.I agree to comply with all city and county ordinances and state ion and hereby authorize representatives of this city to aveer Lender's Address to building construct for inspection purposes.(We)agree to the above mentioned property p ARCHITECT'S DECLARATION inify and keep harmless the City of Cupertino against liabilities,judgments, s which may in consequence of the plans shall be used as public records. costs,and expense accrue against said City permit.Additionally,the applicant understands and will comply I understand my p L9.'I anting of thisp all non-point so ce r ations per the Cupertino Municipal Code,Section Licensed Professional � ,- Date at CITY OF CUPERTINO RECEIPT OPERATOR: patg PERMIT COPY # 1 6 ITEMS OF 22 Rng: Sub: Blk: Lot: Sec: Twp: ; 32648007 . 00 APN DATE ISSUED: : : : : : : 01/28/2010 : BS000009643 RECEIPT # ; 10010170 REFERENCE ID # - SITE ADDRESS 10560 STOKES AVE SUBDIVISION . : : : : : ; : CUpERTINO CITY . • - IMPACT AREA - - • OWNER MARTIN JEN NGS OW I ; 10560 STOKES ADDRESS CUpERTINO CA, CA 95014-1235 CITY/STATE/ZIP RECEIVED FROM VALLEY HEATINGG & COLIC # 141 CONTRACTOR ; ATKINSON, THOMAS VALLEY HEATING & COOLING COMPANY : 1171 N 4 TH ST ADDRESS . • • • • . . . " SAN JOSE, CA 95112 CITY/STATE/ZIP (408) 294-6290 TELEPHONE . . . . . . . • THIS REC NEW BAL QUANTITY AMOUNT -PD_TO_DT- _--_-- ----__--__ UNIT C2 0 . 00 FEE ID ---------- ------ 0 .00 1 . 00 ------ -------- ---- 6, 670 . 00 1. 00 0 .70 0 . 00 VALUATION 0 0 .70 0 .00 0 . 00 1BCBSC 6, 670 .0 0 .00 42 '00 0 .00 1BSEISMICR VALUATION 1 .00 42 . 00 0 .00 126 . 00 1EPERMITFE FLAT RATE 1 .00 126 . 00 42 . 00 0 .00 42 . 00 0 .00 0 . 00 1MFR=<100 UNITS 1 .00 0 .00 42 . 00 1MPERMITFE FLAT- RATE 1.00 42 . 00 ---------- ------0 . 00 FLAT RATE ---------- ------0 . 253 .70 0 . 00 253 .70 0 .00 TOTAL PERMIT VOICE ID DESCRIPTION_--___-_- VOICE ID DESCRIPTION______-_- -------- ___ ___------ 507 FINAL PLUMBING 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURNA-CE/AC . :T. FOR- M PESCITY of IT APPLICATION CUPEkTINO Date: Building Address: Phone# owner's Name: --jam-� Phone Contractor: �I zyqg r Cupertino Business Licens Contracto License#: Phone 0'2 Contact: f Fax#: c, n e-6 Building Permit Info: Mech [� Elect Plumb Commercial ❑ Residential Job Description: f l � installations- 2nd floor i ❑ For R dential In 1 St floor ❑ Attic ❑ setback re uirement Adhere to minimum ,�1,� j El For Commercial Installations: Additional weight (structural ca cs P.ep lacemcnt sarilc weight ❑ ion ❑ Calculations stal at Structural C required for new in •n Approval Required ❑ New installation planning Usage Class): Type of Constructio Cost of Project: ent New Location❑ Replacem❑ Strapped On Platform Bonded Valuation: Building Check: Must attach Green B k list to this application g� Green Building CITY OF CUPERTINO FURNACEAC CITY of FEE SCHEDULE CUPT ILIO Fee Permit Type Quantity • Fee ID Fee Description Grou FURN/AC FURNACE p- denfial for ea gas pipings sy tem of_ —1PG�SRES -- Resi 1-4 Outlets h piping system of 5 or P 1BPGAS For each gas p k` more er outlet. B 1BSEI5 MICR Residential Seismic M 1MECPLN CK Mechanical Plan Check -- BTU install or M =<100 Furnace Syst< 100k 1MF`R relocate ea forced-air/gravity type f&nace/burner,incl ducts/vents j Ulf 0 attached to such appliance up to and include 100,000 Btu/h M Furnace Syst> 100k BTU install or 1NUR- N>100 relocate ea forced-air/gravity type furnace/burner,incl ducts/vents attached to such appliance over 100,000 Btu/h E TFEE Electric Permit Fee IEPERMI M ITFEE Mechanical Permit Fee 1MPERM I P ITFEE Plumbing Permit 1PPERM OC Travel Documentation B 1 TRAVD B 1B USLIC Business License CD CD to c = v, o LW 4 � U 0 0 Enter description here,and enter points avalmw-ilable fior measure m appy Primo categories to the right -- -- -- —___ __--_ 0 p 0 p I Enter description here,and enter poirits available fig measure m pro nate categories to the right - - i p 0 _--- ---- - — i (� Enter description here,and enter points available fior measure��_�PPro riat=_cate Dries to the right- _--- g,�ild It Green Chec>;lists and Enter d=scription her an�tQi Points available fior measure in app_P 4-------- he Guidelines.Enter up to a ;_G,,aidebri=s p reen building objectives oft usin the fink to the right. 4.Innovation:List innovative measures that me.,t the g ested measures, o--�-p` 0 Pts See Innovation Checklist for sug nate categories to the right p 0-" - maximum combined total of 20 p _- --- - p p ter Dints available for measure in appropriate categories to the right 0 0 _ Innovation in Community:Enter description here,and ever porrts available for measure m a A the fight. _— �] Innovation in Energy:Enter description her.,and P r nate cat.gorl.s to 9 l 0 :Enter description here,and enter points available for measure�n aPPro nate categories to the right --�- p— p p 0 0 Innovation in lAflMealth — 0 __ ---i- riate categories to the right. --- i innovation in Resources:Enter description here,andre o rite available forlm measure n aPPtai � 71-gvailable Points in Other=43� p 1 ❑ innovation in Water.Eater description here,an=P - _,-- ---- _ 43+ Total Available Points in Specific Categories` 6 y g I IJinimum Points Required in Specific Categories 0 30 E I c tJAMM reeQnyr�ereded rnirnsrnurn recluirerraertts•: Project has not yet Met the{a•Gtowin9 -Total Project Score of At Least 50 Points _ -Required measures: troei ht -A3a: 5001" I,,aste diversion by g J2-�15°1D-aboVz--itle-24 ��d Checklist into blueprints -N1:Incorporate GreenPoinL Rai. -Mj,-)i,-nOM Points in specific categories: -Energy(30 points) -IAQ-1Health(5 Points) -Resources(6 points) -iyater(9 points) page 4 of 4 Single Family GraanPoint ChecY.list 2007 Version ©2007 Build It Green Community Development 10300 Torre Avenue _ Cupertino CA 95014 408 f � Telephone( )777-3228 Fax(408)777-3333 ClTlf OF "UPE T1NO . De ar tment BuildTin& PERMIT # ADDRESS: l�1 jOBA PH # R'S NAME: ''' FAX # OVVNE R: GENERAL CONTRALTO I am not using any subcontractors: Date Signature an complete the f ollowin information: Please check a licable subcontra ors BUSINESS LICENSE # BUSINESS NAME SUBCONTRACTOR 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 .- Date er/Contractor Signature