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07050168 7777777777777777777 CITY OF CUPERTINO T�IIj'�j 7�q BUILDING bIVISION PEI2IVT 1.V � � I YFUIt TIOl�1�; PERMIT NO. BU(LDTHINESMC CLELLAN RD VALLEY HEATING & COOLING 07050168 PERMIT ISSUE DATE OWNER'S NAME: PIYUSH ROHATGI 1171 N 4 TH ST 05/17/2007 SANITARY NO. CONTROL NO. NE: (408) 296-6290 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p zz LICENSED CONTRACTOR'S DECLARATION Job Description UFI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Pro[ inns C and my license is REPLACE FURNACE & ADD A/C 7 y in full force and s License las •8 :Ftp Da — ContracW a ARCHITECTS DEC RA a< 1 understand my plans shall be used as public records )aU U.y Licensed Professional OWNER-BUILDER DECLARATION � z p v I hereby affirm that 1 am exempt from the Contractors License Law for the following reason.(Section 7031.5,Business and Professions Code:Any city or county < (i which requires a permit to construct,alter,improve,demolish,or repair any structure Z r prior to its issuance,also requires the applicant for such permit to file a signed statement t''q.Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ` $5600 Z (commencing with Section 7000)of Division 3 of thc Business and Professions Code)or i 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($500). 35713024 � ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor($)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Worker's Conipen- 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 Compensation/Insurance carrier and Policy number are: Carrier. 2e�i fLy Policy No.: CERTIFICATE OF EXEMPTION FROM ORKERS' 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.I 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 rA CONSTRUCTION LENDING AGENCY Er I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name a z Lender's Address U 0 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 rJ U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. r" a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 CE RE LATIO • �GC� /T9f)�'~ `r~ Re-roofs S gn rc o cal on6ec or Date Type of R sof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Critic.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? �,^ All roofs:ihall be inspected prior to any roofing material being installed. Cl Yes OK 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 defined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑Yes `5Jo 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 thatif the building does not currently have a tenant,that it is my responsibility to notify the occupant of the reyui nts w h mist t can w nssuancc of a Certificate of Occup Date ._��. Signature of Applicant �� All roof coverings to be Class"B" or better caner or authorized agent Datc CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: BDi: Lot : APN . . . . . . . . . 35713024 . 00 DATE ISSUED. . . . . . . : 05/17/2007 RECEIPT # . . . . . . . . . : BS000001366 REFERENCE ID # . . . : 07050168 SITE ADDRESS 22059 MC CLELLAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . OWNER Pi 1 U S to ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : VALLEY HEATING & CO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY VALLEY HEATING & COOLING ADDRESS 11'11 N 4 TH ST CITY/STATE/ZIP . . . : SAIT JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 FEE ID UNIT QUANTITY hMOUNT 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 5, 600 . 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 .37 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 176 . 34 0 .00 176 .34 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 176 . 34 16084 --------------- TOTAL RECEIPT 176 .34 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 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT # SCC L Pf � aSv �6 � OWNER'S NAME: PHONE # &- C GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Si;, e 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 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -A Owner actor Signature Date