The URL can be used to link to this page

10110184 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10863 LEAVESLEY PL CONTRACTOR:VALLEY HEATING& PERMIT NO: 10110184 COOLING O R'S NAME: WILSON ERIC K AND SUSAN C 1171 N 4 TH ST DATE ISSUED: 11/29/2010 OWNER'S PHONE: 4086918332 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB F C License Class 2 b Li,# 2 S�S MECH RESIDENTIAL COMMERCIAL Contractor Vq �' r Date I hereby affirm that I am licensed under a provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT(SAME LOCATION)&A/C (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT(SAME LOCATION) 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$9100 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35615024.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• � �� 7 Issued b T� Datea��G Si re [�jtti�t i�i 'ocd,L��titi�Date(� ,2 4 (1 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must � -� �u , Date:_/ forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to 'ing construction,and hereby authorize representatives of this city to enter ul eabove mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35615024 .00 DATE ISSUED. . . . . . . : 11/29/2010 RECEIPT #. . . . . . . . . : BS000012108 REFERENCE ID # . . . : 10110184 SITE ADDRESS . . . . . : 10863 LEAVESLEY PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : WILSON ERIC K AND SUSAN C ADDRESS . . . . . . . . . . : 10863 LEAVESLEY PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4747 RECEIVED FROM . . . . : VALLEY HEATING & CO 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 9, 100 . 00 1 .00 0 .00 1. 00 0 . 00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 00 0 .00 1BSEISMICR VALUATION 9, 100. 00 0 .91 0 .00 0. 91 0 .00 1MFR=<100 UNITS 1. 00 126 . 00 0. 00 126 .00 0 .00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 274 .91 0 .00 274 . 91 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 274 . 91 #21349 --------------- TOTAL RECEIPT 274 .91 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 16F&3 Leo v`sle &G(, PERMIT# l �L OWNER'S NAME: j, ' W -(SOT PHONE# GENERAL CONTRACTOR: U 2 f,` o(: BUSINESS LICENSE# 1� ADDRESS: ( K, f CITY/ZIPCODE: 504,t *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ( C/ Signature Date Please check applicable subcontractors and complete the following information: I/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10863 leavesley place DATE: 11/29/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$9,100 *PERMITJul TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY i t t1 SFD or DuplexZ. PENTAMATION FU RN/AC USE: _ r�� il, _-�. PERMIT TYPE: A WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $189.00 Mech.Plan Check0.0 hrs $0.00 ' Mech.Permit Fee: IMPERMIT ,r. Lr Mech.Insp. $42.00 ". ?��'�. r:��_> Li 0.0 hrs ft:S�rJ. {'c'E': - NOTE: Theseees are based on the preliminatUy in ormation available and are only an estimate. Contact the De t or addn I info. FEE ITEMS (Fee Resolution 09-051 Eff. 7% CITY OF CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# �l Date: Building Address: t 7 67(1 v L"S( Cc Owner's Name: ._ Phone#: ,/, L Contractor: ) Phone#:408-2j q-&,zy VQC9 tr/�ye�f�-� �13C! (rn.t� Fax#: Contractor License#: •! Cupertino Business License#: ,259.56 tq ( Contact: _ _ Phone#: AEa ,f g-24 -6 2 q 6 Er Jo�GS Fax#: Building Permit Info: Ele t Plumb Qom' Mech Residential Commercial ❑ Job Description: r�, �r, c -�f>I F c�,. �.,�•t (sc,,z, fc<<. f.` ) For Residential Installations: Attic El1St floor � 2°d floor ❑ Adhere to minimum setback re uirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of Constructio}1,(Usage Class): U 1� Strapped On Platform onded ❑ New Location ❑ Replacement Project Size: Express ❑ Standard ❑ Large ❑ Major❑ Valuation: 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 01/07/09