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07110117 CITY OF C TINO - . -: BUILDIIWG D,11S�.iiv � PE1�1vi1T ��,��,.��.��f ; :; <: ;. ;: ; ,: BUILOINGADDRESS: " ` -` ,;. ,.;: ;: 10171 DEEPROSE PL VALLEY HEATING & COOLING 0'7110117 ..vVNER'S NAME: � PERMIT LS6UE DATE PROPHET ANDREW M AND JEAN A 1171 N 4 TH ST � 11/20/2007 PHOFEP — ( 4 0 8) 2�� 4- 6 2 9 0 SANiTARY NO. CONTROL NO. ARCHI'IECT/EIVGINEER: BUILpING PERMIT INFO B� E� PL� � ° � O LICENSED CONTRACfOR'S DECLARATION r� V� 1 hcreby affirm tlu� I am liccnacd umlcr provisions af Chap�cr 9(commcncing JOI� DCSCT1PUOfl "� z� wi�h Section 7000) of Division 3 of �hc Business and Profcssions Codc, snd m liccnsc is R E P LAC F FjJ1�A C E ADD A/ C y in full fortt and etfec j, � j� Z Licenac Clus , �v Lic. N �� :, G �slc ' CoMncWr �� ` AR 1TEC1'S DECLA A ON U t undcrstanJ my plans s6a11 be uud u public rccords a L O y Gccnsed Pcofcss�onal � y � OWNER-BUILDER DECLpRATION +� <� 1 hcrcby nllirm �hat 1 sm raccmpt Gom ihc Conuanors Liccnu Law for Ux i G � [ollowing �cason. (Scction 7(Y! I.S, Busincss and Profcssions Cak: Any city or rnunty e, � which requiccs a pcm�it to consWCt, alter, improvc. dcmolish. or �epair any swcturc y Z y prior W ils istuancc, alsu rcquims �hc applicant for such pertnit �o filc a signcd sla�mcnt �_ � that he is liccnsed pursuant to thc provisiona o( �hc Contrxtor's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation y F- �(commcncing wi�h Scction 7000) of Division 3 of �hc 8usincss and Profcssions Code) or $118 3 7 y�.. that he is exempt the�etrom and the batis for d�e allegcd eumpUon. Any violauon of Secdo� 7031.5 by airy applicant for a pem�it subjecu �he applicant to a civil penalty of not more than fiw dund�ed dollars (SS00). 3 6 9 0 5 0 2 3!�(� Number Occupancy Type ❑ I. u owner of tl�e property, or my employcea with wages u tLe'v aolc compensatlon, will do t6e work, md the stcucmce is not imm�ded or oReced for salc (Sec. 7044, Busineas and Professiana Co�: The Contcxtm's Licenxe Law does not apply w an owner of Required Inspections propeny who buitds a improves �l�ercon, and who das such work himself ar ihrough his own employccs. Pmvidcd �hat such improvements are not intended or oRercd for sale, l[, however, the building or impmvement is sold within one yar oC complction, the owner- builder wip luva the burden of proving �da� he did not build or improve Cor purpose of sak.). ❑ 1. as awner of the property, am peclusively contruting wilh littnsed rnnuactors W construct the projea (Sec. 7004. Businas and ProCessions Code:)'I1�e Contrubrs Li- cenx Iaw docs no� apply w an owner of property who builds or improves Wemon, and , who conuac�s for such p�ojec�s with a comractor(s) licensed pursuant w We Contractor's ' �cense L,aw, I un aeempt under Sec, , B dc P C for this reason Jwner Date WORKER'S COMPENSA770N DECLARA710N 1 hercby affirm under penalty a[ perjury onc of the follawing declarations: ❑ I hsve and will msintein a CeniGcate of Consent to self-insurc Car Warkcr's Compen- sation, u provided for by Section 3700 of the Labor Code, fm �he perfortnance o( �Frc work for which Ihis pertnit is issucd. ❑ I have and will muntain Workcrs Compensation Insurance, u required by Scctian 3700 0( the l�bor Code, Ca the perCormance of �he work !w which �his pe�mit is issued • My Wor ompensatian Insuwnce carricr and Poliry r�: {� �m Poliry No.• J CERTIFI TE OF EXEMpf(ON FRO WOR! ERS' COMPENSATIONtNSURANCE CI'his scction need irot bc canplcted it the pertnit is for onc hundred dollars (S I0� or Icss.) I cenify �ha� in thc performance of Ihc work for which �his pemiit is issucd. I shall na � cmploy any person in any manncr w u m becomc subject to �he Workcrs' Compcnsation Laws of Califomia. Dam Applicant NOTICE 7'O APPLICAM: If, aflcr making this Ccnilica�c of ExcmpGon, you shoulJ become subject to ihe Worlcer'a Compensation provisions af ihe Latar Code, you muu � O foMwi�h comply with such provisions w this permi� shall bc dxmcd mrokcd. . � CONSTRUCTION LENDING AGENCY [� '" I hcrcbY allitm dut them ia a conswctian Icnding agcnry for thc perfartnancc u( ai � ihc work for which this permit is iuucd (Scc. 3097, Civ. C.) � A Lendcr's Namc � � z Lcnder's Address V Q� I certify Ihat 1 havc read �hiy sppHcation and sulc �hat thc above informatiun is w� cortcn. 1 a;tce to comply wi�h all city and county oNinances and sute Iaws reladng w 0 U building consuuction, and hueby authori�e �cprcscntativ�,c of �his city w cmcr upnn Uu atrove-mcntioned pmpcny for inspeciion purpases, / pase �„�,� a (We) agrce to save, indcmnify and kecp harmless ihe Ci�y of Cupertino against � �..� � liabililiu, judgmcn�s, cosLS and espensea which may in any way uc[uc against said City V,'� in consequencc of �hc granting oC ihis pc ' � APPLICAM UNDERSTANDS I, O W ALL NON-POINT Issued by: Date �� Z�. Ti-� SOURCE REGULATIONS. � J � Signuure of Applican onuac pa � Re-roofs J � f S MA ALS DISCLOSURE Type of Roc f �II thc iant futwc building oaupant s[orc or handlc harardaus matcrial defincd by upenino Municipa! Codc. Chapmr 9.12, and tAe Hcalth and Safcty �«k Scction 25532(a)? All roofs sh;ill be inspected prior to any roofing material being installed. ❑ Ycs w�,i u,� a licant or future buildin occu ant use If a roof is ii�stalled without first obtainin an inspection, I agree to remove PP g p equipment or deviccs which g emit harardous air contaminants as dcfincd by the Bay Area Air Quality Managcmcnt all new mate rials for inspection. Disu;cn. ❑ Yes u 1 havc read hasaMous maicrials requrtcmcnt5 undcr Chaptcr 6.95 of �hc Califor- nia Hcal lh & Safcry Codc. Sections 755p5, 2�3 an� 7s534. t undcrstand that if �c building daes not curtcn�y h ienan� ��y �po�biliry w noufy Uu cecupant nf ihe rcyuucmcn�s ' no '�n o�aCenificate ure of Applicant Date oW� o�a o' gcnt p„� All roof coverings to be Class "B" or better . o 11 � 1 l - 7 � CITY OF CUPERTINO _ �� - --- ---- -- _ _ __ _ -- -- _ _ . _ _ - __ __ _ _ _ _ _ __ ---- _ _ _ ____ _ . . ��, � FU�"rTACETAC - -- - ��,,��1� PERMIT APP)LICATION FORM APN # � Date: �� w V J� �� .. C� � `� � —�G�-4 � Building Address: j � � L � �_ Owner's Name: Phone #: �' � �1 e_ �� -o�:S�3 -�� Cqn�tractor: License #: U � �� S Contact: Cupertino Business License #: �`i C-` � � Building Permit Info: Bld ❑ Elect !� Plumb ❑ Mech �- Job Description: � � GC, _ c:� C'_.-- a ^�-� �c ��C �}'�..� Reside ial Commercial ❑ or Residential Installations: _-- -- Attic � l floor � 2" floor � Adhere to min set back re uirement (� For Commercial Installations: Replacement same weight � Additional weight (structural calcs) � Structural Calculations required for new installation ❑ New installation Plannin A roval Re uired Cost o�R�oject: � Type of� Occupan� gro�: � Strapped On Platform Bonded Sq.Ft. Floor Area: New Location �_ Re lacement �/ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY E ner BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BRElV1AIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Itec tl, Switch & Outlets ELECTRICAL _ _- --BSEISMICRE---- _ --- _ �,__• ___ --. ---- ,�eismic Fee Res.-. - -- ------- -----BUIL�ING-----__ EPERMITFEE �'slec Pernut Issuance ELECTRICAL MPERMITFEE 1V=ech Permit Issuance MECHANICAL PPERMITFEE P;umbin Permit Issue PLUMBING BPERMFEE B�d Permit Fees BUILDING BPLANCHK Pl an Check Fee BUILDING BUSLIC � Ftusiness License BUILDING CITY OF CUPERTINO 8 ITEMS OF 8 PERMIP RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blc: Lot: APN ......... 36a05023.00 - DATE ISSUED.......: 11�20/2007 RECEIPT #.........: BS')00003293 REFERENCE ID # ...: 07:L10117 SITE ADDRESS .....: 10:_71 DEEPROSE PL SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: PRC)PHET ANDREW M AND JEAN A TR ADDRESS ..........: 10:_71 DEEPROSE PL CITY/STATE/ZIP ...: CUI'ERTINO CA, 95014-3335 RECEIVED FROM ....: VAI,LEY HEATING & CO CONTRACTOR .......: ATF:INSON, THOMAS LIC # 141 COMPANY ..........: VAI,LEY HEATING & COOLING ADDRESS ........... 11;1 N 4 TH ST CITY/STATE/ZIP ...: SAPf JOSE, CA 95112 TELEPHONE ........: (4C8)294-6290 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BREMFURN NO UNIT 1.00 14.31 0'.00 14.31 0.00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0.00 BSEISMICRE VALUATION 11,837.00 1.20 0.00 1.20 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 184.20 0.00 184.20 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 184.20 #16988 --------------- TOTAL RECEIPT : 184.20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development j" -c " - "�, 10300 Torre Avenue ;�� > ��:.. � ::� Cupertino CA 95014 Telephone (408) 777-3228 CITl( OF Fax (408) 777-3333 CUPEI�TINO Buildin De artment JOB ADDRESS: �� af�� p�- PERMIT # � � � �(, « OWNER'S NAME: r ^� PHONE # � � � �D' GENERAL CONTRACT R: FAX # , � ., ,. _� �' " `, �,� ( � / ��..__...____ fj I am not using any subcontractors: -�' �/� � Si gnature Date Please check a licable subcont"ractors and com lete the followin information: SUBCONTRACTOR BUSIl1ESS 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 � � r/ ontractor Signature Date