08080205 CITY OF CUPERTINO .x x ran±*lea. =
FUILDING DIVISION PERAUT CONTRAC R NF�ORMATIQN, H
BUIL INCA DRESS: PERMITNO.
q7. , KENTWOOD AVE A & H HEATING 08080205
HER'S NAME; PERMIT ISSUE DATE
!�13'I'131.n:1:ER PATRICIO A AND MARIA 770 CHESTNUT ST 08/26/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHI EC/eNGINEER: BUILDING PERMIT INFO
REMOVE & REPLACE FURNACE BLDG ELECT PLUMB - MECH
O O O O
upQ LICENSED CONTRACTOR'S DECLARATION Job Description
U. I homby affirm Nat I am Iimv under pmvWons of Chapmr 9(mmmcncing l P
with Smart 7pMl)o(Division 3afine Badness and Profcaslom Code.aed my license u
in full farce and e a lJes et
me
LlceC, M S
b— Dam 19Lic.
-- contractor
7�W ARCHITECrS DECLARATION
U I understood my Pluto shall a used ss mod
public rs
Da
c W t; Lwarued Professional
5 OWNER-BUILDER DECLARATION
1 hereby M.that 1 am cumin from mho Contrameh Ucenw Law for the
E O O following mason.(Section 7031.5.Business and Professions Code:Any city of county
_Pi which repeats;a permit he coruwct,alms.improv,demolish.or repair any structure
_Z o, prior m its issuanm.alau requires the applicant for such permit be file a signed matemen,
<
I",ten is licensed pursuers to the prosi4mu of dee Conbecmrs Lieu Law(Chmw9 Sq.Ft.Floor Area Valuation
At (comrercing with Section 7000)of Division 3 of NC Rusiness and Professions Code)or
that he is cannot therefrom and the hssu for the alleged assumption.My violation of
Section 7031.5 by any applicant for a permit subjects Oa applicant m a civil penalty of APN Number Occupancy Type
not moa man five hundred dedlara(SSW). P Y YP
D 1,ss awt�of mho pmpusy,m my wPloyma wins waju u Nes wk campenatim,
will da the snort.and meswctume is notimern ed or offered forsalc(Sec.7041,Business
and Peed..d m Codc:The Contractors License Law does ret apply to an owner of Required Inspections
popery who Wilds or i m proves thereon,and who does such work himself or through big
ownarmplay ps &dmasuchimpmve marenotinwadndoroffemdfrsale If.
however,the building or impronarem is mid within ens year of completion.the owner.
builder mil have the handed of paving that An did wm W U or improve for purpose of
sale.).
❑I.as owner of dm Property,am exclusively contracting with Iicersed conbubrs in
mrtsuuct
the project(Sec.7014.Business and Peofudom Code:)The Canmamrs U. .
cerise law does not apply m an owner of propny who builds or improves dump,and,
who mnuann for such projects with a em.Ks)licensed pursum on tho Canvanors
License law.
❑Iuneaunptmder See40
.BAPCfar ria mown „
nu Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the fallowing doeluatiom:
1 hem and will maintain a Caufmcam of Consent in self-imum for Workers Compen-
sWan.As provided for by Seen.3700 of the labor Code.fm the pAormance of the
work for which this Permit is issued.
❑1 have and will maintain Worleces Compmalon Insurance,As myuimd by Section
3700 mme labor Cade.for the performance ofms scare for which this permit is issued. '
My Workers Compensation.Fl�op"um�me carrier and Policy number are:
Carrier.T��IL V�v] Policy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
('IL's mnlm acted inn acomplemd If the Permit u Trane andred dollars($100)
or It.)
1 certify Na,in the performance of the work for which this Penal is homes.l shml not
employ any' cmr in any maomrw as at beemne abject m the WarkerY Compnamen
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,afar making this certificate of Exemption,yeti should -
become,subject b,a Wodon's ComMosetion provisions of the tabor Cad,you most
.,z roMwith comply with such Provisim.sir this Permit shall be domed mmkcd.
zO CONSTRUCTION LENDING AGENCY
4
1 lauchy affirm that mea its construction leading gamy for the prformanm or
ski A theLe work for which this Permit u headed(Sm.309I,Civ.C.)Landers Nano
D z Lattice.Addm<.
U O 1«dfy that I hoe mad this application and sum mu the mase Imormat m u
lT.F CAMM I agree As comply with 411 City and county on inerces and sum laws relating in
DU aildinjcomtruction,end bemhy suNodm repromudvuof this city rotnerupm me
4 nave-mentioned Property for inspection
(we)agree m cave,indemnify and loop which harness the City of CuPeako agenda,
liabiliuu,Judgmen r� end cxpmm which maa
r
y in anyway ams against said City
U z mc
APPoL Cie Eg'STAng of NANlrmls PLTH ALL NON-
sou cams POINT Issued by: Date
Re-roofs
nuts of ApplicaHAZA DO Daa
IfnznRDoug MATERIALS Dam o handle
Type of Roof
Will NcApplicant mIMuniipalCuamupantrmem aandk hazardous go,,
As defuue by Irk Cupertino Municipal Cade,Chapter 9.13.tad fru Health rend Safely
u<.Oben ss53Z(')7 ..Gff��`''' All roofs shall be inspected prior to any roofing material being installed.
Yu y o
Will Nc applinnn"ffuture building occupant use o4eipereat m demon which If a roof is installed without first obtaining an inspection,I agree to remove
emit haradnus air cmuminants u defrcd by tins Bay Area Air Quality Management all new materials for inspection.
Doirimt
❑Yea
I have mad themmarials aquimmmtsunder .Chepmrfi.95ofthe Cahlor.
nia HcmmhSmelYCude,Sectio 505.25533 and 25534.Iundcrsund tharirda Wilding
dna ret cwendy ha.0 a era Nus it u my on,musibibly b notify Ne occupant of du
roquimmcnts whichm et Priori hawanm ofa Ccdfuaa of Occopacy. Signature of Applicant Date
Omener mthmir agent Dao" All roof coverings to be Class'A*`or better
CITY OF CUPERTINO
C
FURNACE /AC
IT OF
OUPEkTINO PERMIT APPLICATION FORM
APN t Date -
-359 31 _ate. --- ---
Building Address:
119 Ka( o0D AL)67 _
Owner's Name: Pho e #q): -- - �
J_ - - y
Conuaetor: License It
Contact. one -
D�4c=E
Applicant/Contractor: -�
Building Permit lnfo: ---------- -j
Bldg Elect Plumb -- Mech _I
Job Description: - -- - --
Residential: 'R2Wwyr_ �_(le �94"4ea ommercial:
Sq.Ft. Floor Area:
Architect/Engineer: - — Valuation: — --_--
Llspp
pe Of Construction: Occupancy (�t'ouP.. , ----
CITY OF CUPERTINO
FURNACE/AC
`CUAWYINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone#:
Contractor: Phone #:
Fax #:
Contractor License#: Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ Mech ❑
Residential-Q, Commercial
Job Description:
For Residential Installations:
Attic ❑ I"floor � 2"d floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
Strapped R On Platform Bonded 0 New Location Replacement ❑
Project Size: Express ❑ Standard ❑ Laze ❑ Major ❑
Valuation:f-y 5t
b
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/ACaC10F
`
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA 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.
1MCREPALT 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.
IMCSUSHTR Commercial Install/Relocate ea M •
suspended heater,recessed wall htr, or
floor mounted unit heater.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
IMCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
Permit.
IBSEISMICO 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.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater. •
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install ¬ incl in an a 1 permit
Quantity Fee ID Fee Description
=Feeermit Type
CITY OF CUPERTINO
FURNACE/AC
OCUPEkTINO FEE SCHEDULE
Group
FURNACE FURN/AC
1PGASRES 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
1MECPLNCK 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
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 IEPERMITFEE Electric Permit Fee E
/ 1MPERMITFEE Mechanical Permit Fee M
I 1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
Quantity Fee ID Fee Descri tion Fee Permit Type
CITY OF CUPERTINO
FURNACE/AC
CITY OF
CUPERTINO FEE SCHEDULE i
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
more per outlet. CommiResid
1BREMAIRHAN Residential A/C units <= 10k CFM . B
1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
IEPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
CommunrtvDevelopment
10300 Torre Avenue
4., }jc; j 'v, Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
QUPEkj.1N0
Builcun- De artment
JOB ADDRESS: PERMIT #
hl I MAAN w>�b
OWNER'S NAME: (Y� C.PT L PHONE # 73— Pa 2'7
GENERAL CONTRACTOR: ' �q k} 14 ?�-- FAX #
I am not using any subcontractors: --1a �
Signature Date
Please check applicable subcontractors and complete the fotlowin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lath—in-
Masonry
athinMasonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Owner/Contractor Signature Date
10/28/03 "'
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35931007 . 00
DATE ISSUED. . . . . . . : 08/26/2008
RECEIPT # . . . . . . . . . : BS000005904
REFERENCE ID # . . . : 08080205
SITE ADDRESS . . . . . : 1119 KENTWOOD AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LETELIER PATRICIO A AND MARIA
ADDRESS . . . . . . . . . . : 1119 KENTWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5807
RECEIVED FROM . . . . : A&H HEATING & AC
CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079
COMPANY . . . . . . . . . . : A & H HEATING
ADDRESS . . . . . . . . . . : 770 CHESTNUT ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
• TELEPHONE . . . . . . . . : (408) 279-0722
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
113SEI:SMICR VALUATION 4, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
L EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1M17R=<100 UNITS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1.MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
.1.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTA1., PERMIT 286 . 04 0 . 00 286 . 04 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
C:REDIT CARD 286 . 04 MASTER CARD
---------------
'1'0'1.'AL RECEIPT 286 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ----------------------- -- -- ----------------------------
505 FINAL ELECTRICAL - 507 FINAL PLUMBING
508 FINAL MECHANICAL
•