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07050131 7777 CITY OF CUPERTINO BUILDING DIVISION - PERMIT GTQN � MATIfJN, PERMIT NO. BUILI�Iij(i�lD$ES,S_ FOOTHILL BLVD VALLEY HEATING & COOLING 07050131 PERMIT ISSUE DATE OWNER'S NAME: ALLEN BARBARA J TRUSTEE 1171 N 4: TH ST 05/15/2007 SANITARY NO. CONTROL NO. SNE: (408) 294:-6290 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description %Up I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL A/C UNIT AT REAR s m in full force and effect. j ? License Lk•S F AP 71 p Date Con ARCHITECTS DECLARATION a< I understand my plans shall be used as public records )yrJ e u.y Licensed Professional `- 001 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the in o following reason.(Section 7031.5.Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure z; prior to its issuance,also requires the applicant for such permit to file a signed statement .Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 v tq Y.H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty oft Number Occupancy Type not more than five hundred dollars(S5W). 3 2 613 0 6-j .1v ❑1,as owner of the property,or my employees with wages as thew sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 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 sake 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.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes 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 Contractor's License Law. ❑I 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 Workces 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 Worker's 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's ompensation Insurance carrier and Policy number are: Carrier. PolicyNa: CERTIFICATE OF EXEMPTION FROM WORK11R.T COMPENSATION INSURANCE (Chis 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,I shall not employ any person in any manner so as to become subject to the Workcrs'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 f'~t CA I hereby affirm that there is a construction lending agency for the performance of p� > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name ] Z Lendees Address U C) 1 certify that I have read this application and state that the above information is r— correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 0.tFr Lr) liabilities,judgments,costs and expenses which may in any way accrue against said City f U Z in consequence of the granting of this permit. Date APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR ULSONS. Re-roofs Signature of Ap i on torr a Type of R sof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munici Code.Chapter 9.12.and the Health and Safety Code,Section 25532(a)? All roofs;;hall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant or future building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as cfined by the Bay Area Air Quality Management all new materials for inspection. District? C]Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the require h met priortoissuanceofaCertificateof cu Signature of Applicant Date All roof coverings to be Class"B"or better Owner of authorize m Date CITY OF CUPERTINO 7 ITEMS OF 28 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32613069. 00 DATE ISSUED. . . . . . . : 05/15/2007 RECEIPT # . . . . . . . . . : BS000001339 REFERENCE ID # . . . : 07050131 SITE ADDRESS . . . . . : 10536 N FOOTHILL BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ALLEN BARBARA J TRUSTEE ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0803 RECEIVED FROM . . . . : THINH NGUYEN CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (4C8) 294-6290 FEE ID UNIT QUANTITY PMOUNT 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 BREMRECEPT NO. OUTLETS 1 .00 1.20 0 . 00 1.20 0. 00 BSEISMICRE VALUATION 5, 000 .00 0.50 0. 00 0 .50 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 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 161. 93 0 .00 161. 93 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITE' OF CUPERTINO UR CE A.0 CUPEkTINO PERMIT' APPLICATION FORM 67o!5 w31 -2N # Date: Building Address: 11A LL- Lv? G0 �J D Ow er's Name. Phone#: LAI- 08 j Laniraci.oa P'hai�c: L),Cc:nse #: Contact: Phone: Cupertino Business License#: 01 0 qKtJ (t1 Building Permit Info: P. Bldg ❑ Elect [( PI umb L,V Mech Job Description: �Qgm LL Ae, v,,o Residential Commercial ❑ For Residential Installations: Attic ❑. 1St floor �k 2nd floor Adhere to min set back requirement For Commercial Installations: placement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation Cl New installation Planning Approval Required ❑ Cost of Project: Type of Construct:on: Occupancy group: 6zs� N ' !:;�-> Strapped ❑ On Platform Bonded X Sq.Ft. Floor Area: New Location Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Enorgy BUILDING BREWURN Futpace MECHANICAL BREMACOVER A/(:Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL ve BREMRECEPT Re,;ptl, Switch& Outlets ELECTRICAL ✓ BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG ✓ EPERMITFEE Ele.c Permit Issuance ELECTRICAL ✓ MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Blc.g Perrot Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEI�TIN0 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: �., PHONE # GENERAL CONTRACTOR: AX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating V kpm" �$S Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Awo, is/41141 1)60� 41—IV,01 7 o actor Signature to