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07060200 CITY OF CUPERTINO �•t T �h� BUILDING DIVISION PERMIT BUILDING 4DRESS: PERMIT NO. 11 1 YORKSHIRE DR PELLE HEATING & AC INC 07060200 OWNER'S NAME: PERMIT ISSUE DATE STEWART MALCOLM J AND MARY F 3728 C CHARGER PARK DR 06/22/2007 JNE: (408) 9"8-7060 SANrrARY NO. CONTROL NO. ARCHITEC IENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i p Zo LICENSED CONTRACTOR'S DECLARATION Job Description%v p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z u with Section 7000)of Division 3 of the Business and Professions Code,and my license is FURNACE C HANGEOUT. y in full force and effect( j ? License ass Li c•# :ftp pate Contractor ARCHITECTS DECLARATION 2 a 1 understand my plans shall be used as public records )yU U.H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the oO following reason.(Section 7031.5,Business and Professions Codc:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure u Z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5438 a a that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not more than five hundred dollars(5500). 362070,)5 q� ❑1,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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of consent to self-insure for workers Compen- sation,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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker�j on canter and Policy number am:^^ Carrier. [/ "AA Policy No.: v.�(oLt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z , CONSTRUCTION LENDING AGENCY (~i CA I hereby affirm that there is a construction lending agency for the performance of _ R+> the work for which this permit is issued(Sec.3097,Civ.C.) WW Q Lender's Name Lender's Address U C) I certify that I have read this application and state that the above information is i. correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date "y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b`r: Re-roofs NOR=ofApplicant/Contractor Dare Type of Roof HAZARDOUS )ALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M;umci at Code.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r materials for inspection. District? ❑Yes FrNu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it my responsibility to notify the occupant of the n which must or to issuance of a Certificate f ca�prtcy. Signatun.of Applicant Date Owner or authorized agcn Datc All roof coverings to be Class"B"or better CITY OF CJPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 362C7025 . 00 DATE ISSUED. . . . . . . : 06/22/2007 RECEIPT #. . . . . . . . . : BS000001756 REFERENCE ID # . . . : 070E0200 SITE ADDRESS . . . . . : 1163 YORKSHIRE DR SUBDIVISION . . . . . . . CITY CUPE:RTINO IMPACT AREA . . . . . . OWNER STEWART MALCOLM J AND MARY F ADDRESS CITY/STATE/ZIP CUP]ERTINO CA, 95014-4953 RECEIVED FROM . . . . : PEL:,E HEATING & AIR CONTRACTOR . . . . . . . : STFIE PELLE LIC # 27593 COMPANY . . . . . . . . . . : P=EE HEATING & AC INC ADDRESS . . . . . . . . . . : 3723 C CHARGER PARK DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (403) 978-7060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL _ ____ --------- ----- ------------- BENERGY PERMIT FEE 38. 37 34 .86 0. 00 34 .86 0. 0 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BSEISMICRE VALUATION 5, 438. 00 0 .60 0. 00 0.60 0.00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0.00 MPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0.00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 ----38- ------ -- ------------ ---------- - TOTAL PERMIT : 164.88 0. 00 164 .88 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 164 .88 #2205 --------------- TOTAL RECEIPT 164-.88 - VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL Q-,7U� CITY OF CUPERTINO FtJRNACE/A(' CUPS PERMIT APPLICATION FORM WAPNkTINO � — � Date:0�tJ,s� P � • '�-c��1 S�C�� Lice: ntr ctor: Ad C Cupertino Business License #: Contact: �3 Building Permit Info: BI d ❑ Elect I � P[umb LJ Mech lz t scription: V✓� ntial Commercial ❑ entialI st llations: dISTfloor 2°d floore to min set back re uirement❑orommercial Installations: Replacement same weight F1Additional weight(structural calcs) ❑ Structural Calculations required for new installation New installation PI inning Approval Required n occupancy rou Cost of Pro' t: Type o o struc,:ion: P y g Strapped On Platform Bonded I Sq.Ft. Floor Area: New Location ❑ Re lacemenv Qty. if Fee Description Fee Group Applicable Fee ID BUILDING BENERGY I?ner Relocation of Furnace MECHANICAL BREMFURN MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN .�/C Units <= 10, 000 cfm ELECTRICAL BREMRECEPT Rec tl, Switch & Outlets BUILDING BSEISMICRE Seismic Fee Res ELECTRICAL EPERMITFEE Elec Permit Issuance MECHANICAL MPERMITFEE Mech Permit Issuance PLUMBING PPERMITFEE Plumbing Permit Issue BUILDING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License Community Development 10300 Torre Avenue '1 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "WEkTINO Building Department JOB ADDRESS: PERMIT# 0 OWNER'S NAME: PHONE # Lt ,,-j'1 g-1060 GENERAL CONTRACTOR: A FAX # ` , I am not using any subcontractors: S.gnature Date Please check applicable subcontractors and corrlete the following information: SUBCONTRACTOR BUSDVESS 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 OvAer/ConAactor Signature Date