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10030033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19816 BEEKMAN PL CONTRACTOR:VALLEY HEATING& PERMIT NO: 10030033 COOLING 'WNER'S NAME: MANISH VECHARE 1171 N 4 TH ST DATE ISSUED:03/04/2010 -iWNER'S PHONE: 6505757069 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLLAAjRAATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# 6 � 7 "C REPLACE FURNACE Contractor Date G I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:$1995 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31630126.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b �Date: ? /o granting of this permit. Additionally,the applicant understands and will comply y with all non-poin�sourc�epgulations per Cupertino Municipal Code,Section 9.18. RE-ROOFS: Cignature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupe tino unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio and 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 -on the above mentioned property for inspection purposes.(We)agree to save emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION „osts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the 5p4cant understands and will comply with all non-point source ' s upertino Municipal Code,Section Licensed Professional 9.18. Signature Dat CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630126 . 00 DATE ISSUED. . . . . . . : 03/04/2010 RECEIPT #. . . . . . . . . : BS000009877 REFERENCE ID # . . . : 10030033 SITE ADDRESS . . . . . : 19816 BEEKMAN PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MANISH VECHARE ADDRESS . . . . . . . . . . : 19816 BEEKMAN PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2451 RECEIVED FROM . . . . : VALLEY HEATING 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 1, 995 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 995 . 00 0.50 0 . 00 0 .50 0 . 00 1MFR=<100 UNITS 1 . 00 126 . 00 0 . 00 126 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 169. 50 0 . 00 169 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 339. 00 20321 --------------- TOTAL RECEIPT 339. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO at FURNACE/AC CITY OF CUPEkTINO PERMIT APPLICATION FORM d APN# �, Date: Building Address: Owner's Name: Phone#: Lltv Contractor: Phone#: A1, -I. ��� Fax #: �� Contractor Lic4ise#: Cupertino Business License#: Contact: Phone#: r FxIY CPO _ Building Permit Info: Elect❑ Plumb ❑ Mech Residential Commercial ❑. Job Description: For Residential Installations: Attic ❑ l5t floor ❑ 2nd 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 ❑ On Platform ❑ Bonded ❑ New Location ❑ Replaceinen Valuation: Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FURNACEAC CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC --1PGASRES --Residential for ea g-as piping system a —P--- 1-4 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 /t 0c 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 furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h lEPERMITFEE Electric Pen-nit Fee E IMPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B I 6C 85 L ❑ Enter description here,and enter points avallable for measure in appropriate categories to the richt. 0 ( 0 0 0 D D - = - -- - El Enter description here,and enter points available for measure in appropriate categories to the right, D D D _D 0 D ❑ Enter description here,and enter points available for measure in appropriate categories to th=right _ _ 0 D D 0- D ❑ Enter description here,and enter points available fo measure in appropriate categories to the right___ _ __ _ I_ D � 0 ]- D +_0 D -1 D j 4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter u to a Build It Green Checklists and 9 9 ) p -- — J maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right. Guidelines Ll Innovation in Community:Enter description here,and enter points available for measure in appropriate categories to the right 0 0 0 -0 D 0 ❑ Innovation in Energy:Enter description here,and enter points available for measure in appropriate categories to the right. 0 0 0 0 0 D ❑ Innovation in IAOfflealth:Enter description here and enter points available for measure in appropriate categories to the right. ❑ Innovation in Resources:Enter description here,and enter points avallable for measure in appropriate categories to the right 0 0 D ( D -D 0 ❑ Innovation in Water.Enter description here,and enter points available for measure in appropriate categories to the right_— _ D 0 0 j 0 _ 0 0 -� Total-Availahi in Other=43 D Total Available Points in Specific Categories` 4+ 96+ 142+ 166+ 143+ AAinimum Points Required in Specific Categories I 0 30 5 5 9 LE + -r 'E X6 [ 4 PMill 11 'L Project has not yet met the following recornmended minimum requirements: -Tota!Project Score of At Lust 50 Points -Repaired measures: -A3a: 50% Waste jiversion t y"lei0i t -All:Incorporate GreenPoint Rated C-ecklist into blueprints -I✓inimun points in specific catepones: -Energy(30 points) -IAOJHealth(5 points) -Resources(6 points) -14'ater(9 points) ©2007 Build 11 Green Single Family GreenPoint Checklis12007 Varsion Paoa 4 of 4 Community Development 10300 Torre Avenue 1, Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;UPEKTINO Building Department JOB ADDRESS: PERMIT# r �� � �,����� � /�o �D v OWNER'S NAME: PHONE # C GENERAL CONTRACTOR: FAX # e t� I am not using any subcontractors: Signature Date Please check ap licable subcontr tors 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 Shot Rock ile r e ontractor Signature Date